DPRC Newsletter
December 2004
The Triple Epidemic of Violence, Substance Use,
and HIV/AIDS Among Impoverished Women
VIOLENCE AGAINST WOMEN, SUBSTANCE
use and disorder, and HIV/AIDS
represent three significant threats to
the health of women. According to
the National Violence Against Women
Survey, 52 percent of women have
experienced physical assault and 18
percent sexual assault during their
lifetime. In the United States, approximately 15 percent of women between
the ages of 15 and 44 abuse illicit drugs
or alcohol, while AIDS ranks among
the leading causes of death for women
of reproductive age and is the leading
cause of death for African-American
women ages 25 to 34.
Evidence suggests that these three
health threats represent overlapping
epidemics for women. The threats may
be particularly severe for impoverished
women, given their harsher living
conditions and generally reduced access
to health care. A commonly accepted
view among providers of substance
abuse treatment services to women is
that each epidemic contributes to the
others, and that none can be successfully addressed without attention to
all of them.
Research led by DPRC researchers
Suzanne L. Wenzel and Joan S. Tucker
provides insight into these issues by examining the linkages among substance
use, sexual risk behavior, and violence
and their health-related consequences
among homeless and low-income
housed women in Los Angeles County.
The findings indicate the ways in
which these epidemics can affect homeless and low-income housed women
differently, and the research provides
direction for developing more strategically targeted preventive efforts and
interventions.
Violence Against Women,
Substance Use, and Sexual Risk
Behavior Are Co-Occurring
Public Health Problems
The research team conducted baseline
structured interviews with stratified
random samples of 898 sheltered
homeless and low-income housed
women in Los Angeles County as
well as follow-up interviews with 810
women six months later.
Results from the baseline interviews
indicate that women living in shelters
were more likely than those living in
low-income housing to report physical
and sexual violence, substance use
and disorder, and sexual risk behavior
(e.g., trading sex, having two or more
sex partners or casual sex partners, not
always using condoms with casual
partners). As shown in Figure 1, the
researchers also found that, after
controlling for demographic and
background characteristics, sheltered
women were significantly more likely
than low-income housed women to
experience two or more problems
simultaneously.
As shown in Figure 2, sheltered
women were also more likely, after
controlling for demographic and
background characteristics, to report
experiencing some combination of
binge drinking, violence, and HIV
risk behavior. It should be noted that
Contents
The Triple Epidemic of Violence,
Substance Use, and HIV/AIDS
Among Impoverished Women
1
Director’s Message
Building Trust in the Juvenile Justice System
Through a Quality Assessment Approach
4
What Makes Needle and Syringe Exchange
Programs Effecctive in Preventing HIV
Transmission?
6
Project ALERT Evaluation Confirms Value
of Classroom Drug Prevention
8
In Remembrance
DPRC Board Member and
First Chair Norval Morris
10
New Project
RAND Coordinating Center:
Sexual Diffusion of HIV Study
11
New Publications
11
New People
14
2003–04 Lovida Coleman, Jr.,
Speaker Series
15
Advisory Board
16
Figure 1 Co-Occurrence of Any Drug Use, Any Violence, and Any
Sexual Risk Behavior (Weighted Percentages)
All Three
Problems
Sheltered
Housed
Violence +
Sexual Risk
Drug Use +
Sexual Risk
Drug Use +
Violence
0
5
10
15
20
25
30
35
Percentage reporting two or more problems
these two figures were derived using
a “liberal” definition of problem behaviors (i.e., any drug use/binge drinking,
any physical or sexual violence, and any
sexual risk behavior).
The significantly higher rates of
health threats among women living
in shelter situations suggest that these
women urgently need health services
that simultaneously encourage behaviors that protect against HIV, while
reducing their alcohol and drug use
and their risk of being victimized,
and addressing any negative physical
or psychological impacts of previous
victimization. Although their rates
of problems were lower, low-income
housed women also stand to benefit
from such services. Among the low-
income housed women in this study,
rates of past-year drug use (16 percent)
and violence (13 percent) were higher,
respectively, than the 9 percent and
3 percent reported for women in the
general population in the National
Household Survey on Drug Abuse.
Experiencing Interpersonal
Violence: Perspectives of
Sexually Active, SubstanceUsing Women
The interviews allowed researchers to
better understand low-income women’s
perspectives on and interpretations of
violence against women in general and
their own experiences in particular,
including their perceived responsibility
for violence and the role of substance
Figure 2 Co-Occurrence of Any Binge Drinking, Any Violence, and Any
Sexual Risk Behavior (Weighted Percentages)
All Three
Problems
Sheltered
Housed
Binge Drinking
+ Sexual Risk
Binge Drinking
+ Violence
0
5
10
15
20
25
Percentage reporting two or more problems
2
30
35
use. To explore these issues, researchers
used data from the 172 women who
reported having at least one sexual
partner, any substance use, and at least
one episode of violence in the past 12
months. Forty-one of these women also
completed an interview on their worst
violent episode.
The experiences and interpretations
of violence reported by sheltered and
low-income housed women differed in
notable ways. Whereas housed women
tended to put blame squarely on their
assailants, most of the sheltered women
thought they were partly or wholly
to blame for the violence, which they
often attributed to their use of drugs
or alcohol or their decision to stay with
partners who repeatedly abused them.
In-depth interviews revealed that sheltered women were more likely to experience aggression involving an assailant
who used violence to force money or
drugs from them. In contrast, housed
women tended to be more vulnerable
to hostile aggression from an intimate
male partner.
Substance use played varying roles in
the worst violent episodes reported by
the women. One-third of the sheltered
women were using crack at the time of
their worst event, compared with none
of the housed women (although half
of the housed women did report the
involvement of alcohol and/or marijuana). For both sheltered and housed
women, episodes of relationship violence that had themes of jealousy and
possessiveness almost always involved
alcohol use by both partners. Many
women indicated that their experiences of violence contributed to an
increase in their substance use over
time (housed: 25 percent; sheltered:
43 percent). However, 19 percent of
sheltered women indicated that their
experiences of violence encouraged
them to decrease their substance use.
These results indicate that, for sheltered women, there is a need for stable
housing and income that may, among
other benefits, result in less vulnerability to opportunistic violence and
engagement in high-risk survival-based
activities. Better access to substance
abuse treatment services is also critical.
For housed women, substance abuse
treatment service for women and their
partners may also go a long way toward
reducing the worst types of violence
experienced by these women. The
findings also suggest a need for safe
housing and neighborhoods, greater
employment and financial opportunities, and services that focus on safety
and on supporting and promoting
independence from abusive partners.
Violence and Substance Use Are
Associated with HIV-Related
Outcomes Over Time
Follow-up interviews six months after
baseline offer insights into the ways
in which violence and substance use
can be intertwined with women’s
HIV-related risk behaviors, including
their involvement in unprotected sex.
