Cannabis Grow

In practice, GMO labeling has not given EU consumers greater choice, because food processors in Europe have recombined ingredients away from GMOs to avoid labeling. As suggested by comments from meat packers, the same pattern may develop with COOL. Just as intended, COOL is a non-tariff barrier to trade; this does not necessarily mean that it will be challenged at the WTO, but it could be vulnerable to such a challenge, or subject to negotiation. At the WTO, country-of-origin labeling is covered as a technical regulation subject to the WTO Agreement on Technical Barriers to Trade which states that countries are allowed to take measures to protect human health or prevent deception of consumers, subject to the requirement that countries are not unjustifiably discriminated against, and that measures do not constitute a disguised restriction on trade.In NAFTA, country of origin labeling is allowed, but requirements must be minimally difficult and costly. Concerns about meeting this requirement may have been what initially prompted Secretary of Agriculture Ann Venneman to speak positively about the suggestion that a “North American” label could be appropriate . COOL compliance may be most costly for developing country suppliers to the U.S. market who lack record keeping infrastructure to maintain audit trails. To this extent, COOL directly conflicts with the spirit of trade liberalization in the Doha Development Agenda, which aims to give preference to the trade agendas of developing countries. To justify the continued existence of the Export Enhancement Program, which purports to offset subsidies and other trade-distorting practices used by other countries, Congress expanded its list of unfair trade practices to include “unjustified trade restrictions or commercial requirements, such as labeling, that affect new technologies, including biotechnology” .

The irony of this new requirement in the same bill mandating country-of-origin labeling will not be lost on U.S. trading partners where consumer distrust of biotechnology, whatever its scientific merits,vertical grow system is an important phenomenon. Challenging labeling of GMOs at the WTO may be more difficult after the passage and implementation of the 2002 COOL regulation.The 2002 Farm Bill roughly doubles annual federal expenditure on environmental programs, including the Environmental Quality Incentive Program , the Conservation Reserve Program and the new Conservation Security Program , from $2 billion to $4 billion, over 1996 levels.Each of these programs benefits producers in California.EQIP provides technical assistance, cost sharing, and incentive payments for producers that undertake qualifying practices that provide environmental benefits. The new CSP provides incentive payments of about $300 million per year for the maintenance or implementation of soil, water, and air quality conservation activities. By paying producers to maintain practices they have previously found to be profitable to undertake, CSP payments are not necessarily intended to internalize environmental externalities but are certainly intended to support agricultural incomes. The continued exemption of environmental payments from support ceilings makes payments for environmental benefits an attractive program for policy makers wishing to subsidize agriculture while meeting WTO obligations. International trading rules have only recently become potential constraints on the form and content of U.S. domestic support to agriculture. The Uruguay Round Agreement on Agriculture introduced a major reform that the U.S. must take into account when setting domestic agriculture policy: a ceiling on so-called trade distorting domestic support for agriculture.

All support for agriculture must be classified as trade distorting, minimally trade distorting, or non-trade distorting, and, while total support levels are unconstrained, trade-distorting support must fall at or below a negotiated cap that declines over time. “Amber box” support is trade-distorting and counts towards countries’ negotiated cap, and “green box” support is deemed not trade-distorting and may be allowed without limits.14 Since supposedly non-distorting “green box” spending is not subject to a cap on support expenditure, identifying support measures that can qualify as “green box” is valuable from the perspective of policymakers wishing to both subsidize agriculture and meet WTO obligations. Green box support includes income support not related to production decisions , environmental and land retirement program payments, domestic food aid, research and extension services, and export promotion programs like the MAP. Over 80 percent of U.S. domestic support for agriculture in 1998 was defined as “green box” by the USDA in 1998 .From 1995 to 1998, U.S. aggregate measure of support to agriculture declined while Green box support grew slightly.While the rules for some of the environmental programs, in particular the CSP, are still being developed, in general, environmental payment programs can be designed for inclusion in the WTO green box, making increased funding for these programs attractive. Domestic support qualifies for the WTO green box if the measure, is paid for by federal government revenues , does not provide price supports, and does not distort trade or has minimal effects on trade. Environmental payments in particular must be limited to the extra cost or loss of income incurred as a result of participation in the program. Some authors have argued that, whatever its merits as a negotiating position, subsidies for agriculture as a means of generating desirable joint outputs or environmental benefits is poor public policy . This is principally because subsidies for agriculture or payments to agricultural producers for environmental services do not directly target the production of the desired nonfood outputs but do so indirectly.

In general, less transparent programs lacking clear environmental goals are unlikely to be cost-effective means of achieving desired environmental outcomes. Bohman et al. give the example of beautiful meadows to illustrate this claim. Meadows are desirable, and one way of creating them is to provide support to dairy farmers; in this case, meadow existence is indirectly supported. A more transparent policy, more closely targeted to meadow creation, would be to compensate people for maintaining meadows. Dairy farmers may or may not be the most efficient providers of the desired good. More generally, other social objectives can be accomplished by broader development initiatives , and environmental externalities can be internalized through targeted and transparent regulations and taxes. The key empirical question, on which further research is needed, is which desirable nonfood outputs are genuinely joint outputs of food production, and which of these would be supplied at a socially inefficient level if food production were not subsidized . Too often, proponents of multi-functionality may overstate the extent to which positive environmental or social externalities are truly joint outputs of food production as an excuse to avoid the politically difficult task of reducing subsidies to agriculture. Environmental goals might be more cost-effectively achieved with policies not intended to subsidize agriculture.California agricultural producers cannot all win from increased trade liberalization. Ending government support for agriculture and lowering tariff barriers will inevitably benefit some more than others. On the whole however, California producers sell high value competitive products, and their major markets, especially Japan and the EU,cannabis plant growing remain protected and difficult to penetrate. Coordinated liberalization that affords California increased access to these markets, even if at the expense of increased competition from China and Mexico, could be an important opportunity. This is all the more true because most of California’s agricultural producers have few subsidies to give up. Even the loss of the export promotion programs would not be very costly; these programs provide little benefit to the industries they support. Because California agricultural producers as a whole stand to gain from global trade liberalization, if the 2002 Farm Bill jeopardizes the possibility of wide ranging reform at the WTO, it may be correct to conclude that the Farm Bill was costly to California farmers. Negotiations are currently stalled; largely over disputes about government support to agriculture in the U.S. and EU. The international response to the 2002 Farm Bill has generally been negative; the Bill has been characterized as politically motivated, and a violation of the spirit, if not the law, of the U.S. commitment to reduce domestic subsidies for agriculture undertaken in the URAA and at the commencement of the Doha round of negotiations.

It does appear that the U.S. will not violate its support cap of $19 billion as a result of the 2002 Farm Bill , although this depends on whether the U.S. commits explicitly to reducing support outlays in the event that a violation appears likely. Yet there is some suggestion that the moral authority of the U.S. as a proponent of liberalization at negotiations has been compromised. Others argue that new provisions of the Farm Bill may represent bargaining chips that can be used in negotiations to encourage other developed countries to reduce their own support for agriculture . The current U.S. negotiating position, announced in July 2002, proposes further tariff reductions, an end to export subsidies and a somewhat tighter cap on amber box domestic support . Despite the negative international reaction to the Farm Bill, there remains a relative consensus, at least in the popular press, that the EU’s CAP is possibly more damaging to developing country agriculture than U.S. farm policy. In addition, as recently as January 2003, the French government reaffirmed its commitment to protect French farms from international competition. It is difficult to predict how this unapologetic stance, in contrast to the continuing claims by U.S. representatives at the WTO that their country is committed to reform, will impact WTO negotiations. The U.S. balancing act between a stated commitment to trade liberalization at the WTO and the 2002 Farm Bill also contrasts with the position of the Cairns Group of countries at the WTO.17 The Cairns Group countries , provide little domestic support for agriculture and are relatively competitive producers expected to benefit from trade liberalization. The Cairns group has called not only for substantial reductions in distorting domestic support and an end to export subsidies, but also a stricter interpretation of the rules for including support measures as green box support. The group’s negotiating proposal states that “since the conclusion of the Uruguay Round the green box has been abused” .18 Certainly, it is plausible that, even if individual programs in a country’s green box claim do not distort trade, the total level of green box support may do so. Given the wide differences between the visions of the EU and the Cairns Group, with the U.S. somewhere in between, trade negotiations will continue to be difficult. 19Government influences agriculture everywhere. This chapter reviews some of the most significant governmental programs that influence California agriculture and highlights similarities with and differences from agricultural policy elsewhere. The chapter describes government programs that support California commodities and attempts to quantify that description. We present new producer support estimates building on the work of Sumner and Hart. Federal government programs and some California state programs support California agriculture. The central legislative basis for federal farm programs is now the Farm Security and Rural Investment Act of 2002 . The law affects program crops and provides a framework for government support of some conservation programs that affect a wider array of commodities. We also discuss the implication of implementation of the Uruguay Round Agreement on Agriculture , which became effective in 1995. Federal budget outlays that support California agriculture are also covered. The most important of the California state policies that we cover is the milk marketing order. However, we also discuss other state marketing orders and state outlays for agricultural support.Other chapters in this book have dealt with environmental and resource policies that are particularly important in California. Labor market policy is also important and the subject of a separate chapter. Here we focus the discussion mainly on farm commodity programs, but other governmental policies that provide support to agriculture are also included in the review. As noted throughout this book, one of the most striking aspects of California agriculture is the breadth of commodities produced. This breadth makes it nearly impossible to deal with each of the policies or programs that may be important for government support for agriculture. We highlight major programs that affect the most important handful of the commodities grown commercially in the state. Government’s overall effect on agriculture includes the impacts of a variety of policies that affect business in general. These policies include taxes on sales, income, excise, and real estate property, as well as provisions of infrastructure, education, and other government services. In addition, regulation of certain other businesses may affect agriculture indirectly. While these general policies pertaining to business may be important, they will be dealt with here only to the extent that agriculture is treated differently from other industries.

