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Development of a vaccine against gonorrhoea is a global priority, driven by the rise in antibiotic resistance. Although Neisseria gonorrhoeae (Ng) infection does not induce substantial protective immunity, highly exposed individuals may develop immunity against re-infection with the same strain. Retrospective epidemiological studies have shown that vaccines containing Neisseria meningitidis (Nm) outer membrane vesicles (OMVs) provide a degree of cross-protection against Ng infection. We conducted a clinical trial (NCT04297436) of 4CMenB (Bexsero, GSK), a licensed Nm vaccine containing OMVs and recombinant antigens, comprising a single arm, open label study of two doses with 50 adults in coastal Kenya who have high exposure to Ng. Data from a Ng antigen microarray established that serum IgG and IgA reactivities against the gonococcal homologs of the recombinant antigens in the vaccine peaked at 10 but had declined by 24 weeks. For most reactive OMV-derived antigens, the reverse was the case. A cohort of similar individuals with laboratory-confirmed gonococcal infection were compared before, during, and after infection: their reactivities were weaker and differed from the vaccinated cohort. We conclude that the cross-protection of the 4CMenB vaccine against gonorrhoea could be explained by cross-reaction against a diverse selection of antigens derived from the OMV component., (© 2024. The Author(s).)

Neisseria meningitidis is a human-adapted pathogen that causes meningitis and sepsis worldwide. N. meningitidis factor H-binding protein (fHbp) provides a mechanism for immune evasion by binding human complement factor H (CFH) to protect it from complement-mediated killing. Here, we discuss features of fHbp which enable it to engage human CFH (hCFH), and the regulation of fHbp expression. Studies of host susceptibility and bacterial genome-wide association studies (GWAS) highlight the importance of the interaction between fHbp and CFH and other complement factors, such as CFHR3, on the development of invasive meningococcal disease (IMD). Understanding the basis of fHbp:CFH interactions has also informed the design of next-generation vaccines as fHbp is a protective antigen. Structure-informed refinement of fHbp vaccines will help to combat the threat posed by the meningococcus, and accelerate the elimination of IMD., Competing Interests: Declaration of interests C.M.T. is an inventor on patents related to fHbp., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Rationale: Pretomanid is a new nitroimidazole with proven treatment-shortening efficacy in drug-resistant tuberculosis. Pretomanid-rifamycin-pyrazinamide combinations are potent in mice but have not been tested clinically. Rifampicin, but not rifabutin, reduces pretomanid exposures. Objectives: To evaluate the safety and efficacy of regimens containing pretomanid-rifamycin-pyrazinamide among participants with drug-sensitive pulmonary tuberculosis. Methods: A phase 2, 12-week, open-label randomized trial was conducted of isoniazid and pyrazinamide plus 1 ) pretomanid and rifampicin (arm 1), 2 ) pretomanid and rifabutin (arm 2), or 3 ) rifampicin and ethambutol (standard of care; arm 3). Laboratory values of safety and sputum cultures were collected at Weeks 1, 2, 3, 4, 6, 8, 10, and 12. Time to culture conversion on liquid medium was the primary outcome. Measurements and Main Results: Among 157 participants, 125 (80%) had cavitary disease. Median time to liquid culture negativity in the modified intention-to-treat population ( n  = 150) was 42 (arm 1), 28 (arm 2), and 56 (arm 3) days ( P  = 0.01) (adjusted hazard ratio for arm 1 vs. arm 3, 1.41 [95% confidence interval (CI), 0.93-2.12; P  = 0.10]; adjusted hazard ratio for arm 2 vs. arm 3, 1.89 [95% CI, 1.24-2.87; P  = 0.003]). Eight-week liquid culture conversion was 79%, 89%, and 69%, respectively. Grade ≥3 adverse events occurred in 3 of 56 (5%), 5 of 53 (9%), and 2 of 56 (4%) participants. Six participants were withdrawn because of elevated transaminase concentrations (five in arm 2, one in arm 1). There were three serious adverse events (arm 2) and no deaths. Conclusions: Pretomanid enhanced the microbiologic activity of regimens containing a rifamycin and pyrazinamide. Efficacy and hepatic adverse events appeared highest with the pretomanid and rifabutin-containing regimen. Whether this is due to higher pretomanid concentrations merits exploration. Clinical trial registered with www.clinicaltrials.gov (NCT02256696).

Background: Tuberculosis preventive therapy (TPT) is recommended for people with HIV infection, including during pregnancy. The effect of TPT exposure at conception and during pregnancy is poorly documented., Methods: We report pregnancy outcomes among South African women with HIV enrolled in a randomized trial of 4 TPT regimens (two 3-month regimens, rifapentine/isoniazid [3HP] or rifampin/isoniazid [3HR], isoniazid for 6 months, or isoniazid continuously). Descriptive statistics and risk ratios were assessed to examine relationships between study regimens and outcomes., Results: 216/896 women (24%) conceived during the study. Women who conceived were younger (27.9 vs 31.3 years) and had higher mean CD4 counts (589.1 vs 536.7). The odds of pregnancy were higher in women in the rifamycin-isoniazid arms than those in the isoniazid arms (3HP: relative risk [RR] 1.73, P = 0.001; 3HR:RR 1.55, P = 0.017) despite increased contraceptive use compared with the standard 6H therapy. Thirty-four women became pregnant while taking preventive treatment (8 rifamycin and 26 isoniazid monotherapy). Pregnancy outcomes in these women were as follows: 17 (50%) mother/baby healthy, 3 (9%) spontaneous abortions, 6 (18%) elective abortions, 1 (3%) premature delivery, 2 (6%) neonatal deaths [1 rifamycin-isoniazid and 1 isoniazid], and 5 (15%) unknown., Conclusions: Pregnancy was common in women who had received TPT and more frequent in women who had received rifamycin-isoniazid-based regimens., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Rationale: Carbapenems are recommended for treatment of drug-resistant tuberculosis. Optimal dosing remains uncertain. Objectives: To evaluate the 14-day bactericidal activity of meropenem, at different doses, with or without rifampin. Methods: Individuals with drug-sensitive pulmonary tuberculosis were randomized to one of four intravenous meropenem-based arms: 2 g every 8 hours (TID) (arm C), 2 g TID plus rifampin at 20 mg/kg once daily (arm D), 1 g TID (arm E), or 3 g once daily (arm F). All participants received amoxicillin/clavulanate with each meropenem dose. Serial overnight sputum samples were collected from baseline and throughout treatment. Median daily fall in colony-forming unit (CFU) counts per milliliter of sputum (solid culture) (EBA CFU0-14 ) and increase in time to positive culture (TTP) in liquid media were estimated with mixed-effects modeling. Serial blood samples were collected for pharmacokinetic analysis on Day 13. Measurements and Main Results: Sixty participants enrolled. Median EBA CFU0-14 counts (2.5th-97.5th percentiles) were 0.22 (0.12-0.33), 0.12 (0.057-0.21), 0.059 (0.033-0.097), and 0.053 (0.035-0.081); TTP increased by 0.34 (0.21-0.75), 0.11 (0.052-0.37), 0.094 (0.034-0.23), and 0.12 (0.04-0.41) (log 10 h), for arms C-F, respectively. Meropenem pharmacokinetics were not affected by rifampin coadministration. Twelve participants withdrew early, many of whom cited gastrointestinal adverse events. Conclusions: Bactericidal activity was greater with the World Health Organization-recommended total daily dose of 6 g daily than with a lower dose of 3 g daily. This difference was only detectable with solid culture. Tolerability of intravenous meropenem, with amoxicillin/clavulanate, though, was poor at all doses, calling into question the utility of this drug in second-line regimens. Clinical trial registered with www.clinicaltrials.gov (NCT03174184).