Results from these interviews show that
many women who reported violence
at baseline subsequently changed their
sexual behaviors in ways that appeared
to be self-protective. For example,
sheltered women who were victims of
partner violence at baseline were less
likely to be sexually active at follow-up,
and, among all sexually active women,
those who experienced partner violence
at baseline experienced a marginal
decline in the frequency of sex and
were less likely to have unprotected sex
at follow-up. Among all sexually active
women, those who reported baseline
violence at the hands of someone other
than an intimate partner showed a decline in the frequency of sex over time.
Substance use at baseline was associated with changes in HIV-related
attitudes over time, and the nature
of these associations depended on
whether the substance was alcohol or
drugs. Alcohol misuse appeared to
foster feelings of vulnerability and powerlessness: Those women who drank to
intoxication at baseline exhibited an
increase in their perceived susceptibility
to HIV and, among sheltered women,
a decrease in their ability to refuse
unwanted sex. In contrast, drug use
at baseline appeared to foster feelings
of empowerment: Those women who
engaged in drug use exhibited increases
in self-efficacy of using condoms and
ability to refuse unwanted sex. Although these are generally considered
to be positive outcomes, they may
not be in this context. For example, if
drug-using women are increasing their
engagement in high-risk sex over time
in ways that were not measured (e.g.,
trading sex, anonymous sex, multiple
partners), their heightened condom
use self-efficacy and ability to refuse
sex may simply reflect their attempts
at self-protection as they negotiate a
riskier sexual environment.
Policy Implications
Health care providers increasingly
recognize that impoverished women
have a number of overlapping needs
that must be addressed simultaneously.
This research makes very clear that the
presence of multiple and urgent needs
is not restricted to poor women in
particular settings; rather, there exists
a substantial need for services among
poor women more broadly. Critical to
future efforts will be the further development of multifaceted interventions
and collaborative relationships among
providers to facilitate comprehensive
health care services for impoverished
women, adequate funding to support
these interventions and collaborations,
and additional community resources
such as safe and affordable housing.
3
For more information, please see
Elliott, M. N., D. Golinelli,
K. Hambarsoomian, J. Perlman, and
S. L. Wenzel, Sampling with Field
Burden Constraints: An Application to
Sheltered Homeless and Low-Income
Housed Women,” Santa Monica, Calif.:
RAND, DRU-3057-NIDA, 2003.
Tucker, J. S., S. L. Wenzel, M. N.
Elliott, G. N. Marshall, and S. Williamson, “Interpersonal Violence, Substance
Use, and HIV-Related Behavior and
Cognitions: A Prospective Study of
Impoverished Women in Los Angeles
County,” AIDS and Behavior, Vol. 8,
No. 4, 2004, pp. 463–474.
Tucker, J. S., S. L. Wenzel, J. B. Straus,
G. W. Ryan, and D. Golinelli,
“Experiencing Interpersonal Violence:
Perspectives of Sheltered and LowIncome Housed Women,” Violence
Against Women (in press).
Wenzel, S. L., J. S. Tucker, M. N.
Elliott, K. Hambarsoomian, J. Perlman,
K. Becker, C. Kollross, and D. Golinelli,
“Prevalence and Co-Occurrence of
Violence, Substance Use and Disorder,
and HIV Risk Behavior: A Comparison
of Sheltered and Low-Income Housed
Women in Los Angeles County,”
Preventive Medicine, Vol. 39, No. 3,
2004, pp. 617–624.
Wenzel, S. L., J. S. Tucker, M. N.
Elliott, G. N. Marshall, and
K. Hambarsoomian, “Physical
Violence Against Impoverished
Women: A Longitudinal Analysis of
Risk and Protective Factors,” Women’s
Health Issues, Vol. 14, No. 5, 2004,
pp. 144–154. ■
Director’s Message
Building Trust in the Juvenile Justice System
Through a Quality Assessment Approach
SUBSTANCE ABUSE AND DRUG-RELATED
crimes among youth often bring
adolescent and teen offenders into the
juvenile justice system. At its best, the
juvenile justice system can function as
a means of getting substance-using and
other youth “back on track” by directing juvenile offenders to appropriate
treatment and rehabilitation options.
At its worst, the system can result in
haphazard and sometimes unfair decisions concerning youth placement or
punishment. In this article, we explain how a Quality Assessment (QA)
approach might be used to promote
transparency, accountability, and
change in the juvenile justice system.
Racial Inequities in the Juvenile
Justice System
One of the most troubling trends in
the juvenile justice system today concerns the significant disparities apparent in the system’s handling of black
youths compared with whites and
Hispanics. According to a recent report
from the Office of Juvenile Justice and
Delinquency Prevention (OJJDP),
between 1985 and 1999, the ratio of
black to white juvenile drug offenders
was 8 to 1, with drug offenses accounting for 9 percent of all juvenile placements (excluding technical violators).
As of October 1999, approximately 1
of every 100 black juveniles was in a
juvenile residential placement facility, compared with approximately 1
of every 200 Hispanic juveniles and 1
of every 500 white males (Sickmund,
2004).
Studies have shown that young
black males are overwhelmingly more
likely to be arrested or imprisoned
than their Hispanic and (especially)
white counterparts. The OJJDP report
indicates that between 1980 and 1998,
black juveniles were arrested at a rate
5.7 times that of whites. In 1995,
black juvenile males had a 3.33 percent
chance of being taken into custody by
age 18, compared with a 1.21 percent
chance for Hispanic juvenile males,
and a 0.66 percent chance for white
juvenile males. Moreover, between
1985 and 1999, prison admissions for
juveniles under the age of 18 increased
68 percent for black males, compared
with 38 percent for white males.
In some states, the disproportions
are even more striking. De Como
notes that in South Carolina, almost
one in three black males was taken
into custody prior to age 18, a rate 9
times greater than that for white males.
Table 1 lists the states with the greatest
disproportions in arrest rates for black
and white youths (calculated from De
Como, 1998). Only in one of these
Ratio of Black to White Arrests
for Males Under Age 18
State
Ratio of
Black:White Arrests
New Jersey
34:1
New York
17:1
Louisiana
17:1
Mississippi
14:1
Georgia
14:1
Connecticut
12:1
Idaho
11:1
Illinois
10:1
Delaware
10:1
North Carolina
10:1
4
Martin Y. Iguchi, Director
states (Idaho) were black youth arrested
at a significantly lower rate than whites.
A number of explanations have
been offered to account for these
notable disparities. On the macro-level,
Sampson and Laub (1993) found that
structural factors such as racial inequality, underclass poverty, and even
urbanism can affect the way that blacks
are processed through the juvenile
courts. On the micro-level, Bridges and
Steen (1998) found that probation officers, in their recommendations to the
courts, were significantly more likely
to attribute black offenders’ behavior
to internal causes (i.e., emotional state
or intention) and whites’ behavior to
external causes (i.e., mitigating environmental factor or events), even when
controlling for criminal act and prior
record.