The lower endorsement of the two trauma items and one schizoid personality item may be the result of the stigma that is associated with abuse, specifically sexual abuse, and severe mental illness, e.g., being afraid of being crazy. For social support, participants indicated that a majority felt they had family members who they could talk to and rely on. Similarly high was the frequency for having peers to hang out with and not talk about work or family issues. Overall, nearly all participants indicated at least one form of social support. That is, they said yes to at least one or more items on the survey. Affirmative responses for substance problems were calculated for answers that indicated some lifetime use. For example, positive answers to using substances one year ago or more recently were coded yes. The majority of participants said that alcohol and other drug use never made them feel depressed or experience any other kind of psychological problem. Half of the participants indicated that they used AOD weekly or more often in the past 2-12 months compared to a third saying they were trying to hide AOD use, and parents or others complained about their AOD use for the same time frame. Irrespective of a time frame, a majority of participants reported using AOD weekly, and indicated that others were complaining about their AOD use at some point in their lives. Therefore, it appears that a large proportion of the sample showed problematic substance use behaviors or substance problems. Table 1 represents the percentages of affirmative responses to the study items.In order to address hypothesis 2.1, a CFA determined whether the measurement model for trauma,growing cannabis outdoors schizoid personality, social support, and substance problems was valid for the youth offender sample. A CFA was performed on the entire sample using the factor structure indicated by previous research.

The aim of the CFA was to validate the four-factor structure for the sample; that is, it served to reveal whether the four latent constructs can be measured by the observed variables or survey items. The trauma factor was specified by eight indicators, all of which comprised a sub-scale of past traumatic experiences on the GAIN General Victimization Scale. Schizoid personality consisted of six indicators, all of which reflect criteria of the DSM-IV-TR and relevant case studies . Substance problems were measured by five indicators of the recency of problematic drug-using behaviors. Social support was measured by nine indicators capturing different sources of support at school, work, home, or outside of school. Each indicator had an error term indicated by the small error pointing to it as depicted in Figure 1. The error on the indicator reflects variance that is not explained by the latent factor. Factor loadings were considered adequate for values greater than 0.30 . The unstandardized factor loading of the reference variable for each factor was set to 1.0, while the remaining variables were allowed to be freely estimated. The following goodness-of-fit statistics helped to determine adequate model fit: the comparative fit index , the Tucker-Lewis Index , and the root-mean-square error of approximation were consulted. CFI and TLI values close to .95 , and RMSEA values below .08 were considered adequate . The chi-square fit statistic was examined but given less weight in determining fit because of its sensitivity to sample size and the increased likelihood for committing a type I error . Modification indices were requested in order to assess whether correlating any indicator error terms would improve overall fit. Decisions for modifications were based on the value of the modification index, the standardized expected parameter change, parsimony, and general fit. Good model fit demonstrated how well the estimated variance-covariance matrix resembled the observed variance-covariance matrix.

Good model fit indicates that the model is appropriate to detect observed relationships and that it is able to explain a large percentage of the endogenous variables. Moreover, parsimony is a critical component of a good model since highly complex models have less free parameters and tend to have more constraints. Finally, the weighted root-mean-square residual , which is a relatively new fit index, was not considered to determine the viability of the model because of a lack of established research on it. A SEM model was specified in which psychological trauma was hypothesized to have an indirect effect onto substance problems and a direct effect on schizoid personality. Another path was modeled from schizoid personality to social support and to substance problems. Social support had a direct regression path onto substance problems. Together, trauma, schizoid personality, and support, were modeled to predict substance problems. All modeled relations are depicted in Figure 2. Factor loadings specified for each factor were allowed to be freely estimated, except for the reference indicator for each factor that was constrained to be 1.0 as part of unit-loading identification. Akin to the CFA, WLSMV was used as an estimation method, which was selected in the presence of dichotomous indicators in Mplus. Since model fit was good, no modifications were made. Results for research hypotheses 3.1-3.5 show that the following path coefficients were significant in the hypothesized direction: trauma significantly and positively predicted schizoid traits when controlling for social support and substance problems. In other words, an increase in one standard deviation in trauma yielded a .53 standard deviation increase in schizoid personality characteristics. This supported hypothesis 3.1. The effect size suggested that trauma explains 28% of the variance of the schizoid personality factor.Another set of findings is related to the viability of the constructs of trauma, support, personality, and substance problems when applied to the youth offender population.

Many of those constructs have been primarily employed with non-offending youths or adults, so that it was important to test whether they would work equally well with this sample before moving into the structural model analysis. Results show that these constructs worked well for assessing personality and risk constructs among youths on probation, and that these constructs are interrelated in meaningful ways. This suggested that the subsequent analysis of direction and significance of the paths between them could be conducted. The relations among the four constructs were examined. It was hypothesized that trauma would have a direct, positive, and significant effect on the development of schizoid personality traits. This hypothesis was confirmed. It was hypothesized that schizoid personality would negatively impact social support due to interpersonal difficulties that result in social withdrawal. This was confirmed by the significant, negative association schizoid personality had on social support. In other words, the more schizoid traits an adolescent endorsed, the less likely he was to have different types of support at school or home. It was also hypothesized that social support would decrease substance problems. This hypothesis was not confirmed. That is, for this sample having access to more and different types of support ranging from school counselor to parents did not decrease AOD use. It was hypothesized that schizoid personality would have a positive, direct,growing cannabis indoors and significant effect on substance problems. This was confirmed because higher levels of schizoid traits predicted higher AOD use. Similarly, the hypothesis of trauma having an indirect, positive relationship with substance problems was confirmed. Trauma had an indirect, significant, positive association with substance problems providing evidence for the role of childhood abuse adversely affecting AOD use behaviors in adolescence. This effect was found for the traumaschizoid pathway only but not for the trauma-schizoid-social support pathway. This implies that substance problems share a pathway with trauma and personality. As a consequence, the epidemiology of substance problems should encompass traumatic experiences as well as personality traits. The conceptualization of problematic underage AOD behaviors requires a multifaceted model that accounts for the association between intrapsychic factors and extrapsychic outcomes. This study explored whether social support decreases the association of schizoid personality with substance problems.

In the literature social support in the form of parental support was found to decrease adolescent substance use by instilling healthier coping mechanisms and better self-control . The measure of social support used in this study did not focus on only one type of support but included a variety of sources to which youths have access; i.e., teachers, parents, friends at school, and friends at home as well as hobbies. Assessing different forms of support including instrumental and emotional support, the hypothesis was not confirmed. For individuals with schizoid traits having different sources of social support did not ameliorate the negative trajectories of childhood trauma to substance problems. Particularly, social support did not act as a resilience factor in the trauma-schizoid-substance problems pathway. Over one third of the participants responded to items on the schizoid personality scale indicating that they did not care to be around people, and they did not feel emotional about people. Besides, twice as many reported not trusting most people, wanting to get even, and space out the world. These findings carry implications for counselors, as well as for probation officers, courts, and school personnel. The endorsement of several schizoid items clearly indicates a differentiated personality profile from the antisocial type. This overlooked type presents with a complex affective, cognitive, and behavioral profile that is shaped by past trauma and personality traits that require a special set of interventions. High levels of introversion, mistrust, and emotional detachment are qualitatively different from the emotional coldness of the so-called psychopath . A person with such a profile is likely to have a rich inner life created in an attempt to compensate for failed relationships with caregivers that is not accessed via conventional AOD treatment. Even though early traumatic experiences do not inevitably lead to personality disorders, they impact the way individuals see the world and others. Hence, assessing for personality traits should not be minimized to diagnostics, but serve the need for a greater understanding of the individual client. Research finds that relational trauma between child and caregiver has long-lasting effects on development . Childhood abuse is a risk factor for psychiatric disorders as it impacts the way individuals relate to others and the self . This is because the experience of abuse becomes internalized psychologically and physiologically in the form of brain function . Research on childhood trauma indicates that physical, sexual, and emotional abuse are associated with interpersonal hostility, low self-esteem, inadequate social functioning, and lower use of social coping strategies . From an object relations perspective, schizoid traits are the result of post-natal failures of loving relationships in which a strong sense of self was prevented from unfolding . Copious research has studied the relations trauma has with mental health and antisocial behaviors, such as substance abuse . Giaconia et al. found that as a result of affective, cognitive, and behavioral vulnerabilities trauma survivors are more likely to experience substance problems as well. This pathway was supported by the results of this study. This study also contributed an additional element, i.e., schizoid personality, into the conceptualization of the pathway between trauma and substance use. While schizoid traits in themselves are not pathological, having more of those traits in the context of trauma predicted substance problems. Hence, moving toward the higher end of the schizoid dimension poses a risk factor for problematic AOD use among youths who committed a crime, including trying to hide one’s use, using substances more frequently, and annoying others with their use. Psychoanalytic accounts of schizoid personality state that underneath the expressions of indifference and emotional coldness is a hunger for love and intimacy, a hyper-reflectiveness about the self, and a curiosity about others . This may help to conceptualize the relationship between schizoid traits and substance problems when thinking of AOD use as a way to numb the potentially distressing, unmet needs for interpersonal connectedness. Generally, results suggest that having experienced trauma in childhood is related to emotional detachment and psychological distress. This study was able to demonstrate that the effects of childhood trauma on personality can entail schizoid traits. Moreover, the alternative model demonstrated that when including personality in the model the direct effect between trauma and substance problems became non-significant, therefore providing empirical evidence for subsequent intrapsychic effects of trauma that led to maladjustment and not the occurrence of trauma per se. This corresponds to a resilience framework whereby maladjustment is not an irrevocable result but instead springs from the presence of additional risk factors that may have emerged from the original trauma. This work contributed to the resilience literature by examining the role of social support for different populations and personality types.

Object relations are interpersonal relationships that are part of a person’s most fundamental desire or libido because they strengthen the self . Objects can be thought of as actual persons that carry a maternal or caregiving role in a child’s life . Babies form a relationship to the world and subsequently to themselves by relating to an external object, i.e., the mother . In other words, relating to others is a behavior external to the individual that has an intrapsychic function. Object relations theory directs attention to disturbances in early parent-child interactions that negatively affect the child’s personality development and interpersonal functioning. Social relationships from a psychoanalytic account are far more than having someone to talk to; they are essential for developing self-regulatory mechanisms. Object relations are critical for developing an inner sense of self that can be distinguished from, yet that is related to, an outside reality . According to Winnicott children need to be reared in a “good enough” home with a mother or caretaker who adapts to the child’s needs and facilitates development. He notes that the mother’s preoccupation with the child’s needs is critical, so that the child experiences an omnipotent object that is strongly attuned to his needs until he is able to tolerate some frustrations without being traumatized by mother’s shortcomings . Recognizing the child’s needs and responding to the child’s internal processes by reflecting them back are essential caretaking roles that communicate emotional availability and interest . Adequate object relations in infancy are established by a variety of activities by the caretaker,cannabis grow table such as looking at the child, smiling, appropriate touching, and joining the child in his gaze or activity. Object relations theorists state that a child requires love, recognition, and attention from an object to develop a sense of self and reality of self.