Background: Meropenem is being investigated for repurposing as an anti-tuberculosis drug. This study aimed to develop a meropenem population pharmacokinetics model in patients with pulmonary tuberculosis and identify covariates explaining inter-individual variability. Methods: Patients were randomized to one of four treatment groups: meropenem 2 g three times daily plus oral rifampicin 20 mg/kg once daily, meropenem 2 g three times daily, meropenem 1 g three times daily, and meropenem 3 g once daily. Meropenem was administered by intravenous infusion over 0.5-1 h. All patients also received oral amoxicillin/clavulanate together with each meropenem dose, and treatments continued daily for 14 days. Intensive plasma pharmacokinetics sampling over 8 h was conducted on the 14th day of the study. Nonlinear mixed-effects modeling was used for data analysis. The best model was chosen based on likelihood metrics, goodness-of-fit plots, and parsimony. Covariates were tested stepwise. Results: A total of 404 concentration measurements from 49 patients were included in the analysis. A two-compartment model parameterized with clearance (CL), inter-compartmental clearance (Q), and central (V1) and peripheral (V2) volumes of distribution fitted the data well. Typical values of CL, Q, V1, and V2 were 11.8 L/h, 3.26 L/h, 14.2 L, and 3.12 L, respectively. The relative standard errors of the parameter estimates ranged from 3.8 to 35.4%. The covariate relations included in the final model were creatinine clearance on CL and allometric scaling with body weight on all disposition parameters. An effect of age on CL as previously reported could not be identified. Conclusion: A two-compartment model described meropenem population pharmacokinetics in patients with pulmonary tuberculosis well. Covariates found to improve model fit were creatinine clearance and body weight but not rifampicin treatment. The final model will be used for an integrated pharmacokinetics/pharmacodynamics analysis linking meropenem exposure to early bactericidal activity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Abulfathi, de Jager, van Brakel, Reuter, Gupte, Vanker, Barnes, Nuermberger, Dorman, Diacon, Dooley and Svensson.)

Background: Tuberculosis is a top-10 cause of under-5 mortality, despite policies promoting tuberculosis preventive therapy (TPT). We previously conducted a cluster randomized trial to evaluate the effectiveness of symptom-based versus tuberculin skin-based screening on child TPT uptake. Symptom-based screening did not improve TPT uptake and nearly two-thirds of child contacts were not identified or not linked to care. Here we qualitatively explored healthcare provider perceptions of factors that impacted TPT uptake among child contacts., Methods: Sixteen in-depth interviews were conducted with key informants including healthcare providers and administrators who participated in the trial in Matlosana, South Africa. The participants' experience with symptom-based screening, study implementation strategies, and ongoing challenges with child contact identification and linkage to care were explored. Interviews were systematically coded and thematic content analysis was conducted., Results: Participants' had mixed opinions about symptom-based screening and high acceptability of the study implementation strategies. A key barrier to optimizing child contact screening and evaluation was the supervision and training of community health workers., Conclusions: Symptom screening is a simple and effective strategy to evaluate child contacts, but additional pediatric training is needed to provide comfort with decision making. New clinic-based child contact files were highly valued by providers who continued to use them after trial completion. Future interventions to improve child contact management will need to address how to best utilize community health workers in identifying and linking child contacts to care., Trial Registration: The results presented here were from research related to NCT03074799 , retrospectively registered on 9 March 2017.

Shorter, more potent regimens are needed for tuberculosis. The nitroimidazole pretomanid was recently approved for extensively drug-resistant tuberculosis in combination with bedaquiline and linezolid. Pretomanid may also have benefit as a treatment-shortening agent for drug-sensitive tuberculosis. It is unclear how and whether it can be used together with rifamycins, which are key sterilizing first-line drugs. In this analysis, data were pooled from two studies: the Assessing Pretomanid for Tuberculosis (APT) trial, in which patients with drug-sensitive pulmonary TB received pretomanid, isoniazid, and pyrazinamide plus either rifampin or rifabutin versus standard of care under fed conditions, and the AIDS Clinical Trials Group 5306 (A5306) trial, a phase I study in healthy volunteers receiving pretomanid alone or in combination with rifampin under fasting conditions. In our population pharmacokinetic (PK) model, participants taking rifampin had 44.4 and 59.3% reductions in pretomanid AUC (area under the concentration-time curve) compared to those taking rifabutin or pretomanid alone (due to 80 or 146% faster clearance) in the APT and A5306 trials, respectively. Median maximum concentrations ( C max ) in the rifampin and rifabutin arms were 2.14 and 3.35 mg/liter, while median AUC 0-24 values were 30.1 and 59.5 mg·h/liter, respectively. Though pretomanid exposure in APT was significantly reduced with rifampin, AUC 0-24 values were similar to those associated with effective treatment in registrational trials, likely because APT participants were fed with dosing, enhancing pretomanid relative bioavailability and exposures. Pretomanid concentrations with rifabutin were high but in range with prior observations. While pretomanid exposures with rifampin are unlikely to impair efficacy, our data suggest that pretomanid should be taken with food if prescribed with rifampin. (This study has been registered at ClinicalTrials.gov under identifier NCT02256696.)., (Copyright © 2021 American Society for Microbiology.)