Although we do not fully understand the causes of these disparities,
it is clear that greater accountability
is needed from the juvenile justice
system. A QA approach can begin to
address these disparities by providing
a means for continuous system
improvement.
Need for a Quality Assessment
(QA) Approach
A QA approach provides a systematic
means of bringing greater transparency
and accountability to an organization
or system. Hallmarks of a QA approach
include clearly stated policies and procedures, which have been determined
through the involvement of all stakeholders and can be used to provide
administrative oversight; formulation
of performance criteria, metrics, and
benchmarks; collection of relevant
data, which is made widely available
to stakeholders and used to make
decisions and identify appropriate
interventions; and reporting measures,
including performance “report cards,”
which provide objective data about
the system’s functioning to stakeholders and ensure that the system is held
accountable.
Importantly, efforts to implement
a QA approach can begin locally—
and at a low cost. We highlight a few
examples here.
The QA Approach: Some
Real-World Examples
The W. Haywood Burns Institute for
Juvenile Justice Fairness and Equity,
under the leadership of Executive Director James Bell, is working with ten
communities scattered across the country to reduce the overrepresentation of
youth of color in their juvenile justice
facilities. Although the institute has
not specifically used the term “Quality
Assessment,” many of its policies and
practices clearly show the hallmarks of
QA, including its efforts to bring stakeholders together, gather data in order
to understand and respond to disparities, and clarify policies and procedures
at all levels.
For example, Bell and colleagues
noticed that black female juveniles
were dropping out of a San Francisco,
California, group home at much higher
rates than any other group. Interviews
with young women at the site indicated
that the problem “had to do with hair.”
At entry, all residents received a bottle
of Prell shampoo and were instructed
to wash their hair; most black females
refused since this was not appropriate for their hair care. Because refusal
to wash one’s hair typically meant
discharge, many girls were expelled
from the home. Once the source of the
problem was understood, the home
implemented new, more culturally
sensitive approaches and succeeded in
reducing the disparity.
Haywood Burns Institute staff in
San Francisco also noted that a juvenile
hall screening to determine adolescents’
“risk of offending” if returned to society resulted in blacks being assigned to
detention at a disproportionate rate.
Additional review indicated that black
adolescents were far more likely to be
sent to detention through an “override”
recommendation (which is required
to send a youth to detention when the
risk score did not indicate the need).
An audit of black youths’ risk forms
indicated that 14 percent had never
been filled out, 14 percent provided no
reason for referral, and 12 percent recommended detention because a parent
could not easily be located. Moreover,
virtually all of the “overrides” were
released from detention at the judicial
hearing within three days—at a cost to
the system of $225/day and an increase
in perceptions of unfairness on the part
of those detained. Once it became clear
that most overrides were uncalled for,
a new policy was implemented to
establish an administrative quality
check by requiring supervisor approval
of all overrides.
In Santa Cruz, California, a review
of court records indicated that minority juveniles were significantly more
likely to miss their judicial hearings in
the daily morning sessions of the North
County court than were white offenders.
On-site interviews revealed that most of
the minority offenders were located at a
South County juvenile facility in Watsonville, California, and that there was
no early morning bus service between
the South and North counties. Further,
5
the nearest bus stop was more than a
mile from the courthouse at the top of
a steep hill. To remedy the problem, a
new courtroom was opened in South
County, closer to the minority adolescents. Once this recommendation was
implemented, the “failure to show” rate
decreased significantly.
Improvements were also instituted
in a San Jose, California, juvenile
court to reduce the number of adolescents who were being routinely being
dropped off at the court by police
whether or not this was appropriate for
the individual case. In this case, Bell
and colleagues established clear operational criteria for placement in the juvenile detention facility and developed
a “criteria card,” which police could
carry in their wallets. The card also
provided phone numbers and placement criteria for alternative settings
(e.g., drug treatment) to assist police in
identifying appropriate options.
Conclusion
As indicated in the examples above, a
Quality Assessment approach is both a
feasible and cost-effective first step for
addressing disparities in the juvenile
justice system. The data-driven QA
approach supports continuous system
improvement, increases accountability, and improves outcomes, allowing
disparities to be addressed without the
usual descent into charges of discrimination, the bureaucracy of denial, and
the vicious downward spiral that often
follows.
A QA approach will not solve all
problems in the juvenile justice system.
In fact, the initial implementation of
such an approach is likely to expose
some of the system’s more challenging
problems. However, only if such problems are brought to light and understood can the system begin to change
in a significant and lasting way.
For more information, please see
Bridges, G. S., and S. Steen, “Racial
Disparities in Official Assessments
of Juvenile Offenders: Attributional
Stereotypes as Mediating Mechanisms,”
American Sociological Review, Vol. 63,
August 1998, pp. 445–570.
De Como, R. E., “Estimating the
Prevalence of Juvenile Custody by Race
and Gender,” Crime and Delinquency,
Vol. 44, 1998, pp. 489–506.
Sampson, R. J., and J. H. Laub,
“Structural Variations in Juvenile Court
Processing: Inequality, the Underclass,
and Social Control,” Law and Society
Review, Vol. 27, No. 2, 1993,
pp. 285–312.
Sickmund, M., Juveniles in Corrections,
Washington, D.C.: Office of Juvenile
Justice and Delinquency Prevention,
2004. ■
What Makes Needle and Syringe
Exchange Programs Effective in
Preventing HIV Transmission?
SAFE AND CERTAIN ACCESS TO STERILE
syringes is widely regarded as among
the most effective methods for preventing the spread of HIV and hepatitis B
and C viruses among injection drug
users (IDUs) who are unwilling or unable to stop using drugs. In the absence
of a national policy on this issue, state
and local governments have been left
to decide whether and how to provide
access. This situation has resulted in a
wide range of conditions under which
IDUs might acquire sterile syringes. In
many states, access is provided through
syringe exchange programs (SEPs).
However, the level of access provided
through SEPs can be limited due to a
program’s scope and geographical location as well as other obstacles, including laws and regulations that prohibit
IDUs from possessing syringes, limit
the number of syringes provided
through SEPs, or forbid the purchase
of syringes through pharmacies.
A new study led by DPRC researcher
Ricky N. Bluthenthal compared SEPs
in three U.S. cities to examine how
variations in legal restrictions or
program-related conditions might be
associated with different outcomes for
SEP users, such as different rates of
syringe reuse or sharing. The study’s
findings suggest that legal access to
sterile syringes through SEPs may not
be sufficient in itself to reduce syringe
reuse if such programs operate under
conditions that limit the number of
syringes that can be exchanged, purchased, or possessed.
The study used HIV risk assessment data collected between 1998 and
2000 from IDUs in Chicago, Illinois;
Hartford, Connecticut; and Oakland,
California—all of which have SEPs.