If the caregiver fails to provide attunement to the child, he will experience this as a rejection regardless of the reasons for the lack of love . As a result the child internalizes the parent as a bad object who failed to meet his most basic needs. This leads to feelings of deprivation and inner emptiness . According to the British object relations school internal and external objects fulfill qualitatively different relationships; that is, the child who experienced frustrating external object relations is turning to internally generated fantasies of mergers and identification with the desired object . Hence, the libido for connection is turned inward toward objects of fantasy. It is this process that has great significance for the development of antisocial behaviors such as substance problems. Object relations theory adds to the biological model of addiction by claiming that impulses have to be met by a self-state. In the case of the schizoid personality type the self has become dissociated, so that drug addiction is a reflection of a dissociated self-state that once was yearning for love . Psychoanalytic self-psychology theorists have proposed that the parents’ or self-objects’ lack of mirroring and love can have long-lasting negative consequences for the development of the child, and it contributes to the development of schizoid personality disorder . The term self-object stems from Kohut’s self psychology theory that is related to object relations and emphasizes the “internal psychological experience of an object” . Mirroring is an important self-object function that serves to satisfy the child’s needs for recognition and praise . It helps the child develop a sense of reality of self that is worthy. Guntrip describes schizoid tendencies as a reaction to negative self-object relations.

Failures by the mother as the mirroring self-object put the child at risk for being traumatized due to experiencing a discontinuity of existence . Hence, from a psychoanalytic point of view the absence or inconsistency of parental adaptation to the child is a risk factor for the child’s self-fragmentation enhancing the vulnerability for maladaptive personality types. Fairbairn , one of the pioneers of the object relations school, studied schizoid personality intensely. He asserts that schizoid states stem from failed object relations that leave the child feeling unloved and rejected. The early rejection translates into a fear of closeness and true intimacy, and behaviors of withdrawal and chosen isolation . Individuals who experience schizoid states fear that their love will destroy the object because it is too consuming . They therefore prefer relying on internalized object relations and inner fantasies. They are able to role-play sociable interactions when necessary and can therefore easily be overlooked and underestimated in terms of their psychopathology and suffering. Similarly, self-psychology theory is helpful for understanding the emergence of personality and personality disturbances because it is concerned with “the self’s structural defects and shortcomings [in an interpersonal context]” . From that perspective a personality disorder results from insufficient self object responding to the child’s needs for “affirmation, merger, and idealization” . Affirmation is related to empathic attunement discussed earlier. Merger describes the experience of fusion of the self with a self object whereby the internal experience is temporarily fused with the external experience. Idealization, from Kohut’s perspective, refers to the three main areas of self, which are the “two polar areas” of the grandiose self, the “idealized parent imago” , and the “executive functions [that are] talents and skills” . The grandiose self is related to feelings of omnipotence and perfection, which can lead to narcissistic disturbances if they are not mirrored by the mother.

For example, a child who stands up for the first time needs to see pride in his mother’s eyes, a smile, and encouragement in order to satisfy an experience of self and of his potential. The child also maintains a feeling of omnipotence by projecting it onto his caregivers, which is called the “idealized parental imago” . The child’s idealizing expectations of the parent will unavoidably be frustrated, which will transform the child’s internalization to accept strengths and weaknesses in himself and others. For example, mother may not look at him every time he takes a new step or makes a discovery. Experiencing such frustrations within an overall caring, consistent care giving relationship helps the child de-intensify his grandiose self to enable more mature self object relations . Finally, the child needs the executive functions to achieve the ambitions represented by the grandiose self and the idealized parent. Ultimately,hydroponic cannabis system this will lead to productivity and meaning creation. Fair bairn notes that schizoid characteristics are an outcome of unsatisfying emotional bonds with parents and particularly with mother . This includes possessive and indifferent mothers who leave their children emotionally deprived, which causes regression to more primitive states for basic love need satisfaction. This more basic state may lead to depersonalization and “de-emotionalization” of object relations. As a result children may develop low distress tolerance and dependence in adult life. The traumatic experience that underlies schizoid characteristics stems from an emotional frustration because the mother does not love the child for himself and because she does not accept and value his love for her . This coins the child’s interpersonal style to adopt a distanced stance toward others since they are unable to fulfill his love needs. Intrapsychically, the child shifts object relations inside of himself where he relates to internalized others by incorporating or taking as opposed to giving and sharing. According to Fair bairn individuals with schizoid traits fear to give themselves emotionally to others because it feels to them like losing parts of their personality. They do not receive the same intrinsically motivating emotions from giving, such as creating values and self-respect . Another resulting feature from the relational trauma is the experience of inferiority due to not feeling loved in their own right . This sense of low self-worth may lead to a fixation on mother and narcissism as a defense against it . The schizoid character, albeit rare in the general population, appears to be relevant for the offender population. That is because it relates to antisocial behaviors in several ways: First, it is known that the prison population has elevated rates of trauma and dysfunctional family relationships that may foster schizoid traits; second, the process of identification with a bad object, i.e., the perpetrator of abuse, can lead to criminal behavior. Because the libido relates to parental objects, forms of abuse create inner conflict that can leave the child feeling ashamed.

By means of identification with a parent who abuses, the child develops a sense of badness . For Fair bairn whether a child becomes delinquent or not depends on several factors; the extent of internalization of the bad object in the unconscious, the degree of dysfunction of the object, the extent of identification with the bad object, and the ego defenses available to protect against acting out the bad object. Fair bairn makes an interesting and important point that a child may be motivated to engage in antisocial behaviors in order to release the repressed badness, and to protect the ideal image of his parents that appear good opposite to his badness. As a result, some of the character traits of schizoid personality may be considered defenses against a repressed, internalized bad object. In sum, parenting is critical in the child’s personality development because by serving as self objects parents help the child develop the affective and self-affirming structures it relies on for development and later functioning. Mirroring and idealization serve the narcissistic development and experience of omnipotence, which precede self-esteem and adaptation . When considering the experience of abuse by the hands of the caregiver or self object, it becomes apparent how devastating relational trauma can be for a child’s development. Surprisingly, differences in personality factors are rarely addressed in treatment allocation and intervention. This is astonishing provided that personality characteristics have significant influence on interpersonal and intrapersonal functioning that are central for recovery and rehabilitation. It is helpful to think of personality in dimensions to represent developmental levels and typologies . The dimensions can have substantial overlap, and people tend to oscillate along the dimensions because their functioning is impacted by stressors.The typology dimension captures the specific kind of defenses used, and helps classify them along the developmental dimension. For example, personality types using denial would be classified at the lower end of maturity and at the higher, more severe end of the typology. It is important to note that this study refers to personality types rather than personality disorders as listed in the DSM-IV-TR because it takes the participants’ developmental stage into consideration. Adolescence is a developmental phase in which personality is still emerging and traits are flexible. It is important to note that personality is conceptualized as a fluid construct consisting of propensities that undergo developmental changes and that are directly affected by stressors in the environment, such as poverty and poor family relations . Therefore, it is helpful to think of personality type as propensity or tendency, rather than a permanent set of thought and feeling patterns. Personality disturbances comprise of patterns of cognition, affect, impulse control, and interpersonal relationships. Individuals who suffer from personality disorders have inner experiences and perceptions that are often not mirrored by the outside world and do not meet society’s expectations and norms . Personality disturbances can therefore result in high levels of distress for the individual. Personality disorders like many other disorders occur on a spectrum of high and low intensities that include overlaps with other, related disorders. For example, schizoid personality shares symptoms of a lack of interest in personal relationships and emotional detachment with autism spectrum disorders. Furthermore, it is critical to diagnostically differentiate schizoid symptoms from contextual factors that affect an individual’s emotional style and behaviors. Growing up in disadvantaged neighborhoods and experiencing ethnic discrimination can cause individuals to display detachment and emotional indifference as a form of self-protection that should not be classified as a personality disturbance. Many individuals with schizoid personalities are highly functioning, hold jobs, and lead productive lives . A schizoid personality style describes individuals who tend to be introverted and solitary . Individuals high on this trait tend to be shy, avoid competitive relationships, and are described as eccentric . Individuals with schizoid traits display autistic thinking that entails daydreaming without a loss of a sense of reality . When confronted with an unpleasant stimulus, such as a disagreement, individuals with schizoid traits rather withdraw than express hostility .

ABAG-MTC provides support for achieving PDA visions through the PDA Planning Grant and Technical Assistance Program, Place making Initiative, One Bay Area Grant , East Bay Corridors Initiative, Resilience Program, and Entitlement Efficiency working group. PCAs are open spaces identified as lands in need of protection from urban development and other uses. Such spaces provide agricultural, natural resource, scenic, recreational, and/or ecological values and ecosystem functions. PCA identified lands are eligible for funding through the OBAG program. The PPA program would create a third land use designation in Plan Bay Area. Planning for non office businesses is often left out of the PDA framework. ABAG-MTC’s staff describes PDAs as places that bring housing, transit and economic services together. Thus, PDAs often are not specifically job oriented. Even when jobs are included in PDAs, the mixed-use environment and implied level of density is not compatible with most industrial jobs. The PPA program would provide an opportunity for regional planning to consider land use needs of a broader range of employment types and for cities to receive regional support for areas of importance to employment that do not have the housing and transit location characteristics of PDAs. The PPA program would also build off of the partnerships and knowledge pool that the Bay Area Urban Manufacturing Initiative has developed over the past three years.Through this ongoing effort, BAUM has developed tool kits to provide city staff, policy makers, and partner organizations with strategies to support manufacturing. While this effort is focused on manufacturing,planting table the PPA program provides an opportunity to continue and expand regional coordination around a broader set of industrial land uses. This report summarizes findings from an initial PPA program development phase that initiated outreach and engagement with local jurisdictions.

Interviews with eleven cities and four economic development experts in the region and secondary data analysis provided insight into how a PPA might work in different cities, the degree to which a PPA could benefit different jurisdictions, potential criteria cities could use to designate PPAs, and how transportation challenges around industrial land could be addressed through the PPA program. The findings discovered during this process will serve as a launching point for ABAG-MTC as they begin to shape the PPA program. Conversations with local jurisdictions revealed that city staff are interested in a PPA program that could address a number of challenges that cities experience with industrial land, including market pressures and competition with other uses, limited space, mixed-use districts, outdated zoning codes and policies, outdated infrastructure, environmental concerns, talent attraction, internal city government resources and structure, political barriers, and a lack of constituency. Staff expressed that the PPA program would be useful in addressing these challenges by elevating the profile of industrial land through a regional framework, focusing on employment issues, providing funding, and establishing a toolbox of regional best practices. Transportation challenges to, from and within industrial sites for both goods and people were identified as a primary concern across jurisdictions. Given ABAG-MTC’s role in transportation planning and financing, creating a transportation plan could be a key element of the PPA program. The following sections will discuss each of these issues identified by city staff in more detail and how they could shape the ultimate form of the PPA program. It is no secret that space in the core Bay Area is limited for all uses, and the housing crisis is rightfully receiving the spotlight. The ABAG Executive Board action on the PPA program acknowledges the need for both housing and industrial uses and the importance of a program that will not divert resources from addressing the under supply of housing.