Background: Current options for temperature measurement in children presenting to primary care include either electronic axillary or infrared tympanic thermometers. Non-contact infrared thermometers could reduce both the distress of the child and the risk of cross-infection., Objectives: The objective of this study was to compare the use of non-contact thermometers with the use of electronic axillary and infrared tympanic thermometers in children presenting to primary care., Design: Method comparison study with a nested qualitative study., Setting: Primary care in Oxfordshire., Participants: Children aged ≤ 5 years attending with an acute illness., Interventions: Two types of non-contact infrared thermometers [i.e. Thermofocus (Tecnimed, Varese, Italy) and Firhealth (Firhealth, Shenzhen, China)] were compared with an electronic axillary thermometer and an infrared tympanic thermometer., Main Outcome Measures: The primary outcome was agreement between the Thermofocus non-contact infrared thermometer and the axillary thermometer. Secondary outcomes included agreement between all other sets of thermometers, diagnostic accuracy for detecting fever, parental and child ratings of acceptability and discomfort, and themes arising from our qualitative interviews with parents., Results: A total of 401 children (203 boys) were recruited, with a median age of 1.6 years (interquartile range 0.79-3.38 years). The readings of the Thermofocus non-contact infrared thermometer differed from those of the axillary thermometer by -0.14 °C (95% confidence interval -0.21 to -0.06 °C) on average with the lower limit of agreement being -1.57 °C (95% confidence interval -1.69 to -1.44 °C) and the upper limit being 1.29 °C (95% confidence interval 1.16 to 1.42 °C). The readings of the Firhealth non-contact infrared thermometer differed from those of the axillary thermometer by -0.16 °C (95% confidence interval -0.23 to -0.09 °C) on average, with the lower limit of agreement being -1.54 °C (95% confidence interval -1.66 to -1.41 °C) and the upper limit being 1.22 °C (95% confidence interval 1.10 to 1.34 °C). The difference between the first and second readings of the Thermofocus was -0.04 °C (95% confidence interval -0.07 to -0.01 °C); the lower limit was -0.56 °C (95% confidence interval -0.60 to -0.51 °C) and the upper limit was 0.47 °C (95% confidence interval 0.43 to 0.52 °C). The difference between the first and second readings of the Firhealth thermometer was 0.01 °C (95% confidence interval -0.02 to 0.04 °C); the lower limit was -0.60 °C (95% confidence interval -0.65 to -0.54 °C) and the upper limit was 0.61 °C (95% confidence interval 0.56 to 0.67 °C). Sensitivity and specificity for the Thermofocus non-contact infrared thermometer were 66.7% (95% confidence interval 38.4% to 88.2%) and 98.0% (95% confidence interval 96.0% to 99.2%), respectively. For the Firhealth non-contact infrared thermometer, sensitivity was 12.5% (95% confidence interval 1.6% to 38.3%) and specificity was 99.4% (95% confidence interval 98.0% to 99.9%). The majority of parents found all methods to be acceptable, although discomfort ratings were highest for the axillary thermometer. The non-contact thermometers required fewer readings than the comparator thermometers., Limitations: A method comparison study does not compare new methods against a reference standard, which in this case would be central thermometry requiring the placement of a central line, which is not feasible or acceptable in primary care. Electronic axillary and infrared tympanic thermometers have been found to have moderate agreement themselves with central temperature measurements., Conclusions: The 95% limits of agreement are > 1 °C for both non-contact infrared thermometers compared with electronic axillary and infrared tympanic thermometers, which could affect clinical decision-making. Sensitivity for fever was low to moderate for both non-contact thermometers., Future Work: Better methods for peripheral temperature measurement that agree well with central thermometry are needed., Trial Registration: Current Controlled Trials ISRCTN15413321., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 53. See the NIHR Journals Library website for further project information.

Background: Tuberculosis preventive therapy (TPT) is highly effective at preventing tuberculosis disease in household child contacts (<5 years), but is poorly implemented worldwide. In 2006, the World Health Organization recommended symptom-based screening as a replacement for tuberculin skin testing (TST) to simplify contact evaluation and improve implementation. We aimed to determine the effectiveness of this recommendation., Methods: We conducted a pragmatic, cluster-randomized trial to determine whether contact evaluation using symptom screening improved the proportion of identified child contacts who initiated TPT, compared to TST-based screening, in Matlosana, South Africa. We randomized 16 clinics to either symptom-based or TST-based contact evaluations. Outcome data were abstracted from customized child contact management files., Results: Contact tracing identified 550 and 467 child contacts in the symptom and TST arms, respectively (0.39 vs 0.32 per case, respectively; P = .27). There was no significant difference by arm in the adjusted proportion of identified child contacts who were screened (52% in symptom arm vs 60% in TST arm; P = .39). The adjusted proportion of identified child contacts who initiated TPT or tuberculosis treatment was 51.5% in the symptom clinics and 57.1% in the TST clinics (difference -5.6%, 95% confidence interval -23.7 to 12.6; P = .52). Based on the district's historic average of 0.7 child contacts per index case, 14% and 15% of child contacts completed 6 months of TPT in the symptom and TST arms, respectively (P = .89)., Conclusions: Symptom-based screening did not improve the proportion of identified child contacts evaluated or initiated on TPT, compared to TST-based screening. Further research is needed to identify bottlenecks and evaluate interventions to ensure all child contacts receive TPT., Clinical Trials Registration: NCT03074799., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background: Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV)-infected individuals globally. Screening for TB at the point of HIV diagnosis with a high-sensitivity assay presents an opportunity to reduce mortality., Methods: We performed a cluster randomized trial of TB screening among adults newly diagnosed with HIV in 12 primary health clinics in rural Thyolo, Malawi. Clinics were allocated in a 1:1 ratio to perform either point-of-care Xpert MTB/RIF assay (Xpert) or point-of-care light-emitting diode fluorescence microscopy (LED-FM) for individuals screening positive for TB symptoms. Asymptomatic participants were offered isoniazid preventive therapy in both arms. Investigators, but not clinic staff or participants, were masked to allocation. Our primary outcome was the incidence rate ratio (RR) of all-cause mortality within 12 months of HIV diagnosis., Results: Prevalent TB was diagnosed in 24 of 1001 (2.4%) individuals enrolled in clinics randomized to Xpert, compared with 10 of 841 (1.2%) in clinics randomized to LED-FM. All-cause mortality was 22% lower in the Xpert arm than in the LED-FM arm (6.7 vs 8.6 per 100 person-years; RR, 0.78 [95% confidence interval {CI}, .58-1.06]). A planned subgroup analysis suggested that participants with more advanced HIV (World Health Organization clinical stage 3 or 4) disease had lower mortality in clinics randomized to Xpert than to LED-FM (RR, 0.43 [95% CI, .22-.87])., Conclusions: In rural Malawi, using point-of-care Xpert MTB/RIF to test symptomatic patients for TB at the time of HIV diagnosis reduced all-cause 12-month mortality among individuals with advanced HIV., Clinical Trials Registration: NCT01450085., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background and Objectives: This paper examines risk factors of gambling and problem gambling among racial subgroups in the U.S. population, namely Native Americans and blacks, for whom research data are lacking., Methods: Findings are based on a large representative general population survey (n = 3,474) of gambling in the U.S. with an oversample of Native Americans (n = 549). Multiple domains were assessed including sociodemographic factors; ecological factors (census-defined neighborhood disadvantage, geocoded density of casinos within 30 miles of respondents' homes, and perceived gambling convenience); impulsivity; and alcohol abuse., Results: After controlling for all variables in the study, neighborhood disadvantage has a significantly greater effect on overall gambling, frequent gambling, and problem gambling for Native Americans than for the rest of the U.S., Population: In addition, the relationship between frequent gambling and heavier drinking is much stronger for blacks than for the rest of the U.S., Discussion and Conclusions: There is a lack of research on gambling involvement among minority groups in the U.S. Blacks and Native Americans are at a higher risk for problem gambling as compared with the rest of the population. Furthermore, social factors and alcohol abuse may show a stronger co-occurrence with gambling involvement among minority groups than among whites., Scientific Significance: This study is a large representative U.S. sample with sizeable numbers of Native Americans and blacks. Thus, prevalence rates and risk factors can be assessed for these important population subgroups. This will allow for targeted intervention programs for Native Americans and blacks with problem gambling and alcohol abuse. (Am J Addict 2017;26:713-721)., (© 2017 American Academy of Addiction Psychiatry.)