These cities offer a range of legal and
program-related conditions, as shown
in the table. While both Chicago and
Hartford permit the legal possession
of syringes under certain conditions,
Oakland bans any possession of drug
paraphernalia, including syringes. The
Hartford SEP’s distribution policy
coheres with legal mandates restricting
the number of syringes that can be
carried (10 through September 1999
and 30 thereafter), while both Chicago
and Oakland have relatively permissive, large-volume syringe exchanges
that augment one-for-one exchange of
syringes with additional sterile syringes.
Legal and Program Variations for Syringe Access—1998 to 2000
Hartford, Connecticut
Chicago, Illinois
Legal restrictions
on carrying
syringes
Legal to carry a limited
number of syringes
(10 prior to 9/99; 30
after that)
Legal to carry syringes
with client identification card from SEP
Illegal to carry syringes
under any circumstances
SEP access
conditions
Access to a small-volume
SEP that conforms to
legal mandates on the
number of syringes
that could be carried
Access to a very large,
legal SEP providing
syringes on a one-fortwo basis
Access to a very large, legal
SEP providing syringes on a
one-for-one plus five syringes
basis
Pharmacy access
conditions
Ability to purchase up
to 10 syringes per visit
No pharmacy access
No pharmacy access
6
Oakland, California
Hartford allows IDUs to purchase up
to 10 syringes at pharmacies, while the
other cities do not permit pharmacy
purchase.
SEP Outcomes Varied
Across Cities
The study found significant variation in
the outcomes of the three programs.
• IDUs residing in the most legally
restrictive locale (Oakland) had
more police contact for possession
of drug paraphernalia (37 percent)
than their counterparts in Chicago
(20 percent) or Hartford (17 percent).
• IDUs who participated in large-scale
syringe exchange programs (Chicago
and Oakland) were less likely to
report syringe reuse than their Hartford counterparts, although not less
likely to engage in receptive syringe
sharing.
• After controlling for sociodemographics and other factors, the rate
of syringe reuse in Hartford was not
significantly lower than that in the
other cities, despite the fact that all
IDUs could purchase 10 syringes in
pharmacies.
These findings indicate some of the
ways in which the effectiveness of SEPs
might vary according to the context
in which they operate. For example,
studies have shown that police contact
for syringe possession is associated with
injection-related HIV risk, suggesting that communities with strict drug
paraphernalia laws, such as Oakland,
should consider excluding syringes
from these regulations in order to
reduce the spread of infectious diseases
among IDUs. The study’s findings also
suggest that SEPs that do not have caps
on the number of syringes exchanged,
such as those in Chicago and Oakland,
may be more likely to affect syringe
reuse among IDUs than those with
such caps, such as Hartford. Moreover,
the lack of impact on syringe reuse
seen from Hartford’s pharmacy access
program provides further evidence of
the potential counterproductiveness
of capping the number of syringes
provided to IDUs even when syringe
access is provided through a variety of
methods.
Better Understanding Is
Needed of Community and
Operational Factors Influencing
SEPs’ Effectiveness
Taken together, these findings point to
the need for better understanding of
the impact of community context (e.g.,
legal restrictions on syringe possession
and pharmacy access) and SEP operational factors (e.g., syringe distribution
policies and limits on access) on the
effectiveness of syringe access programs.
Examples of other community factors
that might affect SEP effectiveness
include the prevalence of HIV and its
incidence among IDUs in the local
community, the drug being injected,
and the sexual mixing patterns between
IDUs and other groups with high HIV
prevalence (e.g., men who have sex
with men). Other important operational characteristics include the location of SEP services (e.g., health clinic,
van, shooting gallery, staff on foot),
number of hours and days of the week
that services are available, ancillary
services provided, and the cultural
appropriateness of the staff to the
population served.
Now that there is little question of
the effectiveness of SEPs in the broad
sense, new research efforts are needed
to help guide public health care providers and policymakers in deciding
where and what type of SEPs to implement in their communities.
7
For more information, please see
Bluthenthal, R. N., M. Rehan Malik,
L. E. Grau, M. Singer, P. Marshall, and
R. Heimer for the Diffusion of Benefit
through Syringe Exchange Study Team,
“Sterile Syringe Access Conditions and
Variations in HIV Risk Among Drug
Injectors in Three Cities,” Addiction,
Vol. 99, No. 9, 2004, pp. 1136–1146.
Kral, A. H., and R. N. Bluthenthal,
“What Is It About Needle and Syringe
Programmes That Make Them Effective
for Preventing HIV Transmission?”
International Journal of Drug Policy,
Vol. 14, 2003, pp. 361–363. ■
Project ALERT Evaluation Confirms
Value of Classroom Drug Prevention
ALTHOUGH DRUG USE AMONG MIDDLE
school students appears to have leveled
off during the late 1990s, U.S. adolescents continue to use alcohol, tobacco,
and marijuana at unacceptably high
rates. The good news is that a large-scale
evaluation of Project ALERT, the widely
used middle school drug prevention
program developed by a team led by
DPRC researcher Phyllis Ellickson,
shows that the program successfully
alters the course of substance use for
many youth. The program even helps
high-risk youth, whom many have
claimed are beyond reach.
Project ALERT is a two-year classroom curriculum that seeks to motivate
students against using drugs and to
give them the skills needed to translate
that motivation into effective resistance
behavior. Initially field-tested in the
1980s, the current Project ALERT
curriculum was released to schools in
1995 and is now used in all 50 states.
In 2001, the U.S. Department of
Education named Project ALERT an
Exemplary Model Program.
DPRC researchers evaluated the
Project ALERT curriculum, which the
RAND Corporation revised based on
earlier research results, across more
than 4,000 students at 55 South
Dakota middle schools from 1997 to
1999. Students were randomly assigned
to program and control groups, with
program students receiving Project
ALERT lessons in 7th and 8th grades.
Students were surveyed about their
drug-related attitudes and substance
use in the fall of 7th grade (at which
point they were classified as low-,
moderate-, or high-risk users) and
resurveyed in the spring of 8th grade.
Reductions in Substance Use
Among Project ALERT Students
At the end of the 18-month evaluation,
the Project ALERT students had made
major improvements in their substance
use compared with the control students.
Alcohol misuse. Among all students,
overall alcohol misuse scores (in terms
of such problem behaviors as binge
Figure 1 Alcohol Misuse at End of Evaluation
Average alcohol misuse score
3.0
2.5
Control
ALERT
20% drop
2.0
Cigarette use. Among all students,
the proportion of new smokers in the
ALERT group was 19 percent lower
than in the control group. The proportion of weekly smokers dropped by
23 percent.
Marijuana initiation. For the lowest-
risk students (those who had not tried
cigarettes or marijuana by 7th grade),
the proportion of new marijuana users
was 38 percent lower in the ALERT
group. For the moderate-risk students—
those who had already tried cigarettes—
marijuana initiation was 26 percent
lower (see Figure 2).
As the figures show, Project ALERT
helped even those youth who had already started smoking and drinking by
7th grade. The findings counter claims
by critics that school-based programs
fail to affect high-risk and moderaterisk adolescents.