The PPA program will seek to complement the existing development strategies for housing and office jobs in an effort to retain industrial spaces that provide operating space and support services for driving sectors or important local clusters in the Bay Area. The Industrial Land and Jobs Study for the San Francisco Bay Area , conducted by Professor Karen Chapple at the Center for Community Innovation , inventoried the region’s industrial land and examined its capacity for future growth, occupancy, and expected demand. Study analysis reveals that, although the supply of industrial land exceeds projected demand at a regional scale, there is a mismatch between available land supply and expected growth in demand in the urban core, where industrial lands are at risk of pressure to convert to other uses. Chapple defines industrial land uses to include production, distribution, and repair businesses – a definition adopted from San Francisco’s PDR industrial land preservation program. PDR uses go beyond what one may typically envision as industrial and the classic assumption that industrial means manufacturing. Chapple predicts the following industries, in rank order, as those that will contribute an additional 1,000 new jobs or more by 2040: Merchant Wholesalers of Durable Goods and Non-durable Goods , Repair and Maintenance , Transit and Ground Passenger Transportation , Waste Management and Remediation , Machinery Manufacturing , Truck Transportation , Support Activities for Transportation , and Warehousing and Storage . Furthermore, the types of businesses that constitute each of the PDR categories often varies by city and is somewhat in flux given evolving industries, especially tech and R&D uses that could be considered office or industrial. Chapple finds that industrial lands contain a high share, relative to the region, of jobs that provide middle-wage opportunities for workers without a college degree. Overall, middle-wage jobs were found to be sixty percent more concentrated on industrial land as in the region. Furthermore, in 2011, middle-wage jobs accounted for almost half of jobs on exclusive industrial land, while low-wages jobs accounted for 28%, and high-wage jobs for 28%; the study predicts that this distribution of employment is expected to remain similar through 2040 . This finding suggests that a loss of industrial land in the urban core could push out these middle-wage jobs in the PDR sector, exacerbating sprawl and equity issues.

Industrial land has been converted in areas where the market values non-industrial uses over industrial uses and the city has permissive zoning codes. When land is in short supply, PDR businesses react in a variety of ways: some businesses will leave; others will increase productivity to compensate for increased land prices; and others may adapt their land consumption altogether, transforming their business model to relocate to high density sites downtown while outsourcing or moving their production facilities . However, while land availability will not drive industrial job growth single handedly, preserving space for industrial uses is key to maintaining the PDR sector’s role in the region . Once industrial land is converted to another use, it is highly unlikely that it will ever be converted back to industrial. Although the PDR sector may not stimulate regional job growth on its own, providing space for industrial uses is key to stabilizing the PDR sector that plays a critical role in two driving sectors in the Bay Area: high-tech and consumption needs for the creative workers. The interrelationships between these sectors enables agglomeration economies that support the regional economy and often provide value to city governments in the form of revenues. Additional clusters are supported through the PDR sector,cannabis indoor grow system such as the agricultural and food sector, as well as logistics. Industrial land preservation is expected to have several advantages . In 1986, Heikkila and Hutton suggested that an industrial land preservation policy offers the advantages of keeping rents low for businesses and providing certainty to developers about city intentions, particularly when the industrial district is economically viable, there is a high level of structural employment, and the industry generates negative externalities. Furthermore, Howland finds that industrial districts support the regional economy as job generators, providers of supplies and services, including back-office functions or automobile repair for businesses and households, and low-cost space. Chapple establishes a causal link between industrial land designation and job creation or retention that further supports the importance of industrial land preservation. Her analysis reveals that firm size plays the most important role in business dynamics, and the availability of industrial zones and large buildings also support firm expansion. Thus, retaining a reserve of flexible industrial zones that can accommodate a range of industrial businesses is critical to sustaining industrial agglomeration economies. Policy makers use industrial land’s role in regional agglomeration economies to justify public intervention in the market based on industrial land’s roles in regional agglomeration economies. However, there are also costs, or potential inefficiencies, of industrial land preservation.

Heikkila and Hutton suggest that preserving industrial land has a number of potential costs, including inefficient use of resources, inhibition of industrial transition, and impacts on the local tax base. Opponents also contend that the costs of the city subsidizing the land outweigh the benefits of the policy and dispute the regional growth claim by arguing that this policy slows relocation of industrial businesses to perhaps more economically efficient areas . Furthermore, zoning for industrial land has been accused of interfering with the market that may on its own generate more economically and socially optimal outcomes. However, zoning also is a means of correcting market failures, such as negative externalities generated by industrial uses. The fact that zoning and land use controls operate under local control calls for conversations with local jurisdictions to better understand industrial land across the region. A number of cities across the U.S. are often cited for their industrial land preservation policies or strategies. Chapple’s study highlights three cities that have established programs to preserve their industrial spaces through local land use controls: Chicago’s Planned Manufacturing Districts and Industrial Corridors, New York’s Industrial Business Zones , and San Francisco’s Production, Distribution, and Repair zones . In addition, Portland, Philadelphia, Boston and Vancouver, BC also have notable industrial land preservation regulations. The Puget Sound Regional Council provide tax incentives, assistance with workforce development, services for business retention and attraction, and assistance with site selection for businesses looking to expand or relocate . Regions that have taken a regional approach to industrial land use planning, namely Los Angeles and Seattle, are more relevant to the concept of the PPA program. The City of Los Angeles’ Industrial Development Policy Initiative frames its industrial land strategy withina regional and global context, recognizing that private and public policy forces at all scales influence industrial businesses and development. One of the primary categories within the city’s initial industrial land policy framework was “regional cooperation for economic development.” The Puget Regional Council , the MPO for the Puget Sound region, created a regional industrial designation in 2003, Manufacturing/Industrial Centers . Given PSRC’s role as a Metropolitan Planning Organization the recent legalization of cannabis in California. Additionally, in the current market, city officials suggested that developers prefer to outprice industrial users and turn industrial land into R&D office space, versus trying to intensify a higher-value site that is designated for office uses.Addressing the need for employment lands in the context of the current housing crisis is often not so easy in practice. For instance, San Jose city officials stated that they believe current real estate values for industrial spaces in their city include a premium within the cost of land, with the underlying assumption that at some point the city will allow residential on the industrial sites. Staff at the City of San Jose highlighted the challenges they face in preserving industrial land in this market, stating that “We’ve been consistent on holding the line on preserving industrial. But at the same time, we don’t really have anything that has enough teeth to […] put our foot down and really make it 100 percent clear to the market that these areas are going to stay for production.” They have found this to be particularly true in industrial areas near residential, as developers could eventually generate significant profit on housing at some point. The housing crisis in the Bay Area is a regional issue, yet the pressures are felt most strongly in the inner core areas. A conversation with the East Bay Economic Development Alliance emphasized that the political climate around housing will pose challenges in the inner core for the implementation of the PPA program: “[The PDR sector] is not going to succeed just because you set up some rules. It’s going to succeed if you have housing, if you have proper training for the workforce, all of those things.

Outcomes of such practices and variations between trauma registries leads to a lack of confidence regarding data accuracy and resulting analyses. Motor impairment and/or execution of complex behavioral sequences often accompany psychotic symptoms, as in the case of obsessive-compulsive disorders. Such an occurrence likely reflects the anatomical overlapping of brain areas serving both motor and cognitive functions.Cannabimimetic drugs represent an interesting tool to investigate psychomotor behaviors, because of their documented ability to influence both motor and cognitive performances . Indeed, cannabinoid administration is accompanied by profound effects on motor behaviors, as well as by attenuation of d-amphetamine-induced hyperactivity and stereotypy. In addition, cannabinoid substances produce a large spectrum of psychotropic effects in humans, ranging from euphoria, short-term memory impairment, altered perception of space and time, and dream states. Similarities between certain cognitive impairments occurring in psychoses and the pharmacological effects of D 9 -tetrahydrocannabinol, the active principle in marijuana and hashish, have also been documented. The discovery of the brain cannabinoid receptor, CB1, and the mapping of its neuroanatomical distribution, have greatly improved our understanding of the effects of cannabimimetic drugs on psychomotor functions. CB1 receptors are most concentrated in areas of the central nervous system that are critical for the regulation and processing of motor functions, cognition,stacking pots and motivation. In keeping with this distribution, disruption of the CB1 receptor gene has been shown to severely impair movement control and to result in a functional reorganization of the basal ganglia.

The pharmacological properties of cannabis-derived drugs have prompted clinical evaluations of marijuana use in motor disturbances, such as spasticity, tremor, and dystonias . At the same time, the discovery of naturally occurring ligands of cannabinoid receptors, and the identification of their pathways of biosynthesis and inactivation, have opened a new research field aimed at investigating the physiological role of these molecules in health and disease, as well as their possible use as a new target for therapeutic interventions. The purpose of this mini-review is to draw together these studies, pointing out to the potential involvement of the endogenous cannabinoid system in psychomotor disorders.The cloning of the CB1 cannabinoid receptor and the mapping of its distribution in the brain has impelled the search for the corresponding naturally occurring ligands within the brain. Two endogenous cannabimimetic substances have been identified so far, arachidonylethanolamide and 2-arachidonylglycerol. Unlike neurotransmitters that are released from synaptic terminals via vesicle secretion, both anandamide and 2-AG are thought to be produced upon demand through stimulus-dependent cleavage of two distinct phospholipid precursors present in neuronal membranes . Anandamide, but not 2-AG, is released extracellularly by neural activity evoked by localized pulses of high K1, and it is thought to act near its sites of production as a local neuromodulator. Whether 2-AG is produced in vivo under physiological circumstances and/or it exits neurons in other regions of the CNS, has not been determined yet. The biological actions of anandamide are terminated by two subsequent reactions consisting of high-affinity transport into cell, followed by hydrolysis catalyzed by an amidohydrolase enzyme. 2-AG is thought to be inactivated by cleavage into glyceroland arachidonic acid. The enzyme activity involved in this reaction has not been clearly identified, though anandamide amidohydrolase and monoacylglycerol lipase have been suggested to play a role. Other saturated and monounsaturated fatty acylethanolamides are produced by activated neurons together with anandamide.