Background: HIV-infected individuals have increased risk of developing obstructive lung disease (OLD). Studies from developed countries report high viral load, low CD4 counts, and anti-retroviral therapy (ART) to be associated with OLD; but these findings may not be generalizable to populations in resource-limited settings., Methods: We conducted a prospective cohort study of lung function in 730 HIV-infected black South African adults. Pre-bronchodilator spirometry was performed at enrollment and repeated annually for three years. Logistic regression models were used to identify factors associated with OLD, defined as FEV1/FVC<0.70, at enrollment. Excess annual declines in FEV1 and FVC were modelled as the product-term of follow-up time and exposures using random effects regression., Results: Median (IQR) age at enrollment was 36 (32-41) years, 85% were female and 30% ever-smoked with a median (IQR) exposure of 3 (1-6) pack-years. Median (IQR) CD4 count and viral load at enrollment were 372 (261-518) cells/mm3 and 2655 (91-13,548) copies/mL respectively. Overall, 25% were receiving ART at enrollment, 16% of whom reported at least 6 months of ART receipt. OLD was found in 35 (5%) at enrollment. Increasing age (aOR = 2.08 per 10-years [95%CI 1.22-3.57], p = 0.007), current smoking (aOR = 3.55 [95%CI 1.20-10.53], p = 0.02), and CRP (aOR = 1.01 per unit-increase [95%CI 1.00-1.03], p = 0.04) were significantly associated with OLD at enrollment; while increasing CD4 count (aOR = 1.02 per-100 cells/mm3 [95%CI 0.85-1.22], p = 0.82), viral load (aOR = 0.67 per log-increase [95%CI 0.43-1.10], p = 0.12) and receipt of ART (aOR = 0.57 [95%CI 0.18-1.75], p = 0.32) were not. The median (IQR) follow-up time was 18 (12-24) months. Participants with a history of tuberculosis (TB) had a 35 mL (95%CI 2-68, p = 0.03) and 57 mL (95%CI 19-96, p = 0.003) per year excess loss of FEV1 and FVC respectively., Conclusion: Prevalent OLD was associated with older age, current smoking and higher CRP levels, but not CD4 counts and ART, in HIV-infected South African adults. Better understanding of the long-term effects of TB, smoking and inflammation on lung function in HIV-infected populations is urgently needed.

In this article we examine data from a national U.S. adult survey of gambling to determine correlates of problem gambling and discuss them in light of theories of the etiology of problem gambling. These include theories that focus on personality traits, irrational beliefs, anti-social tendencies, neighborhood influences and availability of gambling. Results show that males, persons in the 31-40 age range, blacks, and the least educated had the highest average problem gambling symptoms. Adults who lived in disadvantaged neighborhoods also had the most problem gambling symptoms. Those who attended religious services most often had the fewest problem gambling symptoms, regardless of religious denomination. Respondents who reported that it was most convenient for them to gamble had the highest average problem gambling symptoms, compared to those for whom gambling was less convenient. Likewise, adults with the personality traits of impulsiveness and depression had more problem gambling symptoms than those less impulsive or depressed. Respondents who had friends who approve of gambling had more problem gambling symptoms than those whose friends did not approve of gambling. The results for the demographic variables as well as for impulsiveness and religious attendance are consistent with an anti-social/impulsivist pathway to problem gambling. The results for depression are consistent with an emotionally vulnerable pathway to problem gambling.

In this article we examine the relationship between extent of gambling for U.S. adults and the distance from their residence to the nearest casino or track. We employ data from a telephone survey of U.S. adults conducted in 2011-2013. The chances that the respondents gambled in the past year, were frequent gamblers, or were problem gamblers were greater if they lived close to a casino. The chances that the respondents gambled in the past year or were frequent gamblers were greater if they lived close to a horse or dog track. The effects of closeness to a casino on the likelihood of past-year gambling, frequent gambling, and problem gambling, as well as the effect of closeness to a track on past-year gambling, extended to about 30 miles from the respondent's home. In addition, the concentration of casinos within 30 miles of the respondent's home was positively related to the respondents' chance of being a frequent or problem gambler. If a respondent had no casinos within 30 miles, he or she had a 2.7 % chance of being a problem gambler; if one casino, a 3.9 % chance; if six or more, a 6.2 % chance. The authors estimate that at least part of this effect is causal.

In this article, we examine the relationship between the total number of types of gambling that are legal in a state and the gambling involvement of state residents. Of particular interest is whether more types of legal gambling are associated with higher rates of problem gambling. Telephone surveys of U.S. adults were conducted in 1999-2000 and 2011-2013. The same questions were used and the data sets were combined for most of the analyses. Gambling exposure was defined as the sum of the number of years that all types were legal. Results tabulated by state showed progressively higher rates of problem gambling, frequent gambling and any past year gambling as the number of legal types of gambling increased. Holding constant the number of legal types, problem gambling rates increased as exposure increased. States with longer exposure to legal lotteries or casinos tended to have higher rates of problem gambling. An analysis was also conducted in which the data sets from 1999 to 2000 and from 2011 to 2013 were compared. Among the states, there was a striking positive relationship between changes in the number of legal types of gambling between the two studies and changes in rates of frequent gambling between the two studies. For states that had fewer types of legal gambling in 2011 than in 1999, the rates of frequent gambling went down. For states that increased their types of legal gambling, rates of frequent gambling typically, but not always, went up. Possible explanations for these results were discussed.

Background: The combination of rifapentine and moxifloxacin administered daily with other anti-tuberculosis drugs is highly active in mouse models of tuberculosis chemotherapy. The objective of this phase 2 clinical trial was to determine the bactericidal activity, safety, and tolerability of a regimen comprised of rifapentine, moxifloxacin, isoniazid, and pyrazinamide administered daily during the first 8 weeks of pulmonary tuberculosis treatment., Methods: Adults with sputum smear-positive pulmonary tuberculosis were randomized to receive either rifapentine (approximately 7.5 mg/kg) plus moxifloxacin (investigational arm), or rifampin (approximately 10 mg/kg) plus ethambutol (control) daily for 8 weeks, along with isoniazid and pyrazinamide. The primary endpoint was sputum culture status at completion of 8 weeks of treatment., Results: 121 participants (56% of accrual target) were enrolled. At completion of 8 weeks of treatment, negative cultures using Löwenstein-Jensen (LJ) medium occurred in 47/60 (78%) participants in the investigational arm vs. 43/51 (84%, p = 0.47) in the control arm; negative cultures using liquid medium occurred in 37/47 (79%) in the investigational arm vs. 27/41 (66%, p = 0.23) in the control arm. Time to stable culture conversion was shorter for the investigational arm vs. the control arm using liquid culture medium (p = 0.03), but there was no difference using LJ medium. Median rifapentine area under the concentration-time curve (AUC0-24) was 313 mcg*h/mL, similar to recent studies of rifapentine dosed at 450-600 mg daily. Median moxifloxacin AUC0-24 was 28.0 mcg*h/mL, much lower than in trials where rifapentine was given only intermittently with moxifloxacin. The proportion of participants discontinuing assigned treatment for reasons other than microbiological ineligibility was higher in the investigational arm vs. the control arm (11/62 [18%] vs. 3/59 [5%], p = 0.04) although the proportions of grade 3 or higher adverse events were similar (5/62 [8%] in the investigational arm vs. 6/59 [10%, p = 0.76] in the control arm)., Conclusion: For intensive phase daily tuberculosis treatment in combination with isoniazid and pyrazinamide, a regimen containing moxifloxacin plus low dose rifapentine was at least as bactericidal as the control regimen containing ethambutol plus standard dose rifampin., Trial Registration: www.ClinicalTrials.gov NCT00728507.

