Adolescent inhalant abuse leads to other drug use and impaired growth; implications for diagnosis.

OBJECTIVE: Abuse of inhalants containing the volatile solvent toluene is a significant public health issue, especially for adolescent and Indigenous communities. Adolescent inhalant abuse can lead to chronic health issues and may initiate a trajectory towards further drug use. Identification of at-risk individuals is difficult and diagnostic tools are limited primarily to measurement of serum toluene. Our objective was to identify the effects of adolescent inhalant abuse on subsequent drug use and growth parameters, and to test the predictive power of growth parameters as a diagnostic measure for inhalant abuse. METHODS: We retrospectively analysed drug use and growth data from 118 Indigenous males; 86 chronically sniffed petrol as adolescents. RESULTS: Petrol sniffing was the earliest drug used (mean 13 years) and increased the likelihood and earlier use of other drugs. Petrol sniffing significantly impaired height and weight and was associated with meeting 'failure to thrive' criteria; growth diagnostically out-performed serum toluene. CONCLUSIONS: Adolescent inhalant abuse increases the risk for subsequent and earlier drug use. It also impairs growth such that individuals meet 'failure to thrive' criteria, representing an improved diagnostic model for inhalant abuse. Implications for Public Health: Improved diagnosis of adolescent inhalant abuse may lead to earlier detection and enhanced health outcomes.

Moderating effects of perceived social benefits on inhalant initiation among American Indian and White youth.

This study examined whether perceived social benefits moderated the relationship between social influence variables (school attachment, peer inhalant use, perceived family caring, and parental monitoring) and stage of inhalant initiation (Study 1) and lifetime inhalant use (Study 2). Participants were 7th to 12th grade students attending schools on or near American Indian reservations, with comparisons made between American Indian and White students. A total of 3,498 American Indian and 1,596 White students were surveyed. Differences in mean levels of social influence variables were found across ethnicity and stage of inhalant initiation and lifetime inhalant use. Structural equation models were evaluated to examine variable relationships for the 2 studies. For Study 1, social influence variables did not clearly differentiate early versus later inhalant initiators, and perceived social benefits failed to serve as a moderator. More differences were observed between users and nonusers across measures of social influence (Study 2). Perceived social benefits generally did not moderate the relationships, with 2 exceptions. Low perceived social benefits provided greater protection against the influence of peers on lifetime inhalant use among White students, whereas high perceived social benefits increased risk of peer influence among American Indian students. (PsycINFO Database Record

Lifetime use of cigarettes, alcohol, marijuana and inhalants in Latino early adolescents.

A growing population in the US is Latinos, an ethnic group defined by people of origin from Latin America. By 2050, Hispanics will be at least one quarter of the United States population (U.S. Census Bureau, 2006 ) with a substantial proportion under the age of 25 (Vaughan, Kratz, & D'argent, 2011 ). Yet, the literature on substance use among Latino adolescents is not advancing parallel to the growth of the population (Szapocznik, Lopez, Prado, Schwartz, & Pantin, 2006 ). Health concerns during early adolescence can have a lasting impact on the Latino community and society at large, as early substance initiation can lead to addiction during adulthood (Behrendt, Wittchen, Höfler, Lieb, & Beesdo, 2009 ). Therefore, research that aims to identify psychosocial determinants that serve as risk and protective factors specific to Latino early adolescents is needed as a critical first step in the development of culturally specific prevention initiatives (Vaughan et al., 2011 ).

"My body breaks. I take solution." Inhalant use in Delhi as pleasure seeking at a cost.