Although these lipids share a common biosynthetic mechanism with anandamide, they do not bind to cannabinoid receptors and they are not released extracellularly in vivo. The possible physiological roles of these compounds are still largely unexplored. One exception is represented by palmitylethanolamide which was shown to exert peripheral anti-inflammatory and antinociceptive effects, mediated through a putative CB2-like cannabinoid receptor .The basal ganglia are a forebrain region playing a key role in sensorimotor and motivational aspects of behavior. The high density of CB1 receptors in this area indicates that cannabinoid substances may modulate essential aspects of basal ganglia physiology. The existence of an endogenous cannabinergic tone in the basal ganglia has been suggested by the finding that the CB1 receptor antagonist SR141716 was able to produce increased locomotion in mice and stereotypies in rats. These findings have been recently confirmed by in vivo microdialysis studies, showing that membrane depolarization stimulates the outflow of anandamide from striatal neurons. Functional interactions between endogenous cannabinoids and distinct neurotransmitter systems modulating basal ganglia functions have been also postulated. Neuroanatomical studies have shown that CB1 receptors are mainly located in the terminals of GABA-ergic medium-spiny neurons projecting from the striatum to the globus pallidum and substantia nigra. Although direct evidence for an interaction between endogenous cannabinoids and GABA-ergic system is still lacking, it is known that exogenously administered cannabinoids can modulate GABA transmission, as suggested by their ability to inhibit GABA release from striatal and hippocampal nerve terminals and potentiate GABA-induced catalepsy. Coexpression of m -opioid and CB1 receptors in striatal cells indicates that opioids and endocannabinoids can also interact within the striatum. In keeping with this, chronic cannabinoid exposure regulates proenkephalin mRNA levels in the rat striatum. Finally, a role for the cannabinoid system as a modulator of dopaminergic activity in basal ganglia is emerging.

Activation of cannabinoid receptors was shown to cause significant reductions of the electrically evoked dopamine release from rat striatal slices, and to potentiate neuroleptic-induced catalepsy. Moreover, injection of cannabinoid receptor agonists into the basal ganglia counteracts the motor responses of locally administered D2-receptor agonists. Conversely, cannabinoid-mediated motor behaviors can be affected by dopamine manipulations. For example, chronic administration of dopamine D1 and D2 receptor agonists results in differential modulation of the locomotor effects of the cannabinoid agonist HU-210, suggesting a possible cross-talk between dopaminergic and cannabinergic systems within the striatum. In this regard, the observation that anandamiderelease can be induced by pharmacological activation of the D2 class of dopamine receptors in freely moving animals suggests that endogenous cannabinoids may represent a primary component of the network of neurochemicals modulating striatal function. Further support to this hypothesis is provided by behavioral studies showing that the hyperactivity associated with post-synaptic D2 receptor activation is markedly potentiated by the CB1 antagonist SR141716A. Taken together, these data suggest that pharmacological blockade of cannabinoid receptors enhances quinpirole-induced motor activation by removing the inhibitory control exerted by the endogenously released anandamide. Furthermore, the lack of effect of SR141716A when given alone at the same dose used to potentiate quinpirole-induced motor activation, indicate that anandamide can reach a sufficient concentration to induce its behavioral effects only after stimulation of D2 receptors. Thus, the released anandamide may offset dopamine D2-induced facilitation of psychomotor activity . Functional interactions between endogenous cannabinoids and dopaminergic system may have important therapeutic implications in pathologies that involve disregulated dopamine neurotransmission, such as Parkinson’s disease, Tourette syndrome,grow lights and schizophrenia. On a speculative basis, the blockade of anandamide inactivation and the consequent increase of endogenous levels of this lipid, may be beneficial in reducing hyperactivity and hyperkinesia associated with Huntington’s disease, a pathology where a massive loss of CB1 receptor binding has been reported in the basal ganglia of postmortem patients. However, the potential therapeutic use of cannabinoids for the treatment of psychomotor disorders is not only matter of speculation. It has been shown that blockade of CB1 receptors may potentiate or prolong the effects of dopamine-based therapies currently used in Parkinson’s disease and use of D 9 -THC for the treatment of Tourette syndrome has been reported. Increasing evidence suggests that schizophrenia may be associated with abnormalities in the function of the endogenous cannabinoid system. Clinical evidence indicates that cannabis consumption is significantly higher in schizophrenic patients than normal individuals and chronic use of high doses of cannabinergic substances may precipitate schizophrenic symptoms in vulnerable patients. Additional support for a role of cannabinoid signaling in schizophrenia comes from the observation that anandamide is markedly elevated in the cerebrospinal fluid of schizophrenic individuals. The non-cannabinoid acylethanolamide PEA is also increased in these patients. Although PEA is produced in the CNS through a biosynthetic mechanism similar to anandamide’s, this lipid is not released in vivo as a consequence of D2-receptor stimulation. Therefore, further investigations are needed to clarify the physiological role of PEA in the CNS as well as its possible link to schizophrenia. Drugs that block D2-like dopamine receptors have been extensively used to mitigate symptoms of psychoses and motor disorders.

Given the linkage between D2-receptor activation and anandamide release, it is likely that the high CSF levels of this lipid may reflect homeostatic adaptations of the endogenous cannabinoid system to disturbances in dopamine neurotransmission occurring in schizophrenia. Additional support for this possibility comes from the observation that chronic treatment with D2-family antagonists results in upregulated expression of CB1 receptor mRNA in striatum. On the other hand, alterations in cannabinoid signaling may directly contribute to the manifestation of subgroups of symptoms in schizophrenic syndromes. Further investigations in larger populations of patients and studies aimed at determining the neuronal origin of the AEs in CSF may help elucidate the possible participation of these lipids in the pathogenesis of schizophrenia.Successful viral suppression from combination antiretroviral therapy has led to an increase in life expectancy among persons living with HIV . While severe HIVassociated neurocognitive disorder is less prevalent in the cART era, mild to moderate HAND persists despite virologic suppression. HAND affects up to 50% of HIV-positive persons, with older HIV-positive adults at greater risk for neurocognitive impairment than their younger counterparts.Among neurocognitive domains affected by HAND, complex motor skills are consistently compromised across time. Complex motor skills refer to a combination of cognitive and perceptual-motor abilities, including perception, planning, continuous tracking, and sequential movements.Although the prevalence of complex motor impairment has receded in comparison to the pre-cART era, deficits in complex motor functioning are still observed in approximately 30% of those with HAND. Complex motor impairment is related to everyday functioning impairment, including driving ability, highlighting the clinical relevance in understanding mechanistic pathways underlying HIV-associated motor dysfunction. A recent longitudinal study found that complex motor function is particularly vulnerable to the effects of age and stage of HIV infection, and implicated the basal ganglia as a neural correlate of interest.The effects of acute HIV infection on the basal ganglia are well documented, with greater atrophy associated with psychomotor slowing.Inflammatory processes are one putative factor that may contribute to central nervous system injury, including deficits in complex motor skills. Biomarkers of inflammation, such as cytokines and monocytes, are elevated in the context of HIV infection. HIV, viral products, and activated immune cells are able to cross the blood brain barrier and contribute to inflammation in the CNS. Neuroimaging studies have shown that peripheral inflammatory biomarkers are able to alter neural activity in the basal ganglia, including dopaminergic activity, which is reflected by psychomotor slowing in HIV-negative adults. Among HIV-positivepersons, global neurocognitive impairment is associated with elevation of various peripheral biomarkers of inflammation and coagulation . Taken together, deficits in complex motor performance are commonly observed among HIV-positive persons, and elevation in peripheral biomarkers of inflammation may be a contributing factor. Thus, we hypothesize that HIV will have negative direct and indirect effects via inflammation on complex motor performance.Participants were 90 HIV-positive and 94 HIV-negative persons, with balanced recruiting in each age decade , from the five-year Multi-Dimensional Successful Aging among HIV-Infected Adults study conducted at the University of California, San Diego .Only baseline data were included in this analysis. The study received approval from the UCSD Institutional Review Board. Participants provided written, informed consent. Exclusion criteria for the parent study were diagnosis of a psychotic disorder and presence of a neurological condition known to impact cognitive functioning . Additional exclusion criteria for current analyses included being off ART, having detectable HIV viral load , and meeting criteria for a current substance use disorder. HIV infection was screened via a finger stick test and confirmed with an Abbott Real Time HIV-1 test or by submitting specimens to a Clinical Laboratory Improvement Amendments -certified laboratory for HIV-1 viral load quantitation. Although neurologic findings commonly associated with HIV infection have been suggested to largely remit with initiation of cART, our cross-sectional study observed worse complex motor skills across the adult age continuum of HIV-positive, relative to HIV-negative, adults. Inflammation burden was higher among HIV-positive adults, compared to the HIV negative comparison group.

Study methods employed by each of the eight included studies varied with some studies utilizing medical chart reviews, while others utilized validated surveys and questionnaires to gather their data. The studies by Andelic et al., Barker et al., and Bombardier et al. all utilized the participants’ medical charts for retrospective review for presence of substances. The studies by Andelic et al., Nguyen et al., and O’Phelan et al. used trauma registry databases to collect data on TBI patients and the presence of substance abuse. Pakula et al. collected data on the presence of substance abuse in post-mortem patients with traumatic cranial injuries by evaluating autopsy reports. Finally, the studies by Bombardier et al., Kolakowsky-Hayner et al., and Kreutzer, Witol and Marwitz utilized questionnaires to interview participants. The variance in study methods, ranging from retrospective review of charts to the use of self-report methodology subjects the included studies to recall bias and unreliable data. A factor negatively contributing to the quality of the included studies is the variance in defining a TBI. Three of the studies did not provide a definition for what constitutes a TBI, nor did they describe the severity of TBI. The study by Andelic et al. defined TBI using the TBI Modified Marshall Classification. The study by Barker et al. defined TBI using the TBI Model Systems Data Base definition. Nguyen et al. used the International Classification of Diseases-Ninth Revision codes and the Abbreviated Injury Severity codes to define TBI. These codes are widely used in trauma data registries for entering and recording the injury type and severity,garden racks wholesale for performance improvement and billing purposes. However, reliability can be an issue as coding may be subjective. The information is extracted from the chart by registrars who read and enter notes written by physicians.