Gambling opportunities on and near Native American lands have increased in recent decades; yet there is a lack of research examining the patterns of problem gambling and alcohol abuse among Native Americans in the US. Traditional Native American cultural identity may be a protective factor for problem gambling and alcohol abuse among Native Americans. Telephone interviews were conducted with 415 Native American adults aged 18 years and older across the US. The past-year prevalence of gambling among Native Americans is similar to the rate for non-Native Americans in the US (80 vs. 77%). However, Native Americans have over twice the rate of problem gambling as the US sample (18 vs. 8%). Although Native Americans have a lower rate of past-year alcohol use than the US population (47 vs. 68%), they have a somewhat higher rate of alcohol abuse than their US counterparts (5.5 vs. 4.3%). Logistic regression analysis, with problem gambling as the dependent variable, revealed that lower socioeconomic status is significantly associated with an increased odds of problem gambling for Native Americans. Counter to the hypothesis, the higher the score on the Native American orientation, the higher the odds of being a problem gambler. Further, living by the "White way of life" was associated with a decreased odds of being a problem gambler; and perceived gambling convenience was associated with an increased odds of being a problem gambler. None of the Native American factors was significant in predicting alcohol abuse. These findings highlight the need for further investigation into the influence of cultural factors on Native American gambling.

Telephone surveys of US adults were conducted in 1999-2000 and again in 2011-2013. The same questions and methods were used so as to make the surveys comparable. There was a reduction in percentage of past-year gambling and in frequency of gambling. Rates of problem gambling remained stable. Lottery was included among the specific types of gambling for which past year participation and frequency of play declined. Internet gambling was the only form of gambling for which the past-year participation rate increased. The average win/loss increased for several forms of gambling, providing a modest indication that gamblers were betting more, albeit less frequently. Between the two surveys, the rates of past-year participation in gambling declined markedly for young adults. In both surveys, rates of problem gambling were higher for males than females, and this difference increased markedly between surveys as problem gambling rates increased for males and decreased for females. For the combined surveys, rates of problem gambling were highest for blacks and Hispanics and lowest for whites and Asians. In both surveys, the rates of problem gambling declined as socio-economic status became higher. Possible explanations for these trends are discussed.

Tuberculosis is the leading cause of death among adults infected with human immunodeficiency virus (HIV), and rates of tuberculosis remain high even after preventive therapy. Among 908 HIV-infected adults in a trial of preventive treatment, we found self-reported alcohol consumption, low baseline CD4 count, high baseline viral load, and tuberculin skin test size >15 mm as independent risk factors for incident tuberculosis.

This study is an up-to-date examination of gambling behaviors as well as gambling problems and their relationships to substance use and abuse. Further, the co-occurrence between problem gambling and substance abuse is studied using a large-scale, representative sample of adults aged 18 years and older in the United States. This random-digit-dial national survey was carried out in 2011-2013 with completed interviews from 2,963 respondents. Of the four gambling and substance use behaviors considered, past year gambling was the most prevalent (76.9%), followed by alcohol use (67.6%), tobacco use (28.7%) and marijuana use (11.2%). Problem gambling and the three substance abuse measures were highly related. Current problem gambling (3+ DIS criteria) was predicted by being male, being black, having low socioeconomic status and by alcohol abuse/dependence, tobacco dependence, and marijuana abuse/dependence. Thus, problem gambling is linked to other problem behaviors, especially substance abuse. Consequently, effective treatment approaches should screen and intervene for both problem gambling as well as co-occurring substance abuse.

Background: The Lesotho Ministry of Health issued guidelines on active case finding (ACF) for tuberculosis (TB) and isoniazid preventive therapy (IPT) in April 2011. ACF has been recommended in maternal and child health (MCH) settings globally, however, the feasibility of implementing IPT within MCH in countries with high concurrent HIV and TB epidemics is unknown., Design/methods: The study evaluated the implementation of ACF and IPT guidelines in MCH settings in 2 health facilities in Lesotho. This descriptive prospective study analyzed data collected during routine services. Categorical data and continuous variables were summarized using descriptive statistics. The χ test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively., Results: Data from 160 HIV-positive and 640 HIV-negative women were reviewed. Within this study population, 99.8% of women were screened for TB, and 11.4% HIV-positive women compared with 2.3% HIV-negative women were reported to have symptoms of TB (P < 0.001). IPT was initiated in 124/158 (78.5%) HIV-positive pregnant women, 64.5% women completed a 6-month IPT regimen, 2 (1.6%) died of causes unrelated to IPT/TB, and 31.5% were lost to follow-up. Predictors of IPT initiation among HIV-positive women included gestational age at the first antenatal visit (unadjusted odds ratio, -0.93; 95% confidence interval: -0.88 to 0.98), and receipt of antiretroviral therapy for treatment rather than for prevention of mother-to-child transmission prophylaxis only (odds ratio, 4.59; 95% confidence interval: 1.32 to 15.93)., Conclusions: Implementation of ACF and IPT is feasible within the MCH setting. Uptake of IPT during pregnancy among HIV-positive women was high, but with a high rate of loss to follow-up.

Background: CD4 count is a proxy for the extent of immune deficiency and declines in CD4 count are a measure of disease progression. Decline in CD4 count is an important component: for estimating benefits of ARV treatment; for individual level counselling on the rapidity of untreated disease progression and prognosis; and can be used in planning demand for health services. Our objective is to report CD4 decline and changes in viral load (VL) in a group of HIV-infected adults enrolled in a randomized trial of preventive treatment for TB in South Africa where clade C infection predominates., Methods: HIV-infected, tuberculin skin test positive adults who were not eligible for antiretroviral (ARV) treatment were randomized to a trial of preventive treatment from 2003-2005. VL and CD4 count were assessed at enrollment and CD4 counts repeated at least annually. During follow-up, individuals whose CD4 counts decreased to <200 cells/mm(3) were referred for antiretroviral therapy (ART) and were analytically censored., Results: 1106 ARV naïve adults were enrolled. Their median age was 30 years and male to female ratio was 1:5. Median baseline CD4 count was 490 cells/mm(3) (IQR 351-675). The overall mean decline in CD4 count was 3.2 cells/mm (3) per annum [corrected].Adjusting for age, gender, baseline hemoglobin, smoking and alcohol use had little impact on the estimate of CD4 decline. However, VL at baseline had a major impact on CD4 decline. The percent decline in CD4 count was 13.3% (95% CI 12.0%, 14.7%), 10.6% (95% CI 8.8%, 12.4%), and 13.8% (95% CI 12.1%, 15.5%) per annum for baseline VLs of <10,000 (N = 314), 10,001-100,000 (N = 338), >100,000 (N = 122) copies/ml., Conclusions: Our data suggests that six and a half years will elapse for an individual's CD4 count to decline from 750 to 350 cells/mm3 in the absence of ART.