Effects on Students’ Attitudes
and Expectations Regarding
Drug Use
1.5
24% drop
1.0
0.5
0.0
All students
drinking, drinking that leads to fights,
and drinking that gets the student in
trouble) were 24 percent lower for the
ALERT group than for the control
group. Moreover, the prevention curriculum was especially successful with
the high-risk baseline drinkers, i.e.,
those who had used alcohol three or
more times in the past year or at least
once in the past month. It reduced by
20 percent their likelihood of experiencing problems from drinking or of
engaging in risky forms of alcohol use
(see Figure 1). However, although Project ALERT helped youth avoid risky
drinking, it did not keep students from
starting to drink or help them cut back
on occasional use.
Baseline drinkers
8
A related study, led by DPRC researcher
Bonnie Ghosh-Dastidar, found that
Project ALERT is also helping change
middle school students’ attitudes and
expectations regarding cigarette and
For more information, please see
Figure 2 Marijuana Initiation at End of Evaluation
Percentage of students
initiating marijuana use
40
35
Control
ALERT
26% drop
30
25
20
15
38% drop
10
5
0
Baseline
nonusers
marijuana use, and to a lesser extent,
alcohol use. Using data from the
program evaluation, researchers assessed whether and to what degree the
Program ALERT curriculum reduced
pro-drug beliefs among middle school
students in four key risk areas: the
consequences of using drugs, the prevalence of drug use and its acceptability
to others, self-efficacy in resisting pressures to use drugs, and expectations of
future drug use.
The study found that, for cigarette
and marijuana use, Project ALERT had
a significant effect in modifying prodrug attitudes and beliefs in all four
areas, with the exception of students’
views on the harm of occasional marijuana use. More modest effects were
seen in relation to beliefs and attitudes
concerning alcohol. Project ALERT
appeared to have the greatest effect
in changing student views on social
norms. The program was particularly
successful in reducing ALERT students’
estimates of how many students used
each target drug and in modifying their
beliefs about perceived peer approval
of drug use, and friends’ reactions to
drug use.
Although the program’s effects were
typically more pronounced for lowand moderate-risk students, Project
Baseline cigarette
smokers
(moderate risk)
ALERT also helped high-risk youths
become more aware of the serious
consequences associated with smoking
and drinking and their own susceptibility to becoming dependent. It helped
these high-risk users recognize that not
everyone uses, reducing their estimates
of how many of their peers smoke,
drink, and use marijuana.
The results of these studies provide
further evidence that school-based
programs can help youths at all levels
of risk for future substance use and
abuse. Started early enough in schools,
drug prevention programs can buy
time, delaying substance use for many
adolescents until they are old enough
to resist temptations to smoke, drink,
or use drugs.
9
Classroom Drug Prevention Works: But
Left Unchecked, Early Substance Use
Haunts Older Teens and Young Adults,
Santa Monica, Calif.: The RAND
Corporation, RB-4560, 2004.
Ellickson, P. L., D. F. McCaffrey, B.
Ghosh-Dastidar, and D. L. Longshore,
“New Inroads in Preventing Adolescent
Drug Use: Results from a Large-Scale
Trail of Project ALERT in Middle
Schools,” American Journal of Public
Health, Vol. 93, No. 11, 2003,
pp. 1830–1836.
Ghosh-Dastidar, B., D. L. Longshore,
P. L. Ellickson, and D. F. McCaffrey,
“Modifying Pro-Drug Risk Factors
in Adolescents: Results from Project
ALERT,” Health Education & Behavior,
Vol. 31, No. 3, June 2004, pp. 318–334.
■
In Remembrance
DPRC Board Member and First Chair
Norval Morris
NORVAL MORRIS, PROMINENT UNIVERsity of Chicago criminologist and
longtime member and first chair of
the DPRC Advisory Board, died on
February 21, 2004, in Chicago of a
heart attack. He was 80 years old.
Combining precise legal scholarship
and an instinct for criminology with
general erudition and entrepreneurial
energy, Morris became internationally
renowned as an expert on criminal
justice systems, publishing 15 books
and hundreds of articles. His academic
career spanned 55 years, the last 40 of
them at Chicago. Morris was founding
director of the University of Chicago
Law School’s Center for Studies in
Criminal Justice, which became a
major force in legal criminology. At the
Center, Morris mentored many young
scholars, including Michael Tonry and
Franklin Zimring. He also created the
leading criminological review series
Crime and Justice, which is about to
celebrate its 30th year.
In the words of DPRC cofounder
Peter Reuter, Morris was not afraid to
state “uncomfortable criminological
truths precisely.” His book (with Gordon Hawkins) The Honest Politician’s
Guide to Crime Control (University of
Chicago Press, 1970) advocated an end
to criminal penalties for “victimless
crimes,” such as public drunkenness,
gambling, and various sex acts. Morris’s
skepticism about the social value of
routine incarceration and critiques of
the American prison system drew anger
from legislators who were pushing
for stiffer sentencing laws. In 1978,
Morris’s opponents in Congress cited
the book in opposing his nomination
to head the federal Law Enforcement
Assistance Administration. President
Jimmy Carter subsequently withdrew
the nomination.
Even-Handed, Disciplined, and
Judicious Leadership
Morris was selected as the first chairperson of DPRC at the time of its
founding in 1989–90. DPRC cofounder Barbara Williams says that
Morris was selected for a number of
reasons, including his professional
standing and strong support of an
empirical, tested basis for drug policy.
Although his professional expertise was
in law enforcement, Morris appreciated
the critical roles played by prevention
and treatment in drug policy.
As chair of the DPRC Advisory
Board, Morris gained a reputation for
being even-handed, disciplined, and
judicious, qualities that were seasoned
with graciousness and a ready wit. In
the words of Williams, “His leadership soon made strangers into friends,
turned sharp differences of opinion
into important questions for research
and analysis, and made the once-a-year
board meeting a continuous source of
influence, help, and support for the
research staff of the Center. Morris’s
leadership set the tone for succeeding
Board chairpersons—and made DPRC
one of the few places where those who
had chosen to study or practice seemingly incomparable aspects of drug
policy could think, learn, and work
together.”
In the 1990s, Morris began writing
novels with criminal justice themes.
He was particularly proud of having
10
Norval Morris, with Barbara Williams
authored the first book of fiction
published by Oxford University Press,
The Brothel Boy and Other Parables of
Law (1992). The novel was a fictional
reconstruction of the experience of Eric
Blair (the real name of George Orwell)
as policeman and magistrate in Burma
(now Myanmar) in the 1950s.
Norval Morris was born in Auckland,
New Zealand, on October 1, 1923.
He received two law degrees from the
University of Melbourne, as well as
a doctorate in criminology, in 1949,
from the London School of Economics. After holding positions at the
University of Melbourne, Harvard, the
University of Adelaide, and the United
Nations Institute for the Prevention of
Crime and Treatment of Offenders in
Tokyo, he joined the University of Chicago in 1964, where he was dean of the
law school from 1975 to 1979 and at
his death was Julius Kreeger Emeritus
Professor of Law and Criminology.