BACKGROUND: Inhalant use has existed in India since the 1970s and has increased significantly over the last decades, especially among street-oriented young people. The latter constitute a heterogeneous category: children from street families, children 'of' the street, rag pickers, and part-time street children. There are also inhalant-using schoolchildren and young people in slums. METHODS: Fieldwork was conducted for 1 year. Team ethnography, multi-sited and comparative research, flexibility of methods and writing field notes were explicit parts of the research design. Most research was undertaken with six groups in four areas of Delhi, exemplifying six generic categories of inhalant-using street-oriented young people. RESULTS: Inhalants in India are branded: Eraz-Ex diluter and whitener, manufactured by Kores, are used throughout Delhi; Omni glue in one specific area. There is a general lack of awareness and societal indifference towards inhalant use, with the exception of the inhalant users themselves, who possess practical knowledge. They conceive of inhalants as nasha, encapsulating the materiality of the substances and the experiential aspects of intoxication and addiction. Fragments of group interviews narrate the sensory appeal of inhalants, and an ethnographic vignette the dynamics of a sniffing session. These inhalant-using street children seek intoxication in a pursuit of pleasure, despite the harm that befalls them as a result. Some find nasha beautiful, notwithstanding the stigmatization, violence and bodily deterioration; others experience it as an overpowering force. CONCLUSION: A source of attraction and pleasure, inhalants ravage street children's lives. In this mysterious space of lived experience, their self-organization evolves. Distinguishing between hedonic and side effects, addiction helps to understand inhalant use as at once neurobiological, cultural, and involving agency. The implications are that India needs to develop a policy of treatment and employment to deal with the addiction.

Risk for inhalant initiation among middle school students: understanding individual, family, and peer risk and protective factors.

OBJECTIVE: Because initiation of inhalants at an early age is associated with a range of health and behavioral problems, including an increased likelihood of inhalant dependence (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), we conducted discrete time survival analyses to determine the role of time-invariant and time-variant (over five waves) risk and protective factors as well as grade in inhalant initiation among middle school students. METHOD: The current study uses data from 3,215 students who were initially surveyed as sixth graders in 2008-2009 and were resurveyed in seventh and eighth grades. Students were part of a larger substance use prevention trial conducted in greater Los Angeles. The sample is racially/ethnically diverse (54% Hispanic/Latino, 16% Asian, 14% White, 3% African American) and 51% male. RESULTS: Seventeen percent of youths initiated inhalants during middle school. Higher drug refusal self-efficacy, familism (i.e., values related to family), and parental respect were associated with decreased odds of inhalant initiation. Having a significant adult or older sibling who used substances was associated with increased risk of initiation, but adult influence declined linearly and by the end of seventh grade was no longer a risk factor. Self-rated popularity was associated with inhalant initiation in seventh grade only, and perceived substance use by peers was associated with inhalant initiation in sixth grade only. CONCLUSIONS: The influence of adults, siblings, and peers on inhalant use may be strongest in sixth and seventh grade. Interventions to prevent inhalant initiation should target sixth and seventh graders, address influence by family and peers, and provide skills training to improve drug refusal self-efficacy.

The normative environment for drug use: comparisons among American Indian and white adolescents.

The current study examined the influence of descriptive norms, injunctive norms, perceived outcome expectancies, and ethnicity on marijuana and inhalant use among 2334 American Indian (AI) and White high school students who lived on or near reservations in the United States. Hierarchical multiple regression analyses were conducted with survey data collected during the 2009-2010 and 2010-2011 school years. Results suggest differences between ethnicities in the influence of the normative environment and outcome expectancies on both marijuana and inhalant use. Study limitations are noted, and future research is suggested.

A prospective study of neurocognitive changes 15 years after chronic inhalant abuse.

AIMS: In a previous study, neurological and cognitive deficits reflecting central nervous system (CNS) disruption from chronic inhalant abuse showed substantial recovery after 2 years' abstinence. Functional recovery was progressive, with recovery rates dependent on the degree of impairment prior to abstinence, and severity and duration of initial abuse. Persistent deficits occurred in those with previous 'lead encephalopathy' from leaded petrol abuse. The current study examined recovery in the same cohort 15 years after baseline. DESIGN: Prospective cohort design. SETTING: Two remote Aboriginal communities in Arnhem Land, Australia. PARTICIPANTS: Using baseline group classifications, 27 healthy controls, 60 ex-chronic inhalant abusers and an additional 17 with previous lead encephalopathy were assessed. MEASUREMENTS: Standard neurological, ocular-motor and cognitive functions and blood lead levels. FINDINGS: Chronic (non-encephalopathic) inhalant abusers showed elevated blood lead levels and abnormal scores on most tasks at baseline. At 2 years' abstinence, blood lead was reduced but remained elevated and most scores had normalized. By 15 years, blood lead and all performance scores were equivalent to healthy controls for this group (P > 0.05). The encephalopathic group was more severely impaired on all scores at baseline and showed little improvement, if any, across all tests after both 2 and 15 years' abstinence. Blood lead for this group declined, and was not significantly different to controls after 15 years. CONCLUSIONS: Some inhalant abusers experience severe and persistent neurological deficits, suggesting irrecoverable damage attributable to lead encephalopathy. In the absence of this encephalopathy long-term abstinence from inhalants may allow recovery of normal brain function.