Two representative U.S. telephone surveys of gambling were conducted-an adult survey of adults aged 18 years and older (n = 2,631) and a youth survey of young people aged 14-21 years old (n = 2,274). Because the questions and methods were the same or similar in both surveys, the data from these two surveys were combined into a single dataset to examine the prevalence and sociodemographic correlates of gambling and problem gambling across the lifespan. The present work focused specifically on gambling on the lottery which is the most prevalent form of gambling in the U.S. The frequency of gambling on the lottery increased sharply from mid adolescence to age 18 which is the legal age to purchase lottery tickets in most states; lottery play continued to increase into the thirties when it leveled off and remained high through the sixties and then decreased among those 70 years and older. Considering multiple sociodemographic factors together in a negative binomial regression, the average number of days of lottery gambling was significantly predicted by male gender, age, neighborhood disadvantage and whether or not lottery was legal in the state where the respondent lived. These findings can be used to inform policies regarding lotteries in the U.S.

Background: Treatment of latent tuberculosis in patients infected with the human immunodeficiency virus (HIV) is efficacious, but few patients around the world receive such treatment. We evaluated three new regimens for latent tuberculosis that may be more potent and durable than standard isoniazid treatment., Methods: We randomly assigned South African adults with HIV infection and a positive tuberculin skin test who were not taking antiretroviral therapy to receive rifapentine (900 mg) plus isoniazid (900 mg) weekly for 12 weeks, rifampin (600 mg) plus isoniazid (900 mg) twice weekly for 12 weeks, isoniazid (300 mg) daily for up to 6 years (continuous isoniazid), or isoniazid (300 mg) daily for 6 months (control group). The primary end point was tuberculosis-free survival., Results: The 1148 patients had a median age of 30 years and a median CD4 cell count of 484 per cubic millimeter. Incidence rates of active tuberculosis or death were 3.1 per 100 person-years in the rifapentine-isoniazid group, 2.9 per 100 person-years in the rifampin-isoniazid group, and 2.7 per 100 person-years in the continuous-isoniazid group, as compared with 3.6 per 100 person-years in the control group (P>0.05 for all comparisons). Serious adverse reactions were more common in the continuous-isoniazid group (18.4 per 100 person-years) than in the other treatment groups (8.7 to 15.4 per 100 person-years). Two of 58 isolates of Mycobacterium tuberculosis (3.4%) were found to have multidrug resistance., Conclusions: On the basis of the expected rates of tuberculosis in this population of HIV-infected adults, all secondary prophylactic regimens were effective. Neither a 3-month course of intermittent rifapentine or rifampin with isoniazid nor continuous isoniazid was superior to 6 months of isoniazid. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00057122.).

Two national U.S. telephone surveys of gambling were conducted, an adult survey (age 18 and over, N = 2,631) in 1999-2000 and a youth (age 14-21, N = 2,274) survey in 2005-2007. The data from these surveys were combined to examine the prevalence of any gambling, frequent gambling and problem gambling across the lifespan. These types of gambling involvement increased in frequency during the teens, reached a high level in the respondents' 20s and 30s, and then fell off in as the respondents aged. The notion that gambling involvement generally, and especially problem gambling, is most prevalent during the teens was not supported. A comparison of the age patterns of gambling involvement and alcohol involvement showed that alcohol involvement peaks at a younger age than gambling involvement; and thus, the theory that deviant behaviors peak at an early age applies more to alcohol than to gambling.

The co-occurrence of gambling with substance use and conduct disorder was examined in a representative U.S. household sample of 2,274 youth 14-21 years old. The findings show that problem gambling occurs within a problem-behavior syndrome with other substance-use behaviors and conduct disorder. Male gender, being black, and being Hispanic were found to be significant in predicting problem gambling over and above the effects of all four substance use and conduct disorder variables. Clinical interventions for one specific problem behavior in youth should consider assessing the other problem behaviors as well. , (© American Academy of Addiction Psychiatry.)

Tobacco involvement among US youth was investigated in a national survey conducted in 2005-2007 of 2,274 respondents aged 14-21, including those not in school. Logistic regressions predicted tobacco involvement. Males had higher rates of tobacco use than females, but males and females had equal rates of heavy use and dependence. Tobacco involvement increased with age. Whites were more tobacco involved than minorities. Tobacco involvement declined with increasing socioeconomic status. Reduced tobacco use was associated with being married and with being a student. Smokeless tobacco use was associated with being male, older, white, and lower socioeconomic status. The implications of these results are discussed.

Objective: Gambling and alcohol use were compared for college and noncollege young adults in the US population., Participants: Participants were 1,000 respondents aged 18 to 21., Methods: Data were analyzed from a representative household sample of US young people aged 14 to 21 years old. Telephone interviews were conducted between August 2005 and January 2007., Results: After taking into account gender, age, race/ethnicity, and socioeconomic status, college student status did not predict gambling, frequent gambling, or problem gambling. In contrast, being a college student was associated with higher levels of alcohol use and problem drinking. Being male was the strongest predictor of both problem gambling and problem drinking. Blacks were less likely than whites to drink heavily; yet they were more likely than whites to gamble heavily., Conclusion: Young males should be targeted for prevention and intervention efforts for both problem gambling and problem drinking regardless of college student status.

Although seatbelts save lives, adolescents may be disproportionately likely to omit their use. Using data from the 1997 Youth Risk Behavior Survey, a national survey of more than 16,000 U.S. public and private high school students, the authors employed a series of logistic regression analyses to examine cross-sectional associations between past year athletic participation and regular seatbelt omission. Controlling for the effects of gender, age, race, parental education, and school urbanicity, student athletes were significantly less likely than nonathletes to report seatbelt omission. Separate gender-specific analyses showed that this effect was significant for girls but only marginally significant for boys; in addition, the effect was strongest for adolescents who participated on three or more school or community sports teams. Possible explanations for the relationship between athletic participation and seatbelt omission, including Jessor's problem behavior syndrome, prosocial sport subcultures, and sensation seeking, are considered.