Morris is survived by his wife of 57
years, Elaine Richardson Morris; three
sons, Gareth and Malcolm, both of
Chicago, and Christopher, of Colorado
Springs; and three grandchildren.
Contributions in honor of Norval
Morris may be sent to The Norval
Morris Memorial Fund, The University
of Chicago Law School, 1111 E. 60th
St., Chicago, IL 60637. The fund will
support at least one public interest
fellow each year. ■
New Project
RAND Coordinating Center:
Sexual Diffusion of HIV Study
The National Institute on Drug Abuse
(NIDA) has established the Sexual
Acquisition and Transmission of HIV
Cooperative Agreement Program
(SATH-CAP) to provide a stable
infrastructure for collaborative research
to expand the scientific knowledge
base on the dynamic behavioral, biological, and environmental processes
involved in transmitting HIV among
and across drug-using population subgroups and in diffusing HIV from drugusing populations to non-drug-using
populations.
RAND is serving as the coordinating center for the SATH-CAP. In this
capacity, RAND is responsible for providing technical support and expertise
to facilitate the collection of cross-site
collaborative data. Four institutions are
responsible for collecting data in the
field: UCLA, Yale, Research Triangle
Institute, and the University of Illinois,
Chicago, with data collection activities in Los Angeles, Chicago, North
Carolina, New Haven, and St. Petersburg, Russia. Among RAND’s responsibilities as coordinating center are to
collaborate with research centers and
NIDA to refine methods and designs;
develop and maintain a center Web
site; assist with quality control; serve
as a data repository; and assist in the
development of publications. ■
New Publications
PREVENTION
Chinman
M. S., and M. Y. Iguchi,
“Coercive Use of Vaccines Against
Drug Addiction: Is It Permissible and
Is It Good Public Policy?” Virginia
Journal of Social Policy & the Law, Vol.
12, No. 2, Winter 2004.
Vaccines against drug addiction may
represent hope for addicted individuals
eager to access treatment and may also
seem attractive to a society seeking to
lower the social and economic costs of
addiction. But will current law support
the coercive use of vaccines? The paper
discusses potentially pertinent statutes
and case law bearing on the state’s
ability to justify the use of coercion.
The researchers conclude that coerced
immunotherapy is likely to be legal for
some classes of individuals and reflect
upon issues of fairness in implementing
policy on coercion.
M., D. Early, P. Ebener,
S. Hunter, P. Imm, P. Jenkins, J. Sheldon,
A. Wandersman, “Getting to Outcomes:
A Community-Based Participatory
Approach to Preventive Interventions,”
Journal of Interprofessional Care, Vol. 18,
No. 4, November 2004, pp. 441– 443.
This brief report discusses using
the Getting to Outcomes (GTO)
framework as a way for academics and
community members to collaborate
in improving the quality of substance
abuse prevention efforts at the local
level. The article also describes an
ongoing CDC-funded participation
research project to test GTO at two
U.S. substance abuse coalitions. Although too early for results, field notes
show the GTO process, facilitated by
technical assistance, is already changing
the way the programs are implementing preservation.
Chinman,
TREATMENT
Ridgely,
M., P. Imm, and A. Wandersman, Getting to Outcomes 2004:
Promoting Accountability Through Methods and Tools for Planning, Implementation, and Evaluation, Santa Monica,
Calif.: The RAND Corporation,
TR-101-CDC, 2004.
Substance abuse prevention can
improve community health, but only
when implemented well. This manual
presents a new model that emphasizes
collaboration between prevention
science and local prevention practice.
Incorporating traditional evaluation,
results-based accountability, and
continuous quality improvement, Getting to Outcomes (GTO) involves a
ten-step process designed to enhance
practitioners’ prevention skills while
empowering them to plan, implement,
and evaluate their own programs.
11
Lamb,
R. J., K. C. Kirby, A. R.
Morral, G. Galbicka, and M. Y. Iguchi,
“Improving Contingency Management
Programs for Addiction,” Addictive
Behaviors, Vol. 29, No. 3, May 2004,
pp. 507–523.
Contingency management interventions effectively reduce or eliminate
some individuals’ problem substance
use. Typically, those who do not benefit
never experience the reward or planned
contingency available because they
never produce the behavior (often
abstinence) on which the reward is
contingent. Using two analog studies,
the authors found that the effectiveness
of such interventions improves when
contingencies are arranged so that all
participants are more likely to experience the available reward.
Wenzel,
S. L., S. F. Turner, and M. S.
Ridgely, “Collaborations Between Drug
Courts and Service Providers: Characteristics and Challenges,” Journal of
Criminal Justice, Vol. 32, No. 3, 2004,
pp. 254–263.
Addressing the multiple needs of
drug-involved offenders can enhance
sobriety and recidivism rates, but
requires collaboration between courts
and providers of treatment and other
services. Interviews with administrators
of 14 drug courts and service providers
for offenders in those courts indicated
that, while both administrators and service providers perceived a moderate to
strong level of collaboration, the courts
rarely provided services other than
substance abuse treatment. Perceived
barriers to collaboration included
limitations on funding, management
information systems, and staffing.
Zweben,
J., J. Cohen, D. Christian,
G. Galloway, M. Salinardi, D. Parent,
and M. Iguchi, “Psychiatric Symptoms
in Methamphetamine Users,” American
Journal on Addictions, Vol. 13, No. 2,
2004, pp. 181–190.
The Methamphetamine Treatment
Project (MTP) offers the opportunity
to examine co-occurring psychiatric
conditions in a sample of 1,016 methamphetamine users participating in a
multisite outpatient treatment study
between 1999 and 2001. Participants
reported high levels of psychiatric
symptoms, particularly depression and
attempted suicide, but also anxiety
and psychotic symptoms, as well as
problems controlling anger and violent
behavior, and a correspondingly high
frequency of assault and weapons
charges. Findings continue to support
the value of integrated treatment for
co-occurring conditions.
SUBSTANCE USE AND HIV
Anderson,
R., L. Clancy, N. Flynn,
A. Kral, and R. Bluthenthal, “Delivering Syringe Exchange Services Through
‘Satellite Exchangers’: the Sacramento
Area Needle Exchange, USA,” International Journal of Drug Policy, Vol. 14,
2003, pp. 461, 463.
This paper describes the use of
“satellite exchangers” who provide
services for an illegal SEP in California
by distributing syringes and HIV risk
reduction supplies to other drug users.
Advantages of satellite exchangers included a large geographic coverage area,
lower program costs, ability to provide
services to clients who do not use fixed
site programs, and lower possibility of
program detection by law enforcement.
Disadvantages included potential
limits on ancillary services, less-thanoptimum arrangements for drug users
who do not want to rely on others for
syringe access, and fewer opportunities
for counseling and referral services.
