James C. Anthony - US grants

This application proposes an 18 month renewal of NIDA support for analyses on the epidemiology of cocaine and other drug use by adults, including issues of psychiatric co-morbidity and risk of drug problems. The specific research question include: What is the current best estimate for the degree to which cocaine users are at increased risk of DSM-III mania and related serious psychiatric disturbances? What is the current best estimate for the degree to which cocaine users are at increased risk of DSM-III obsessive-compulsive disorder and related obsession-like or compulsion-like behaviors? What is the current best estimate for the relative risk of drug dependence and other specific types of drug problems in relation to the type of drug used illicitly, and in relation to daily versus non-daily use of these drugs? For example, which drug use pattern is associated with greater risk of drug dependence: daily marijuana use, or non-daily cocaine use? Are there differences in the patterns of drug problems reported by illicit drug users who have had drug abuse treatment encounters, as compared to all illicit drug users who have had drug abuse treatment encounters, as compared to all illicit drug users or to illicit drug users with no treatment history? If there are differences, what are their implications for new development of instruments to assess drug dependence and problems associated with psychoactive drug use? The applicants will use data from the 20,862 participants in the NIMH Epidemiologic Catchment Area Program in analyses to answer these questions, including data on 3925 illicit drug users who reported on their drug problem experiences. The data were gathered prospectively by administering the Diagnostic Interview Schedule at baseline and also at followup roughly one year later. The proposed conceptual models and related statistical models are based on work completed by the applicants during the initial award period and now being published, as well as new latent structure analyses appropriate to dichotomous and highly skewed diagnostic data.

This application is for renewal of NIDA support for a study of drug use by elementary schoolchildren who live in the inner city and other nearby areas of urban Baltimore. The study is a collaborative venture of the Johns Hopkins University and Baltimore City Public Schools. The epidemiologic sample of 2400 children was recruited when the children entered first-grade in 1985-86. The study is prospective and longitudinal, with an experimental design to test two classroom interventions that may delay or reduce occurrence of illicit drug use and other problems. One intervention seeks change in socially maladaptive behavior found to be a sturdy predictor of drug abuse. To date, the children have been assessed each year since Grade 1, including two post-intervention assessments. A recent NIMH grant supports continuation of group-administered questionnaires, teacher ratings, and school record retrieval for five more years. This renewal proposal seeks to continue the NIDA-supported personal interviews on drug-related behavior, concurrent with the NIMH assessments. During the proposed study period, the children will be entering Grades 4-8, when occurrence of illicit drug use will begin to accelerate. In addition to testing for preventive effects of the two interventions, the study also will examine other factors suspected to influence the occurrence and continuation of illicit drug use. A specific focus of this examination is co-occurrence of drug use, psychiatric disturbances, and behavioral disturbances such as fighting and delinquency, as well as a set of other personal, developmental, and adaptational characteristics of the children, which are manifest in self-report measures, ratings by peers, and ratings by teachers. Periodic parent interviews are used to augment these assessments, and to strengthen the study's measurement of neighborhood and family characteristics, such as family behavior management and monitoring strategies. A pilot study is underway to test the feasibility of nesting a case-control study of illicit drug use within this prospective study design, as an epidemiologic strategy to allow intensive measurement of drug use and the conditions under which drug use occurs. Pending results from the pilot study, a companion proposal to support the nested case-control study is planned for late 1989 or in 1990. If successful, this study holds promise as an important new step in understanding risk factors and conditions that affect initiation and early development of illicit drug use. The study's experimental design and intervention plan has a specific focus on socially maladaptive behavior that might be modified to delay or reduce later occurrence of illicit drug use. However, even if the intervention has no effect on drug use, the study is designed to produce important new information on the etiology of illicit drug use and drug-related behavior.

The long-term objectives of the proposed research are (a) to understand the characteristics of individuals, the conditions, and the processes that influence the occurrence of drug-taking, drug dependence, and other forms of serious drug involvement amongst Latin American youths, particularly drug involvement that occurs in clusters; and (b) to translate this understanding into practical public health strategies for the prevention and control of hazards associated with drug-taking in this important and growing segment of the world's population. The project involves a centrally coordinated multi-site cross-sectional survey of teenage drug involvement in the seven countries of Latin America that now participate in the Inter- American Drug Abuse Control Commission (CICAD): Dominican Republic, Panama, El Salvador, Costa Rica, Guatemala, Honduras, and Nicaragua. This project builds from the infrastructure of past CICAD efforts that were intended to quantify the prevalence of youthful drug-taking in these countries. As planned, the project will include the use of standardized classroom survey methods to produce the first nationwide probability sample survey estimates of teenage drug-taking in this region of the America. The research also will use a newly developed statistical procedure ("alternating logistic regression") to examine the degree to which non-medical drug use and other forms of drug involvement might appear in clusters within the boundaries of classrooms, schools, and other local area aggregations of these countries. When the proposed research is completed, the result will be a substantially increased understanding of the epidemiology of adolescent alcohol and drug involvement in the Central American region, as well as a more substantial foundation for NIH-supported international collaborative research in the participating countries. The research plan includes deliberate attention to publication of scientific articles in peer-reviewed journals, which will help to strengthen the participating countries infrastructure for collaborative research beyond the duration of this grant award.