Purpose: The purpose of this analysis is to examine the relationship between current problem gambling and current conduct disorder., Methods: Data were analyzed for a U.S. national survey of respondents aged 14-21 years., Results: A strong co-morbidity between current problem gambling and current conduct disorder was found. However, this co-morbidity was much stronger among younger respondents, declined in strength with increasing age, and was absent among the oldest respondents. Further analyses showed that early-onset problem gamblers had a higher risk for conduct disorder than late-onset problem gamblers., Conclusions: Gambling problems that emerge early are likely to be part of a general pattern of problem behavior, whereas gambling problems that emerge later may have an etiology unique to gambling.

A random telephone survey was conducted with 2,274 United States residents aged 14 to 21. Analyses were performed to assess the relationship between the specific gambling games played and the extent of problem gambling symptoms. The forms of gambling that were most associated with gambling problems were card games, casino gambling, "other" gambling on routine activities, and betting on games of skill such as basketball, pool, or golf. The form of gambling that made the largest contribution to gambling problems per 14 days of play was casino gambling. The hypothesis that rapid forms of gambling, such as slot machines, would be the most problematic forms of gambling was not upheld. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Objective: Problem gambling has been linked with substance misuse among youth in a number of regional studies, yet there have been no large representative U.S. surveys of gambling behaviors and substance use among youth. The present study is designed to compare the patterns and co-occurrence of gambling and alcohol and other substance use among youth in the United States., Method: A random telephone survey was conducted with 2,274 youth ages 14-21 years old living in households in every area of the United States., Results: Problem gambling and substance misuse are prevalent among young people. For instance, 17% of youth reported gambling 52 or more times in the past year, and the same percentage of youth drank five or more drinks on 12 or more days in the past year. Ten percent of youth reported having three or more gambling problems in the past year, and 15% of young people reported having three or more alcohol problems. Controlling for gender, age, and socioeconomic status, black youth have a significantly increased probability of frequent gambling compared with other racial/ethnic groups, yet they have a significantly decreased probability of heavy drinking. Alcohol problems and gambling problems show high co-occurrence, especially for male youth and black youth., Conclusions: Population subgroups with a high co-occurrence of alcohol and gambling problems are important for targeted prevention and intervention strategies.

A random telephone survey was conducted with a representative sample of 2,274 U.S. residents aged 14-21. The prevalence of problem gambling, as measured by the SOGS-RA, was 2.1%. Sixty-eight percent (68%) of the respondents had gambled in the past year, and 11% had gambled more often than twice per week. Males had much higher gambling involvement than females, and gambling involvement increased among older respondents. Blacks were less likely than average to have gambled in the past year, but if they gambled, they were more likely to do so frequently. Low SES respondents were less likely to have gambled in the past year, but if they gambled, they were more likely to be problem gamblers. Life transitions that are associated with assuming adult roles (employment, living independently of parents, non-student status) are also associated with greater gambling involvement. The rates of problem and pathological gambling were lower than those in an adult survey conducted earlier, when measured with the same questionnaire.

Athough conventional wisdom suggests that organized sport deters delinquency by building character, structuring adolescents' time, and providing incentives for socially approved behavior, the empirical evidence to date has been mixed. Based on a sample of approximately 600 Western New York adolescents, the present study examined how self-reported jock identity, school athlete status, and frequency of athletic activity differentially influenced a range of delinquent behaviors. Neither athlete status nor frequency of athletic activity predicted these behaviors; however, jock identity was associated with significantly more incidents of delinquency. This finding was robust across both gender and race. Follow-up analyses indicated that jock identity facilitated both minor and major delinquency, with major delinquency effects for white but not black adolescents.

Rationale: Treatment of latent tuberculosis (TB) infection with weekly rifapentine and isoniazid is a potentially effective alternative to current therapies., Objectives: To compare the efficacy of weekly rifapentine/isoniazid to daily rifampin/pyrazinamide in preventing TB in household contacts of patients with pulmonary TB in Brazil., Methods: Contacts of patients with TB were randomized to rifapentine 900 mg/isoniazid 900 mg once weekly for 12 wk or rifampin 450-600 mg/pyrazinamide 750-1,500 mg daily for 8 wk and followed for at least 2 yr., Measurements: TB rates, adverse events, and adherence to therapy., Main Results: A total of 399 household contacts were enrolled, 206 in the rifapentine/isoniazid arm and 193 in the rifampin/pyrazinamide arm. The median age was 34 yr, median weight was 63 kg, 60% of participants were female, and only one patient was HIV infected. Rifapentine/isoniazid was well tolerated, but the trial was halted by the investigators before completion because of unanticipated hepatotoxicity in the rifampin/pyrazinamide arm. Twenty of 193 participants (10%) receiving rifampin/pyrazinamide experienced grade 3 or 4 hepatotoxicity, compared with 2 of 206 participants (1%) on rifapentine/isoniazid (p<0.001). There were no hospitalizations or deaths due to hepatotoxicity, and all participants' liver enzyme levels returned to normal during follow-up. During follow-up, four cases of active TB developed, three in the rifapentine/isoniazid group and one in the rifampin/pyrazinamide group (1.46 vs. 0.52%; difference, 0.94%; 95% confidence interval, -1.6 to 3.7%)., Conclusions: Rifapentine/isoniazid was better tolerated than rifampin/pyrazinamide and was associated with good protection against TB. Rifapentine/isoniazid weekly for 12 wk is likely a promising therapy for latent TB infection.

Previous research has suggested a link between athletic involvement and elevated levels of adolescent violence outside the sport context. The present study expanded on this literature by positing differences in the sport-violence relationship across dimensions of athletic involvement (athletic participation vs. jock identity), type of violence (family vs. nonfamily), and gender as well as by examining the impact of binge drinking on the sport-violence relationship. Regression analyses using a sample of 608 Western New York adolescents indicated that (a) jock identity (but not athletic participation) was associated with more frequent violence, (b) jock identity predicted nonfamily violence (but not family violence), and (c) the link between jock identity and nonfamily violence was stronger for boys than for girls. Binge drinking predicted family violence among nonjocks only.

Given that gambling, alcohol misuse, other drug use, and delinquency are correlated, it is hypothesized that these problem behaviors have shared antecedents. Measures from 3 explanatory domains--sociodemographic factors (age, race, and socioeconomic status), individual factors (impulsivity and moral disengagement), and socialization factors (parental monitoring and peer delinquency)--were tested for links to problem behaviors in 2 longitudinal samples of adolescents. Black youth had lower levels of problem behaviors than Whites. Impulsivity was a significant predictor of alcohol misuse for females and delinquency for males. Moral disengagement predicted gambling for males. Parental monitoring showed a significant inverse relationship to alcohol misuse and other substance use for males. Peer delinquency showed numerous prospective paths to youth problem behaviors for both genders., (Copyright 2005 APA, all rights reserved.)