Beckett, M., A. Burnam, R. L. Collins,
D. E. Kanouse, and R. Beckman,
“Substance Use and High-Risk Sex
Among People with HIV: A Comparison Across Exposure Groups,” AIDS
and Behavior, Vol. 7, No. 2, 2003,
pp. 209–218.
This study compared the prevalence
of substance use between two groups at
high risk for HIV infection—men who
have sex with men (MSM) and injection drug users (IDUs)—and a third
group, heterosexual men and women.
Substance use was most prevalent
among MSM, and substance use and
current dependence were associated
with being sexually active among
MSM, but not IDUs. Substance use
predicted high-risk sex, with few differences among groups. The results
highlight the need to design effective
substance use interventions targeting
HIV-infected men.
12
Riehman, K. S., A. H. Kral, R. Anderson, N. Flynn, and R. N. Bluthenthal,
“Sexual Relationships, Secondary
Syringe Exchange, and Gender Differences in HIV Risk Among Drug
Injectors,” Journal of Urban Health:
Bulletin of the New York Academy
of Medicine, Vol. 81, No. 2, 2004,
pp. 249–259.
This study found that, among injection drug users (IDUs) at 23 California
SEPs in 2001, women were more likely
than men to exchange syringes for
others and more likely to have IDU
sexual partners. However, women who
exchanged syringes for others were
not more likely to increase their own
HIV risk, though they might increase
risk among their social networks.
Among women, having an IDU steady
sexual partner was not associated with
exchanging syringes for others. Women
who exchanged syringes for others were
more likely to give used syringes to
others, but not to use others’ syringes
or to exchange sex for money or drugs.
SUBSTANCE USE, PREVENTION,
AND TREATMENT AMONG ADOLESCENTS AND YOUNG ADULTS
Caulkins, J. P., R. L. Pacula, S. Paddock,
and J. Chiesa, “What We Can—and
Cannot—Expect from School-Based
Drug Prevention,” Drug and Alcohol
Review, Vol. 23, No. 1, 2004, pp. 79–87.
This paper assesses quantitatively
the social benefits of school-based
drug prevention in the United States.
The benefits per participant stemming
from reduced drug use (approximately
$840 from tobacco, alcohol, cocaine,
and marijuana) appear to exceed the
program costs (approximately $150
per participant); benefits associated
with reduced cocaine use alone (approximately $300) also exceed program
costs, though the figure for marijuana
is small (approximately $20). The majority of benefits stem from reductions
in tobacco and alcohol use, a result
with implications for program funding.
Collins, R. L., and P. L. Ellickson,
“Integrating Four Theories of Adolescent Smoking,” Substance Use & Misuse,
Vol. 39, No. 2, 2004, pp. 179–209.
This study tested the ability of four
theories—the Theory of Planned Behavior, Social Learning Theory, Social
Attachment Theory, and Problem
Behavior Theory—to predict smoking at grade 10 against an integrated
model incorporating predictors from
all the theories. All four of the theories
were able to predict adolescent smoking; however, the integrated model
was superior to all of the theory-based
models. The results emphasize the need
for a multifaceted approach to understanding and preventing adolescent
smoking.
Ellickson,
P. L., C. E. Bird, M. Orlando, D. Klein, and D. F. McCaffrey,
“Social Context and Adolescent Health
Behavior: Does School-Level Smoking
Prevalence Affect Students’ Subsequent
Smoking Behavior?” Journal of Health
and Social Behaviors, Vol. 44, No. 4,
2003, pp. 525–535.
This paper examines the links between an individual adolescent’s smoking and actual and perceived smoking
behavior in the individual’s school
cohort. Adjusting for demographics,
actual school-level prevalence of smoking at grade 7 was strongly associated
with student smoking frequency one
year later, but this association disappeared after adjusting for the individual’s smoking frequency at baseline.
The perceived prevalence of smoking
among grade 8 students was associated
with increased risk of smoking, as were
cigarette offers and exposure to friends
and other peers who smoke.
Ellickson,
P. L., S. C. Martino, and
R. L. Collins, “Marijuana Use from
Adolescence to Young Adulthood:
Multiple Developmental Trajectories
and Their Associated Outcomes,”
Health Psychology, Vol. 23, No. 3, 2004,
pp. 299–307.
This study modeled discrete developmental patterns of marijuana use
from early adolescence (age 13) to
young adulthood (age 23) among a
sample of 5,833 individuals. Researchers identified four smoking trajectory
groups (in addition to abstainers): early
high users, stable light users, steady
increasers, and occasional light users.
Analyses comparing the trajectory
groups at age 29 revealed that abstainers consistently had the most favorable
behavioral, socioeconomic, and health
outcomes, whereas early high users
consistently had the least favorable
outcomes.
Ellickson,
P. L., M. Orlando, J. S.
Tucker, and D. J. Klein, “From Adolescence to Young Adulthood: Racial/
Ethnic Disparities in Smoking,” American Journal of Public Health, Vol. 94,
No. 2, 2004, pp. 293–299.
This study compared trends in smoking among four racial/ethnic groups
from a sample of 6,259 youths ages 13
to 23. Although African-Americans
exhibited higher smoking initiation
rates than whites, they exhibited consistently lower rates of regular smoking than both whites and Hispanics.
African-Americans also had lower rates
of transition to regular smoking and a
greater tendency to quit. Racial/ethnic
disparities in smoking were found to
be accounted for by differences in prosmoking influences, suggesting that
reducing these disparities may require
reducing differences in the psychosocial
factors that encourage smoking.
13
Martino,
S. C., R. L. Collins, and
P. L. Ellickson, “Substance Use and
Early Marriage,” Journal of Marriage
and Family, Vol. 66, No. 1, 2004,
pp. 244–257.
Prior research indicates that substance use is related to adolescent
marriage. Using data from a study of
West Coast youth, researchers assessed
the effects of cigarette, alcohol, and
marijuana use in grades 7 and 10 on
the probability of marriage prior to
age 20. They found that, controlling
for gender, race, and socioeconomic
status, cigarette use in adolescence, but
not other substance use, was associated
with early marriage through a process
that also involves low educational attainment and early unwed parenthood.
The results support the notion that the
link between substance use and early
marriage reflects a disposition toward
risky or unconventional behavior, not
the judgment-impairing effects of drug
and alcohol use.
Orlando, M., J. S. Tucker, P. L. Ellick-
son, and D. J. Klein, “Developmental
Trajectories of Cigarette Smoking and
Their Correlates from Early Adolescence to Young Adulthood,” Journal
of Consulting and Clinical Psychology,
Vol. 72, No. 3, 2004, pp. 400–410.
Adolescence and emerging adulthood
represent a critical time for smoking
prevention and intervention efforts.
This study identified six smoking
trajectories from age 13 to 23 among
5,914 individuals: nonsmokers (28
percent), stable highs (6 percent), early
increasers (10 percent), late increasers
(10 percent), decreasers (6 percent),
and triers (40 percent). By age 23, the
trajectories merged into two distinct
groups of low- and high-frequency
smokers. These results can help researchers identify at-risk individuals
before their smoking becomes too
problematic.