Social rank and inhalant drug use: the case of lança perfume use in São Paulo, Brazil.

BACKGROUND: Lanca perfume (chloroform/ether) is an inhalant used mainly by higher social class students in Brazil. In light of the social and epidemiological features of lanca use, supply, and distribution, this investigation tests hypotheses about the degree to which use of inhalant lanca might be occurring in clusters, consistent with social sharing and diffusion, and might show a direct association with social rank even within the relatively privileged social context of private schools in a large mega-city of Latin America. METHODS: Epidemiologic self-report survey data were from a large representative sample of urban post-primary private school students in São Paulo city, Brazil, in 2008. Newly incident lanca use was studied, first with estimates of clustering from the alternating logistic regressions (ALR) and then with conditional logistic regressions to probe into the hypothesized direct social rank association. RESULTS: ALR disclosed a clustering of newly incident lanca users within private school classrooms (pairwise odds ratio (PWOR)=2.1; 95% CI=1.3, 3.3; p=0.002) as well as clusters of recently active lanca use (PWOR=1.9; 95% CI=1.1, 3.3; p=0.02). Occurrence of lanca use within private school classrooms was directly associated with social rank (odds ratio (OR)=0.2; 95% CI=0.1, 0.8; p=0.03 in the contrast of lowest socio-economic status (SES) versus highest SES strata within classrooms). Thereafter, study of other drugs disclosed similar patterns. CONCLUSIONS: The clustering estimates are consistent with concepts of person-to-person sharing of lanca within private school classrooms as well as other dynamic processes that might promote lanca clusters in this context. An observed direct association with social rank is not specific to lanca use. Direct SES estimates across a broad profile of drug compounds suggests causal processes over and above the more specific initially hypothesized social rank gradients in the lanca diffusion process. A novel facet of the evidence is greater occurrence of drug use among the higher social rank private school students, which should be of interest in the social science community.

Ethnicity and inhalant use among high risk adolescents in Israel.

Inhalant use among 540 high-risk Israeli adolescents was studied from 2004 to 2010. The majority of study participants were of Israeli and Former Soviet Union descent. Study information was collected prior to receiving residential drug treatment. Over the 7-year study, men and women reported similar patterns of age of first, lifetime, and past 30-day inhalant use. Former Soviet Union adolescents began inhalant use at a younger age. The rate of Israeli girls' lifetime use was higher than that reported by Israeli boys and Former Soviet Union girls. Israeli adolescents reported a higher rate of past 30-day use than those from the Former Soviet Union. Study participants reported a higher rate of lifetime use than those attending school in Israel, the United States, and England. Logistic regression analysis showed that age, ethnic status (i.e., country of origin), alcohol use, and pattern of daily activity (i.e., hanging around) were significantly linked to past 30-day inhalant use. Further research for public health and safety reasons is needed about inhalant use that is an international concern.

Residential volatile substance misuse treatment for indigenous youth in Canada.

The Youth Solvent Addiction Program (YSAP) was established in 1996 in response to the misuse of volatile substances among First Nations and Inuit youth in Canada. This article outlines the role of Indigenous culture and its intersection with Western approaches to recovery in YSAP's operation of nine residential treatment centers for youth. Treatment practices and client outcome data are used to illustrate YSAP's approach. Limitations of the article are noted.

The lived experience of volatile substance misuse: how support contributes to recovery and sustained well-being.

This article examines the role of support in the lives, recovery, and sustained well-being of two long-term First Nations volatile substance misusers in Canada. Through the application of visual-arts-based and oral life history methodologies, support is conceptualized and analyzed from joint Indigenous and Western worldviews. With a culturally informed understanding of the types of connections that bring about support, insight is offered to those who are a part of the recovery and maintenance support systems of individuals who misuse volatile substances.