Although previous research has established that high school sports participation may be associated with positive academic outcomes, the parameters of the relationship remain unclear. Using a longitudinal sample of nearly 600 Western New York adolescents, this study examined gender- and race-specific differences in the impact of two dimensions of adolescent athletic involvement ("jock" identity and athlete status) on changes in school grades and school misconduct over a two-year interval. Female and black adolescents who identified themselves as "jocks" reported lower grades than those who did not, whereas female athletes reported higher grades than female nonathletes. Jocks also reported significantly more misconduct (including skipping school, cutting classes, having someone from home called to the school for disciplinary purposes, and being sent to the principal's office) than nonjocks. Gender moderated the relationship between athlete status and school misconduct; athletic participation had a less salutary effect on misconduct for girls than for boys.

Despite recent declines in overall sexual activity, sexual risk-taking remains a substantial danger to US youth. Existing research points to athletic participation as a promising venue for reducing these risks. Linear regressions and multiple analyses of covariance were performed on a longitudinal sample of nearly 600 Western New York adolescents in order to examine gender- and race-specific relationships between "jock" identity and adolescent sexual risk-taking, including age of sexual onset, past-year and lifetime frequency of sexual intercourse, and number of sexual partners. After controlling for age, race, socioeconomic status, and family cohesion, male jocks reported more frequent dating than nonjocks but female jocks did not. For both genders, athletic activity was associated with lower levels of sexual risk-taking; however, jock identity was associated with higher levels of sexual risk-taking, particularly among African American adolescents. Future research should distinguish between subjective and objective dimensions of athletic involvement as factors in adolescent sexual risk.

Suicide is the third leading cause of death among US adolescents aged 15-24, with males incurring higher rates of completion than females. This study used hierarchical logistic regression analysis to test whether athletic participation was associated with lower rates of suicidal ideation and behavior among a nationally representative sample of over 16,000 US public and private high school students. Net of the effects of age, race/ethnicity, parental educational attainment, and urbanicity, high school athletic participation was significantly associated with reduced odds of considering suicide among both females and males, and reduced odds of planning a suicide attempt among females only. Though the results point to favorable health outcomes for athletes, athletic participation was also associated with higher rates of injury to male athletes who actually attempted suicide.

The current study investigated the influence of substance involvement on the trajectory of delinquency. Data were from 625 Buffalo, NY males aged 16-19, interviewed three times at 18-month intervals. Hierarchical linear models were fit separately for respondents with increasing and declining delinquency. In the increasing group, aIcohol involvment was associated with a higher starting point (intercept), and alcohol dependence and drug consequences were associated with a faster increase. In the declining group, alcohol dependence and drug consequences were associated with a higher starting point, and frequency of drug use was associated with a slower decline. Alcohol involvement is important in the early delinquent career whereas illicit drug use delays maturing out of delinquency. In a further analysis, substance involvement variables were time-varying covariates in the within-subjects model and controls in the between-subjects model. Respondents' alcohol and other drug use varied across time in sync with their criminal offending.

To test the comparative value of strain theory and problem behavior theory as explanations of adolescent anabolic steroid use, this study examined gender-specific relationships among steroid use, physical activity, and other problem behaviors. Based on the United States Centers for Disease Control and Prevention's 1997 Youth Risk Behavior Survey, a nationally representative sample of over 16,000 U.S. public and private high school students, binge drinking, cocaine use, fighting, and sexual risk-taking were associated with higher odds of lifetime steroid use. In gender-specific analyses, steroid use was strongly associated with female fighting and smokeless tobacco use as well as male sexual risk. Neither athletic participation nor strength conditioning predicted odds of steroid use after controlling for problem behaviors, nor did steroid-using athletes report more frequent use than steroid-using nonathletes. The study's limitations and policy implications were noted. These data suggest that other problem behaviors such as substance use, fighting, and sexual risk are better predictors of adolescent steroid use than physical activity. Interventions to prevent steroid use should not be limited to male participants in organized sports programs, but should also target adolescents identified as at risk for other problem behaviors.

The current study examined the effect of neighborhood disadvantage and gambling availability on gambling participation and pathology. A national telephone survey included 2631 US adults. Census data was used to characterize the respondent's neighborhood, and the distance from the respondent's home to gambling facilities was calculated. Logistic and linear regressions were performed to predict gambling participation and pathology. Results showed that the neighborhood disadvantage was positively related to frequency of gambling and problem/pathological gambling. The presence of a casino within 10 miles of the respondent's home was positively related to problem/pathological gambling. The permissiveness of gambling laws was positively related to any gambling in the past year, as well as frequent gambling. These results were interpreted to mean that the ecology of disadvantaged neighborhoods promotes gambling pathology, and that availability of gambling opportunities promotes gambling participation and pathology.

Background: Age at first drink has been found to be associated with alcohol problems in adulthood, but little is known regarding the relationship of age at first drink and current alcohol intake variables. This study was designed to determine the relationship of age at first drink to traditional drinking variables as well as novel current drinking variables assessed for the first time in a national general population sample., Method: Data on age of first drink, pathological drinking (DSM-IV alcohol abuse or dependence) and alcohol intake on typical drinking occasions were collected on a national general population sample of 2631 subjects by means of computerized telephone interviewing. Variables assessed for the first time in a national survey included the duration of the typical drinking episode and the predicted peak blood alcohol levels achieved during those episodes., Results: Data from 2276 subjects who reported an age at first drink were used in this study. Men and lifetime pathological drinkers reported an earlier age at first drink than did, respectively, women or lifetime nonpathological drinkers. There were significant regression coefficients between age at first drink and several current drinking measures. The largest coefficients were usually found within younger age groups., Conclusions: Age at first drink may be a useful predictive variable for some current drinking measures, including predicted peak blood alcohol levels as well as lifetime alcohol pathology. Further support was provided for the "convergence" hypothesis that the drinking habits of women have become more like those of men.

The aim of the current study was to determine the effect of simultaneous drinking and gambling on negative consequences from gambling. Data was analyzed from a national telephone survey of 2631 US residents aged 18 or older. Males were more likely than females to drink while gambling. Simultaneous drinking and gambling was more closely associated with video keno, pull tabs, dice (not in a casino) and casino gambling than with other types of gambling. Those who drank while gambling were more likely to be problem gamblers, even when holding constant frequency of gambling, size of the average win or loss, and average alcohol consumption. Those gamblers who are drinkers, but did not drink while gambling, had a prevalence of problem gambling of close to zero. They had a lower prevalence of problem gambling than gamblers who didn't drink alcohol at all in the past year, and a much lower prevalence than those who drank while gambling. These results were interpreted to mean that simultaneous drinking and gambling is an indicator of a more reckless gambler. The results did not support the theory that gambling while under the influence of alcohol causes more risky gambling behavior.

This article describes an analysis of gambling and gambling pathology from a telephone survey of 2631 U.S. residents, using Chi-square Automatic Interaction Detector (CHAID). Catholics were more likely to have gambled (92%) than Protestants (78%), and elderly Protestants were the least likely (55%) group to have gambled. Among past-year gamblers, men gambled more often (74 times) than women (46 times). The most frequent gamblers were divorced, widowed, or cohabiting men (125 times). Minorities were much more likely than whites to be problem gamblers (PGs). Nonpoor, married, or widowed whites were the least likely to be PGs., (Copyright 2004 Elsevier Ltd.)