Often, coding depends on physician documentation, attention by trauma registrars to the various sources of documentation and communicating with physicians when necessary. If not subject to continuous data validation, a data gap may ensue. The study by Pakula et al. defined a central nervous system injury by the presence of any of the following written diagnosis as found in the autopsy reports: 1) TBI, 2) skull base fracture, 3) spinal cord injury, and 4) cervical spine injury. Only one study, the study by O’Phelan utilized a Glasgow Coma Score to define a severe TBI. Risk of bias in terms of selection and information was determined for each study. The majority of the articles were subject to selection bias in terms of their participant population and methods of data collection: See table 2 for specifics. The included studies varied in their definition of TBI. One study used the Modified Marshall Classification of TBI which is a Computed Tomography scan derived metric used to grade acute TBI on the basis of CT findings. Another study defined TBI using the TBI Model Systems National Database definition. The TBIMS-NDB has been funded by the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education to study the course of recovery and outcomes following a TBI. They describe the TBIMS-NDB TBI as: Damage to brain tissue caused by an external mechanical force as evidence by medically documented loss of consciousness or post-traumatic amnesia , or by objective neurological findings on physical or mental examination that can be reasonably attributed to TBI. Three of the eight studies did not specify how TBI was defined. The procedures by which the presence of marijuana exposure was detected varied across the selected studies. In some of the studies, marijuana was detected via a positive urine drug screen or via blood alcohol levels. In addition to utilizing toxicology screening results to identify the presence of marijuana, the studies by Andelic et al., Kolakowsky-Hayner et al., and Kreutzer et al. also utilized the General Health and History Questionnaire to gather self-reported patient incidence or marijuana exposure. As described earlier, the GHHQ questionnaire aims at assessing the psychosocial, neuro behavioral and vocational status of patients with traumatic injuries. Although all eight studies investigated marijuana exposure in TBI patients, only one study specifically investigated the use of marijuana alone on outcomes in TBI.

All other remaining studies investigated the presence of all possible substances and/or drugs, meaning investigators were not specifically examining marijuana exposure by itself. In Nguyen et al. all patients who had sustained a TBI and had a urine toxicology screen were included. The actual noted presence of marijuana was obtained from the urine toxicology screen and not through any other modes of measurement. The authors classified study patients according to marijuana screen results which they defined as greater than 50 ng/ml. Though marijuana was noted to have been detected across all eight studies, the actual numerical or absolute value measured was never reported by any of the studies. Additionally, it is important to note that excluding the study by Nguyen et al., the presence of marijuana was not reported in a quantifiable manner, making any potential statistical inference impossible. Lastly, six of the included studies investigated the presence of marijuana at the time of injury, while the remaining two studies measured the presence of marijuana use during the past year and post-mortem respectively. The study by O’Phelan et al. did not investigate any other time frame for which marijuana may have been used, rather, the authors only collected data on the presence of drugs at the time of injury. An important finding from the systematic literature review showed that marijuana was the most favored drug reported. However, only one study of the eight studies included explicitly searched for and found a connection between the presence of a positive toxicology screen for marijuana and mortality outcomes in TBI patients. Nguyen et al. three-year retrospective review of trauma registry data found that 18.4 percent of all cases meeting inclusion criteria had a positive marijuana screen and overall mortality was 9.9 percent . Nguyen et al. found that mortality in the marijuana positive group was significantly lower when compared to the marijuana negative group . Authors adjusted for the following differences between study participants: age, gender, ethnicity, alcohol, abbreviated injury scores, injury severity scores, and mechanism of injury. After adjusting for differences, Nguyen et al. found that a positive marijuana screen was an independent predictor of survival in TBI patients .This review sought to determine the use of marijuana and its role in TBI prevalence and outcomes.

A key finding from this review is that there are few studies available that examine the specific role of marijuana exposure on TBI severity, leaving many questions unanswered. Furthermore, this review found that there is a significant variation in how substance abuse has been defined, conceptualized, and operationalized in TBI research. Another important finding was that the reviewed studies operationalized substance abuse inconsistently, often combining alcohol and drugs in one category titled ‘substance abuse,’ making it difficult to ascertain if there was an association between specific drugs, particularly marijuana,hydroponic racks and TBI severity and outcomes. The difference in how substance abuse was operationalized in these reviewed studies has important implications for how findings are interpreted as well as provide recommendations for future research. Although there was no restriction made to the countries in which these studies were conducted, those meeting inclusion criteria were all studies conducted in the US except one from Norway. Therefore, the applicability of findings from that one non American study is limited. Additionally, it is difficult to draw valid and reliable conclusions when the studies reviewed utilized a wide variety of study objectives, sample size, study methods, and varying definitions for substance abuse classification. The review showed a great variation existed across the studies in types of data collected and methods used, thus severely minimizing comparability. For example, the disparity in measurement of blood alcohol levels considerably reduce the reliability of data related to pre-injury intoxication. In the reviewed studies, information on alcohol and substance use was obtained from a range of different sources, including self-reports and patient records, as well as a variety of different measures rendering results unreliable across studies. This review set out to answer a specific question: what influence, if any, does marijuana exposure at time of injury have on TBI severity and outcomes? Only one study about marijuana’s effect on TBI outcomes was available. Nguyen et al. reported that a positive marijuana screen is an independent predictor of survival, suggesting a potential neuroprotective effect of cannabinoids in TBI. The rest of the studies yielded a variety of findings, with the most common finding being that marijuana and other drug use, including alcohol, are common before TBI. To clearly understand what marijuana’s influence on TBI is, potential confounding variables must be identified and controlled for.

The literature review identified no consensus on relevant confounding variables aside from age and gender. The variability in all other demographic variables highlights the lack of certainty of the full range of relevant demographic variables. Another potentially important confounding variable is mechanism of injury. Historically, the most frequent cause of TBI related deaths in civilians was considered motor vehicle crashes. However, recent data show that falls are actually the leading cause of TBI related hospitalizations, with the second leading cause is being struck by another object. Importantly, only six of the studies included mechanism of injury as a variable in their analysis of findings. Five of the eight included studies did not address TBI severity as a variable.Andelic et al. used the Marshall classification to classify neurological anatomical abnormalities as seen on CT scans. Nguyen et al. utilized the Abbreviated Injury Scale score for the head and neck region to classify TBI severity. The use of the AIS score is common in general research studies as often times the GCS score is not always recorded for each individual participant. Hence the only study showing a link between marijuana exposure and TBI severity did not use the gold standard of GCS to measure TBI specific severity. Finally, severity as a variable in the TBI population is an important characteristic and is a parameter of interest when answering the research question of whether or not marijuana influences TBI severity; available studies are not able to answer that question mostly because the majority of them did not measure severity in the first place. Severity is important because it provides a level of specificity about the injury which determines management of care. Additionally, TBI severity can yield valuable insight about proximal and distal outcomes. It seems reasonable that it would be an important measure to include when examining the relationship between TBI and all included variables. Additional tools, such as the AIS scores and imaging studies, may be necessary in accurately capturing TBI severity in study participants; these studies, in addition to GCS, should be considered an essential variable that must be accounted for. All of the studies measured presence of marijuana, yet the methods by which marijuana was measured varied. For example, urine was the most common way to measure marijuana concentration in patients in reviewed studies, but urine tests results are not specific to time of injury: The detectable level of marijuana can be present in urine for approximately 4.6 to 15.4 days after last use for infrequent and chronic users respectively. The presence of marijuana on a urine toxicology screen may not accurately reflect or correlate marijuana levels in an individual’s system at time of injury, rather, it reflects recent use. Therefore, when considered as a variable, a marijuana level should be considered as reflective of recent use at time of injury, not directly at time of injury. Finally, this review and other systemic reviews consistently identify blood alcohol concentration as an important potential confounder in TBI studies. All reviewed studies except included alcohol as one of the examined substances. Much has been studied about the relationship between alcohol and TBI. As a prominent pre-disposing factor in TBI, the implications alcohol intoxication has on TBI is important and must be accounted for when examining the effects of marijuana on TBI. The current systematic literature review has several limitations, the first of which was the inability to perform a meta-analysis with the studies acquired. There was heterogeneity across the studies addressing marijuana exposure and TBI; from different criteria used to classify TBI, to diverse populations of interest, to varied outcomes of measures, the studies varied widely preventing a meta-analysis of the 8 included studies.

There is a need to understand the nature of social support that is associated with an increased risk of arrest in order to interrupt this cycle, either by encouraging social networks with positive outcomes or by disrupting cycles of arrests. In this study, Black race was not associated with incarceration, although it is well established that Black Americans are disproportionately incarcerated due to structural racism.Black Americans are significantly more likely to become homeless due to structural racism so there may be lower rates of individual risk factors for incarceration .Thus, non-Black participants may have individual risk factors that elevated their risk of incarceration in a way that we did not account for.As continued homelessness is associated with incarceration, it is possible that rehousing older adults experiencing homelessness could reduce this risk. A recent randomized controlled trial of permanent supportive housing for chronically homeless adults did not find a reduction in jail use. This may have been explained by police having an increased ability to serve outstanding warrants to people upon rehousing.Given the high rates of substance use, expansion of substance use treatment programs might reduce older homeless adults’risk of incarceration. Among all variables that we tested,grow rack parole and probation had the highest hazard ratio. Recidivism may be driven by technical violations of probation or parole rather than new criminal offenses. There are movements to reform probation and parole because they may perpetuate incarceration.

Reform efforts include shortening supervision sentences, reducing conditions and cost, limiting incarceration for violations, and providing specialty community supervision programs which use probation officers with health-focused expertise who incorporate a treatment-oriented approach in collaboration with community resources.Future areas for research include whether reducing or tailoring supervision programs to the needs and risk factors of older homeless adults decreases recidivism. Another innovation is specialty courts , which emphasize connection to treatment, though there is mixed data on their impact on incarceration and recidivism.Subjects for these analyses were 397 men who completed baseline evaluations and all follow-ups from approximate ages 20 to 50 in the San Diego Prospective Study . These men represent 90.0% of 442 individuals who entered the study, were alive at the age 50 follow-up, and participated in all evaluations at 10 , 15 , 20 , 25 , and 30 years. At T1, these subjects responded to mailed questionnaires distributed annually between 1978 and 1988 to new groups of 18-to- 25-year-old Caucasian students and nonacademic staff at the University of California, San Diego, selecting those who indicated they had experience with alcohol but never developed an AUD or SUD. For the approximately 60% who responded, additional exclusion criteria included bipolar disorder, schizophrenia, or the report of physical problems that precluded alcohol challenges. The original protocol was limited to males to optimize the rate of expression of AUDs over time, and to Caucasians because few African-Americans attended UCSD and 40% of Asians had alcohol-related flushing that could affect their LR measures. The requirement that probands did not have an SUD or AUD excluded individuals with early onset substance-related disorders that often reflflect preexisting severe conduct or antisocial problems . Individuals were selected as matched pairs of sons of alcohol-dependent fathers and FH-negative controls who were similar on demography as well as alcohol and drug use histories. By T1, 64% of these probands had some experience with illicit substances.