Riehman,
K. S., R. Bluthenthal, J.
Juvonen, and A. Morral, “Adolescent
Social Relationships and the Treatment
Process: Findings from Quantitative
and Qualitative Analyses,” Journal
of Drug Issues, Vol. 3, No. 4, 2003,
pp. 865–896.
Data from a quantitative study of
449 criminally involved adolescents
show that girls in mandated substance
abuse treatment programs had more
problematic families and peers and
more depressive symptoms than boys
in such programs. Interviews revealed
that girls’ pretreatment networks were
almost exclusively comprised of older
males acting as “protectors” and sexual
partners, while boys’ included samesex, same-aged peers. Girls emphasized
sexuality when discussing in-treatment
relationships and had difficulty developing friendships with other girls in
the program. ■
New People
LAURA
M. BOGART is a behavioral
scientist at RAND who specializes in
applying principles of social cognition
to understanding risky health behaviors
and racial/ethnic disparities in health
care behaviors. Laura has been involved
in the design, implementation, and
analysis of numerous studies in primary and secondary HIV prevention,
and adherence to antiretroviral treatment for HIV. She has also conducted
research examining physicians’ expectations about patients, as well as patients’
attitudes about physicians and perceptions of discrimination in health care.
She was the recipient of an NIMH
grant examining the cognitive strategies used by men who have sex with
men and high-risk heterosexuals to
recall sexual behaviors. She is currently
co-investigator on an NICHD grant
examining the relationship of conspiracy beliefs about HIV and birth
control, and perceived discrimination
in health care, with sexual risk and
contraceptive behaviors among African-Americans. She holds a Ph.D. in
social psychology from the University
of Pittsburgh.
14
MEREDITH
L. MAGNER is a research
assistant at RAND. Among her research interests are the intersection of
substance abuse and violence as well as
HIV risk reduction among substance
abusers. Meredith has contributed
to studies estimating the association
of youth violence with characteristics of Baltimore neighborhoods and
examining the intersection of AIDS
and violence among women residing
in Baltimore. Meredith is currently
facilitating a study on partner-oriented
drug treatment, which aims to assess
treatment outcomes, change in HIV
risk behaviors, and change in personal
drug-using network characteristics for
methadone clients and their partner
referrals. Meredith completed her
M.P.H. at The George Washington
University and received a B.A. in
political science from UCLA.
During
SMART
OTU was a recent visiting exchange scholar from the Department of
Anthropology and Sociology, University of the Western Cape, Cape Town,
South Africa. He came to DPRC under
the sponsorship of the West Africa
Research Association, in collaboration
with the U.S. Department of State, and
worked directly under Martin Iguchi.
Smart completed his doctoral study in
September 2004. His focus and interests include the analysis and profiling
of drug traffickers and drug abusers in
South Africa and Nigeria; organized
crime; drug policy; and criminal justice
theory. He recently completed a wellreceived research project titled “Armed
Robbery in Contemporary Nigeria: A
Criminological Analysis.” Smart is
interested in pursuing postdoctoral
study of organized drug trafficking and
money laundering, with particular
emphasis on the diverse dimensions
drug trafficking can take, its wideranging implications, and global and
local policy issues. He holds a Ph.D.
from the University of the Western
Cape, Cape Town, South Africa.
his time as a 2004 Summer
Associate at the DPRC, RAJEEV
RAMCHAND worked with Martin Iguchi
and Rosalie Pacula to study behaviors
that may place marijuana users at risk
for arrest in the United States. Rajeev
is currently a predoctoral student at the
Johns Hopkins Bloomberg School of
Public Health, where his thesis research
investigates the mechanisms through
which work experience may affect
adolescents’ patterns of drug use and
involvement in both legal and illegal
drug markets. Rajeev received a B.A.
in economics from the University of
Chicago, and has previously worked in
consulting and at the Urban Institute.
■
2003–04 Lovida Coleman, Jr., Speaker Series
Science and Drug Policy
The series provides a forum for decisionmakers and scientists to discuss policies
concerning drug supply, demand, and control. The series is held at The RAND
Corporation, 1776 Main Street, Santa Monica, California. For the latest information on scheduled talks, please see the DPRC Web site, http://www.rand.org/
multi/dprc.
Recent Talks
January 20, 2005
Dr. Susan Tapert, Assistant Professor in Residence, UC San Diego
Department of Psychiatry
This is Your Brain on Alcohol: Neuroimaging Studies in Adolescents with
Substance Use Behavior
April 28, 2004
James Bell, Executive Director of
the W. Haywood Burns Institute for
Juvenile Justice Fairness and Equity
Reducing Disproportionate Minority
Confinement for Youth of Color: Lessons from the Frontlines
February 6, 2004
David Vlahov, Director of the Center for Urban Epidemiologic Studies
(CUES) at The New York Academy
of Medicine
HIV Infection Among Injection Drug
Users: Prevention and Progression
15
Advisory Board
Former Advisory Board Members
Lovida H. Coleman, Jr. (Chair)
Partner, Sutherland, Asbill & Brennan LLP
James E. Burke
Chairman, Partnership for a Drug-Free America
Stephen M. Duncan
Norman A. Carlson
Senior Lecturer, Department of Sociology
University of Minnesota
Tone N. Grant
President, Refco Group, Ltd.
Pedro José Greer, Jr., M.D.
Assistant Dean, University of Miami
School of Medicine
Mathea Falco
President, Drug Strategies
Calvin Hill
Herbert D. Kleber
Professor, Department of Psychiatry,
Columbia University
Fred C. Iklé
Distinguished Scholar, Center for Strategic
and International Studies
David J. Mactas
Amy Pascal
Chairman, Motion Picture Group,
Sony Pictures Entertainment
Janet L. Robbie
Former Executive Vice President,
Miami Dolphins and Joe Robbie Stadium
Cynthia Telles
Director, Spanish Speaking Psychosocial Clinic,
Department of Psychiatry, University of
California, Los Angeles
Barbara R. Williams
Vice President Emeritus,
The RAND Corporation
Daniel P. Garcia
Norval Morris
Julius Kreeger Professor of Law and Criminology
School of Law, University of Chicago
P. Michael Timpane
Senior Advisor for Education Policy,
The RAND Corporation
The Honorable John P. White
Lecturer in Public Policy, John F. Kennedy
School of Government; Senior Partner,
Global Technologies Partners
James Q. Wilson
James A. Collins Professor Emeritus
of Management, The John E. Anderson Graduate
School of Management, University of California,
Los Angeles
Hubert Williams
President, Police Foundation
Judith B. Willis
Health Care Consultant
Richard B. Wolf
James H. Woods
Professor of Pharmacology and Psychology,
Department of Pharmacology,
University of Michigan
R
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