DESCRIPTION (provided by applicant): This is an application for an International Clinical, Operational, and Health Services Research Training Award from the National Institute on Drug Abuse and Fogarty International Center. It aims to increase the count of quantitatively adept scientists who can lead epidemiological studies of tobacco, cocaine, and other drugs, associated infections & medical consequences. Tobacco smoking and other drug use are health-related behaviors of growing importance, quantified in terms of burden of disease and disability in the U.S. and overseas. There is a real shortage of scientists with suitable training and research experience for NIDA-oriented epidemiological studies, not only within the U.S., but also in Latin America and elsewhere. Demand for NIDA-oriented epidemiological surveillance and probing epidemiological studies surpasses the supply of scientists. Peru is located in a major coca cultivation region in Latin America. Like most countries in the region, it faces important health and social problems associated with use of coca leaf products (e.g., cocaine hydrochloride powder) and other drugs such as tobacco. Some recent initial epidemiological surveys in Peru have confirmed an impression of increasing trends in use of coca paste (pastabas), a product of intermediate between coca leaf and cocaine HCL, sometimes mixed with kerosene and other toxic contaminants. Peru also is the site of an existing multi-faceted research and research training collaboration between Johns Hopkins University (JHU) and Universidad Peurana Cayetano Heredia (UPCH). Collaborations already link the UPCH faculty and trainees with a NIDA-supported T32 institutional NRSA training program, and with a separate program for research and training on epidemiology of infectious origins. The proposed award will sustain and extend this collaboration with an initial intermediate-length orientation course and faculty-supervised research experiences for a minimum of 20 predoctoral and postdoctoral Peruvian trainees at the UPCH site. Two will be selected for Ph.D. training at JHU, one PDF for Master of Science training, and three PDF for advanced postdoctoral training and PDF certificates awarded by JHU. They all will return to Peru sites for summer and thesis or PDF research training after completion of required coursework at JHU. The award also will support thesis and research projects for returning students and collaborating faculty members.

DESCRIPTION (provided by applicant): The purpose of this proposed Senior Scientist Award (K05) from the National Institute on Drug Abuse is to provide stability of support for Professor James C. Anthony of the Johns Hopkins University, Bloomberg School of Public Health, in relation to his program of continuing research, research training, mentoring, and science education on the topics of drug dependence epidemiology and enviromics. The research plan and career development activities are organized in relation to five main rubrics of epidemiology and associated research questions: (1) Within the population, how many people are becoming affected by clinically significant syndromes of drug dependence? How many cases have accumulated? (2) Within the population, where are we more (or less) likely to find drug dependence cases, in relation to characteristics of person, place, and time? (3) What accounts for some people becoming drug dependent while others are spared? (4) How do linked sequences of events and processes lead toward the transition from being a non-case to becoming a case of drug dependence, and the hazardous consequences of becoming or being a case? and (5) What can we do to prevent, delay, or reduce the risk of becoming a case of drug dependence, to reduce the duration, or to ameliorate the associated suffering? Whereas the 'genome' refers to the total ensemble of genetic material for a form of life, the 'envirome' is the total ensemble of environmental processes and circumstances required for life form viability and successful adaptation. In complement with genomics and proteomics, drug dependence enviromics is a deliberate search for specific environmental processes and circumstances that promote health by reducing the risk, prevalence, and problems of drug dependence. In drug dependence enviromics, the main objects of study are neither the gene nor the environment, but rather the gene-environment interactions that give rise to drug dependence, prevent or sustain it, interrupt its natural history, and reduce the global burden of drug dependence and associated disabilities.