Baseline data were gathered using a variation of the Renard Diagnostic Interview, and at follow-up using questions from the Semi-Structured Assessment for the Genetics of Alcoholism interview . The latter has 1-week retest reliabilities for SUDs and AUDs of approximately 0.75 . Follow-up information was gathered from subjects and resource persons who gave information using an interview similar to the probands, with the higher figure for an item from either informant used if the 2 sources disagreed. Follow-up data included the prior 5- year interval use of alcohol, illicit drugs, and cigarettes, as well as personal and FHs of DSM-IV substance-related and independent major depressive and anxiety disorders . The Family History Assessment Module was used to gather information regarding lifetime AUDs and SUDs in the proband’s biological parents . As described in detail elsewhere, baseline LRs for probands were determined through alcohol-related changes in subjective feelings of intoxication, standing steadiness, and hormones at breath alcohol concentrations of approximately 60 mg/dl, as measured by an Intoximeter . Across multiple sessions, all subjects consumed 0.75 ml of alcohol or placebo and were evaluated over 3 hours as their blood alcohol concentrations rose, peaked and decreased to close to zero. Z-scores were used to combine data into 1 overall LR score where lower values reflected lower LRs per drink. At T15, probands completed the Self-Report of the Effects of Alcohol questionnaire regarding the number of drinks required for effects during 3 life epochs . SRE5 and total scores incorporating all 3 epochs were generated by summing the number of drinks required for up to 4 effects , and dividing that by the number of the effects reported . Thus, higher SRE scores indicate more drinks needed for effects, or a lower LR per drink. The SRE Cronbach’s a is >0.90, with retest reliabilities of 0.8. Externalizing characteristics were first evaluated at T10 and T15 using the novelty seeking from the Tridimensional Personality Questionnaire, Sensation Seeking from the Zuckerman Questionnaire, and Impulsivity from the Karolinska Personality Questionnaire.

To evaluate the hypotheses, emphasis was placed on LR, externalizing characteristics and internalizing items along with the demographic and alcohol/drug variables likely to predict future alcohol and substance difficulties. Most analyses focused on 4 proband groups regarding substance-related diagnoses over the 30 years: men who developed both SUDs and AUDs over the follow-up ; those with follow-up SUDs only ; subjects who developed AUDs only ; and individuals developing neither diagnosis during the 3 decades . Comparisons regarding Hypotheses 2 to 4 used analysis of variance or chi-square across all 4 groups, with an emphasis on LR, externalizing, and internalizing characteristics along with demographic and earlier alcohol and drug use items. Significant differences were followed with a planned comparison to evaluate if the groups with AUD and/or SUD diagnoses differed from Group 4 with no diagnosis to identify relevant items to test regarding association with Groups 1, 2, and 3 separately. Those significant items were then entered into a series of backward elimination logistic regressions to evaluate if LR, externalizing, and/or internalizing items were still significantly related to each of the 3 groups with diagnoses when considered in the context of other significant items. Comparisons regarding Hypothesis 5 were limited to Groups 1 to 3 who had relevant diagnoses, where an overall significant difference across groups was followed by planned comparisons of how Groups 2 and 3 differed from the combined diagnosis Group 1. For all evaluations, missing data were handled through a maximum likelihood procedure , including 6.8% who needed correction for 1 item and 0.8% for 2 items.As demonstrated by the distribution of the 4 groups in Table 1, over the 30 years, 41.3% of the 397 men met criteria for an AUD,microgreens shelving while 20.6% fulfilled criteria for an SUD. The SUDs included 51.2% of the 397 men with a cannabis use disorder only, 25.6% with an amphetamine and/or cocaine diagnosis only, 14.6% with combined cannabis and stimulant diagnoses, and 8.5% with an SUD related to cannabis or stimulants combined with other drug conditions. Consistent with Hypothesis 1 , in this prospective study of men at high risk of AUDs, the rate of a second substance-related diagnosis was almost 2-fold higher among individuals who had either SUDs or AUDs. Thus, 62 of the 164 probands with an AUD in Groups 1 plus 3 also had an SUD, and 62 of the 82 men with an SUD in Groups 1 plus 2 also had an AUD. The 4 groups of subjects in Table 1 differed on a broad range of early life characteristics. The results indicated significant differences for earlier life LR and externalizing characteristics, but not for having seen a mental health worker or reporting depressive syndromes . There were also differences for several demographic, alcohol, and drug use items. All significant alcohol, drug, and externalizing items in that table also differentiated between the combined Groups 1 through 3 versus the no diagnosis Group 4. In Table 2, further analyses were then carried out to more directly evaluate how items from Table 1 that were significantly different across the combined Groups 1 to 3 versus Group 4 performed when each of Groups 1, 2, and 3 was evaluated for differences from Group 4.

This approach used a series of backward elimination logistic regressions to identify the odds ratios for optimal combinations of items for each group that best differentiated it from the no diagnosis Group 4. In Table 2, the regression predicting Group 3 from among Group 3 plus the no diagnosis Group 4 identified 6 items including: a lower LR per drink; a higher score on an externalizing questionnaire; 2 alcohol use characteristics; 1 drug use item; and lower T1 education. Five of these 6 items also related to the combined diagnosis Group 1 compared with Group 4, with the sixth characteristic similar to Group 3 in that it involved an externalizing questionnaire score. The regression relating to Group 2 from among Groups 2 plus 4 had contributions from 3 items: a higher score on an externalizing questionnaire, 1 alcohol, and 1 drug item . All 3types of items also related to Group 1 membership, but with a different externalizing questionnaire score. Thus, 5 of the 8 items that contributed to the regression for Group 1 versus Group 4, also related to Group 2 and/or Group 3, with 1 of the additional items relating to an externalizing score from a different questionnaire. Similar results for these 3 regressions were seen if hierarchical logistic regressions were used focusing on blocks of demographic items, alcohol, and drug use items, and then LR and externalizing items, with the exception that the equation relating to the block of externalizing characteristics and LR regarding the small Group 2 was a trend . In summary regarding Hypotheses 2 to 4 , externalizing characteristics related to all 3 diagnostic groups, while LR related only to groups with later AUDs. Overall, the characteristics that related to AUDs alone combined with those that best identified subjects with SUDs alone were associated with the combined diagnoses in Group 1, with few predictors that were uniquely related to Group 1. Table 3 addresses Hypothesis 5 . Here, planned comparisons were used because some items were only relevant to groups with AUDs and some were only appropriate for probands with SUDs. Beginning with demography, the only overall significant difference across the 3 groups at age 50 was the higher proportion of individuals in Group 3 who had ever been married, a finding that reflected higher proportions in Group 3 versus the comorbid diagnosis Group 1. The course of alcohol-related items for the 2 AUD groups indicated that members of the combined diagnosis Group 1 endorsed more AUD items, an earlier AUD onset, a higher risk of alcohol-induced mood disorders, and a greater proportion who received formal AUD treatment or who attended Alcoholics Anonymous meetings compared with Group 3. The drug-related items for the 2 SUD groups indicated that members of Group 1 were more likely to use tobacco and reported a higher number of SUD items. Mental health histories over the 30 years were generally similar across the 3 groups, except for a greater probability of having seen a mental health worker for the combined diagnosis Group 1 compared with the AUD diagnostic Group 3. The demographic and alcohol-related characteristics in Table 3 that differentiated between the AUD Groups 1 and 3 were likely to be correlated, so these 6 items were entered into a backward elimination logistic regression analysis to determine which variables remained significantly related to a combined AUD plus SUD outcome among individuals in Groups 1 plus 3. The results demonstrated significant ORs for Group 1 membership for the number of AUD items endorsed , an alcohol induced mood diagnosis , and having received formal AUD treatment . The 2 drug-related items and the SRET score that differentiated between Group 1 and Group 2 in Table 3 were entered into a logistic regression predicting Group 1 membership from among Groups 1 plus 2, with only the SRET contributing significantly .

The overall case-control effect size that we observed, 0.62, was somewhat lower than that reported in meta-analyses . Since the patient sample was older than the control sample and age significantly affected P300, the patient control difference was attenuated somewhat by inclusion of age as a covariate. The effect size was almost certainly also lowered by our conservative data strategy, which likely excluded a number of subjects – primarily patients – with negligible but real P300 responses. This moderately large effect is, nevertheless, well within the expected distribution of published studies. Although we observed a significant difference across test sites, this did not reflect differences in data quality, methodology, or experimental rigor. Rather it reflected differences in the stratification of the samples across sites, as this relates to clinical and socio-demographic confounds or modifiers. In patients, site differences were entirely explained by differences in the level of positive symptomatology. Although the P300 deficit is traditionally thought of as being immune to changes in patients’ clinical status , it should probably be considered as more of a relatively stable deficit. It clearly does not normalize with treatment, even when symptoms dramatically improve. However, it still exhibits modulation over time in association with positive symptoms . Indeed, it is this ability to reflect increasing positive symptomatology that underlies the emerging utility of P300 as a predictive biomarker for imminent prodromal conversion to psychosis . Except for MMSE and UPSA-B,growing indoor cannabis global indices of cognitive ability and real-world functional capacity, no other clinical measures were associated with P300, indicating that the association with positive symptoms is relatively specific.

Since these patients were all clinically stable outpatients on stable medication regiments, differences in positive symptomatology presumably reflected relatively stable trait-like differences on this dimension of illness severity. P300 may therefore be an endophenotype that is especially informative regarding the genetic basis of positive symptoms. The associations with MMSE and UPSA-B highlight the utility of the P300 as a sensitive physiological index of differences in brain function, even within a relatively homogeneous clinical sample. The magnitude of the P300 response has long been considered a broad indicator of “cognitive fitness” and, more specifically, of the ability to appropriately process and respond to task-salient environmental inputs — i.e., to correctly detect a signal within noise. It is thought to require intact attentional and working memory capacities , and to reflect complex neural processes of temporal and spatial integration across multiple brain regions . It is not surprising, therefore, that the P300 would correlate with other measures of cognitive and functional capacity. A similar association between P300 amplitude and MMSE has been reported previously in chronic Alzheimer’s disease patients and, acutely, in uremic patients undergoing dialysis , where the two measures showed a correlated improvement, as well, following treatment. There have been no prior studies reporting a relationship between P300 and specific measures of functional capacity, including UPSA-B, either in schizophrenia patients or other clinical samples. However, this association is entirely consistent with the relationship between P300 and cognition. Prior studies examining the relationship between neurocognitive and functional deficits have routinely found that cognitive ability, specifically working memory, is the strongest predictor of schizophrenia patients’ real-world functional capacity . Indeed, in our own data, we observed a similar robust correlation between MMSE and UPSA-B. These associations support the utility of P300 amplitude as a potential biomarker for predictive risk and treatment studies.