DESCRIPTION (provided by applicant): The proposed Conference on Drug Use and Dependence in East Africa will gather scientists, practitioners, policy makers and community organizations from different disciplines and countries to exchange progress on work in improving the health of urban populations and to foster cooperation among urban health stakeholders in improving policies and interventions for tobacco, alcohol, and other drug use (especially illegal or other nonmedical drug use). The conference will take place in Nairobi, Kenya in coordination with the overall Eighth International Conference on Urban Health, separately supported by the Gates Foundation and others. We propose to draw attention to current NIDA research developments in relation to tobacco and other drug involvement in urban environments and populations, with a focus upon applied aspects of NIDA's research portfolio, in an effort to showcase potentially internationally applicable models of research-to-practice collaborations for urban settings. As such, we are requesting approximately $30,000 of the total cost of the conference (~$1,400,000), which will support the following components of the proposed NIDA-sponsored conference track: (1) Support for plenary sessions with internationally recognized plenary speakers (e.g., NIDA PIs) during the conference, (2) Support for pre- and post-doctoral research trainee registration, (3) Non-plenary parallel or concurrent sessions on focused on NIDA-pertinent research, (4) Poster sessions focused on NIDA-pertinent research, (5) Publication of a supplement of the Journal of Urban Health that will include featured articles and poster abstracts on this NIDA-pertinent research, to be edited by J. Anthony &D. Vlahov. By holding this conference in Nairobi, one of the leading cities in the world, we intend to foster international research collaborations that seek a collective improvement of our understanding of the common health risks faced by urban residents and to influence the development of effective public health interventions across the globe. Perspectives and lessons from different countries can be valuable to share. We have now held seven prior conferences that have been well attended and look forward to continuing this series. A concentration or conference track on drug abuse has been present in earlier meetings and is a critical part of this effort. This type of track seeks to foster interdisciplinary collaborations among NIDA-oriented researchers who are interested in how urban settings influence drug involvement, including geographic and social structural features of urban settings that may serve as modifiable 'causes of incidence'of drug problems. Dissemination of evidence presented at the conference will come in the form of published abstracts and papers in the Journal of Urban Health;press conferences with radio, newspaper, television;and press interviews with key speakers.

DESCRIPTION (provided by applicant): This proposal is for 5 years of renewed institutional T32 NRSA support for the NIH/NIDA Drug Dependence Epidemiology Training Program (DDETP) located within Michigan State University College of Human Medicine Department of Epidemiology. DDETP founder/training program director is Professor James C. (Jim) Anthony, whose NIDA K05 Senior Scientist work between 2003 and 2010 included creation of the MSU DDETP, based upon his model for a successful DDETP at Johns Hopkins University (1990-2003), for which he received three mentoring awards. Also leading the program is Epidemiology Professor Naomi Breslau, and there is an interdisciplinary MSU faculty who represent epidemiology/biostatistics, quantitative methodology generally, clinical sciences/therapeutics, behavioral genetics, preclinical/clinical pharmacology, and allied fields (e.g., sociology, social work, family therapy). The main DDETP goal is to increase the number and quality of quantitatively adept epidemiologists and researchers in allied fields whose career commitment is toward NIDA's mission to prevent and control drug dependence syndromes and related suspected hazards of psychoactive drug use. The proposed 3 NIDA predoctoral trainees first complete 2-3 years of coursework with research apprenticeships, pass qualifying exams to establish candidacy for the PhD, and then complete 2-3 years of research before final defense of a monograph-length dissertation representing significant contributions of new scientific evidence that requires statistical estimation or formal hypothesis-testing in the NIDA epidemiology research context. The proposed 3 postdoctoral trainees at Levels 0, 3, & 7 complete an individualized program of postgraduate research training in drug dependence epidemiology, of 1-3 years duration (mostly 1-2 years), with a greater balance of time in NIDA research. Both types of trainees complete required integrity and ethics training, and work to assemble a portfolio of first-authored and co-authored articles in journals of the field, drafts of their own investigator-initiated NIDA grant award applications, and K-type career development plans, when appropriate. The program plan is designed to meet six challenges: (1) enhancing diversity outreach, (2) greater integration with MSU's new NIH clinical translational research and training initiatives, including HIV/AIDS research, (3) new educational modules on project management and on non-academic career paths toward health science and federal agency administration, small business and industry research (e.g., NIDA SBIR & STTR), (4) use of NIH and NIDA online career tracking programs, as well as online surveys to assess the mentoring process, (5) forging new solutions to a recently appreciated 'drift away' process that now detracts from post-program success in a competitive research funding environment, and (6) cultivation of a new generation of the program's Primary Advising Faculty (PAF) members in order to promote the success of the program during the proposed renewal award period and beyond. PUBLIC HEALTH RELEVANCE: Epidemiology and biostatistics are two of the most basic sciences for public health practice and program evaluation, helping us make unique discoveries about the causal determinants of population-level incidence rates and working toward discovery of individual-level 'causes of cases' as can be identified in community field studies and in clinicl and public health practice settings, often in collaboration with scientists from allied fields. Whe discoveries of a clinical translational character provoke change in clinical or public health practices, large sample evaluation and the epidemiology/biostatistics research approach often is required (Phase III effectiveness research, Phase IV surveillance, etc). Helping to foster success of the NIH/NIDA research mission, this NRSA T32 research training program seeks to increase the number and quality of quantitatively adept epidemiologists and researchers in allied fields whose career commitment is toward NIDA's mission to prevent and control drug dependence syndromes and related hazards of psychoactive drug use.