However, they also emphasize the relatively non-specific nature of the measure. This was evident, as well, in the control sample data. In these otherwise healthy subjects, P300 amplitude was affected by smoking, race and, as one mediator of the race effect, prior history of substance abuse or dependence. Previous studies have shown that nicotine reduces P300 , yet – despite the well-known propensity of schizophrenia patients to smoke – there has been virtually no consideration of the effect of smoking on the auditory P300 in patients. We observed no parallel effect of nicotine in patients, presumably because their ERPs were already suppressed. This is consistent with a recent small study of healthy subjects administered with intravenous ketamine. Ketamine induced schizophrenia-like symptoms and attenuated the auditory target P300 response, but this was unaffected by co-administration of nicotine vs. placebo . Similarly, reduced P300 has been associated with the use of stimulants , opioids and cannabis . Yet, again, we saw no effect of prior substance use on P300 in the schizophrenia patients. This mirrors what was recently reported in a study examining the effects of cannabis in prodromal subjects considered to be at ultra-high risk for developing psychosis. In this sample, those with a history of cannabis use were indistinguishable from those without. However, among the otherwise-healthy controls, those who used cannabis had reduced P300 responses that were indistinguishable from those of the prodromal sample . The impact of substance abuse on the African-American sample may reflect differences in the specific character and/or quantity of substance use within the different racial groupings, which are not captured by a simple dichotomous categorization. Similarly, the residual effects of race, independent of past substance use, could reflect the impact of other psychosocial stressors in the different racial communities. Unfortunately, we have no objective measures of either of stressful life events or physiological markers of stress to test this hypothesis.The fact that modulating factors such as nicotine and substance abuse can differential affect controls, but not patients, raises an important cautionary note about how to interpret study results, potential false negative findings, and what constitutes the best comparison sample for genetic or biomarker studies. A common recommended strategy is to recruit control subjects who are similar to the clinical sample on various modulating factors and co-morbid conditions. The results of this study would seem to temper that recommendation, at least for P300. It suggests that, in matching the samples, individual and group differences may be attenuated for reasons other than psychosis. Consequently, genetic associations with the endophenotype may be obscured and the ability of the measure to predict transition to psychosis may be weakened.

However, the broad utility of P300 as a robust marker for large multi-site studies is confirmed, along with important associations with both positive symptoms and decreased cognitive and functional capacity.KNOWLEDGE ABOUT A person’s family history of a disorder can be useful in both clinical and research settings . For clinicians, knowing if relatives ever evidenced a Mendelian dominant or recessive genetic disorder can help identify early signs of the condition and might contribute to patients’ decisions about having children. Knowledge of a familial complex genetically influenced disorder is also useful, but less informative because each relevant gene probably contributes to only a small proportion of the risk and environment is likely to play a major role . Directly relevant to the current report, knowledge of a subject’s FH can also help researchers select individuals or families on which to focus efforts in order to control costs and maximize the usefulness of the data gathered . There is general agreement that the most accurate FH comes from the Family Study Method that uses personal interviews with all available first- and second-degree relatives . But that approach has downsides including high cost, the time,indoor cannabis growing and effort needed to gather the information from all available relatives, as well as the bias of nonrandom missing data resulting from lack of information on relatives who have died, those too ill to be interviewed, individuals who cannot be located, as well as those who refuse to participate. In an alternate approach, the Family History Method , data can be gathered relatively quickly and at lower cost. Here, relatively simple instruments ask informants about demography and clinical conditions regarding multiple relatives . FHM downsides include inconsistencies in an individual’s reports over time and disagreements among relatives regarding the familial problems . The most salient drawback is the relatively low sensitivity of FHMs . The specific disorder studied relates to FHM sensitivity where obvious medical conditions, are likely to have high FHM sensitivities , but identifying relatives’ psychiatric disorders have lower sensitivities . Regarding substance use disorders , more accurate FHM reports are seen for smoking tobacco with less impressive sensitivities for misuse of alcohol and illicit drugs. Regardless of the condition studied, specificities are often over 90%. The average sensitivities of FHM studies of familial alcohol problems, including AUDs, usually range between 30 and >50% . An example of more promising FHM results involved correlations of 0.70 between college students’ alcohol problems of their parents and those parents self-report using variations of the Short Michigan Alcohol Screening Test . However, offspring missed alcohol use disorder -like problems in 17% of fathers and 50% of mothers. In addition, the parents’ self-reports were not validated by repeated structured interviews over time, the analyses focused on problem patterns for the parents rather than AUDs, and no information was available regarding the performance of individual AUD criteria.

Another study evaluated twin pair concordance regarding their father’s alcohol problems , but the paper focused on agreement among the off- spring reports and did not include DSM AUD criteria. In addition to the condition being studied, other characteristics are also associated with higher FHM sensitivities. These include more severe alcohol histories in the subjects ; informants with conditions that are similar to the subject’s problems ; a subject for whom AUDs ran in their family ; a close genetic relationship between informant and subject ; a focus on more observable criteria such as having ever been in treatment ; the use of less demanding criteria for the subject’s condition ; and when multiple informants are used . The relationships of informants’ and subjects’ demographic characteristics to the accuracy of the informant’s reports vary across studies. Regarding sex, some investigations noted that female subjects with alcohol problems were more likely to be correctly identified than male subjects, although the sex of the informant might have less impact on the accuracy of the reports . However, other studies noted that male offspring might more accurately report alcohol problems in their mothers and female offspring be more accurate in reporting alcohol problems in their fathers . The importance to sensitivity of an informant’s education is also not clear, with one study reporting a fivefold lower accuracy for an informant’s report about a parent’s smoking history for informants with a college education compared to those with less than high school completion . The informant’s age was reported to have little relationship to the validity of their report in some studies , but Pape and colleagues reported a twofold higher odds ratio for correct offspring reports for older informants. The relationships of informants’ and subjects’ demographic characteristics to the accuracy of substance use histories using the FHM require additional study. If demography is closely related to FHM sensitivity, it could be easier to identify which informant is likely to give the most accurate FH. Our every 5-year evaluation over 35 years for members of 2 generations of the San Diego Prospective Study offers an opportunity to expand information regarding relationships of demography and other characteristics to the accuracy of reports of parental alcohol-related problems by offspring. The SDPS incorporates many of the better-established characteristics related to higher accuracy of informants’ FHM reports. These include using standardized personal interviews with subjects and informants, relatively severe alcohol problems and high levels of alcohol intake in subjects, a first degree genetic relationship between informants and subjects, high rates of alcohol problems in both generations, and the focus on relatively broad alcohol problems for fathers that do not require that full AUD criteria be met for the informant’s report to be considered valid. The data reported here were used to evaluate 3 hypotheses. These included the following: higher levels of education in the offspring with the potential greater understanding of human behavior and a greater awareness of problems in their environment will be associated with higher rates of recognition of paternal alcohol problems; for potential reasons similar to the impact of higher levels of education, older informants will more accurately report a father’s alcohol problems; and female offspring will more accurately report their father’s AUDs, as noted in some prior studies.After additional Human Subject’s Protection Committee review, beginning in 1988 100% of the original 453 SDPS probands were located, 99% of whom agreed to participate in the follow-up protocol.

Density of medical marijuana dispensaries and delivery services per city, however, was negatively and strongly associated with greater availability of these products at places where tobacco products are typically sold. The current study examined social factors associated with availability of tobacco products for blunts. Other studies have shown that the tobacco industry aggressively markets specific products, such as menthol cigarettes, in low-income communities and communities of color . This may not be the case for blunts and blunt wrappers. Results of our study indicate, that for the most part, availability of tobacco products associated with blunts was similar in neighborhoods with different socioeconomic status and racial and ethnic composition. Focusing on socioeconomic status, these results are less expected given the associations between some low socioeconomic indicators and use of blunts . Our results regarding racial and ethnic composition are consistent with recent findings that blunt smoking appears to be practiced among a growing number of racial/ethnic groups . Moreover, our finding about the positive association between percent of Whites and availability of cigars at the store is consistent with results of a recent study that cigar use including big cigars, cigarillos, and little cigars has increased among White non-Hispanic men aged 18 to 25 years . Additionally, our findings suggest that convenience stores, smoke/tobacco shops and liquor stores may provide greater availability of tobacco products associated with blunts than do other types of stores that sell tobacco. Because previous studies have shown that exposure to and availability of drugs increase drug use and abuse , policies that limit young people retail access to these products may help to reduce use of blunts and therefore related problems such as growing indoor cannabis and tobacco dependence and smoking-related diseases . Interestingly, all three community-level factors related to marijuana use and access to medical marijuana were found associated with availability of tobacco products associated with blunts. Specifically, higher prevalence of marijuana/hashish use and policy that permits medical marijuana dispensaries and private cultivation were positively associated with availability of tobacco products for blunts in tobacco outlets.

Density of medical marijuana dispensaries and/or delivery services, however, reduced odds of availability of these products. Possible explanations of these results include considering community norms and physical demand. Focusing on the associations between medical marijuana policy and availability, it is possible that community norms that support marijuana use may affect medical marijuana policy which in turn may increase availability of tobacco products associated with blunts. Using structural equations modeling, our previous studies indicated that community norms were directly related to tobacco and alcohol policies . Community-level prevalence of adult marijuana/hashish use was another important factor.In this case, higher rates of marijuana use contribute to more acceptability of marijuana which affects policy and availability. However, it is also possible that increased acceptability of marijuana affects policy and access to marijuana which in turn increases rates of marijuana/hashish users in the community. A recent study found higher odds of marijuana use in states that legalized medical marijuana . The cross-sectional design of the current study limits our understanding of these relationships. Future studies should explore these potential mediation effects and its relationships to youth and adults marijuana and blunts use. We also found that greater density of medical marijuana dispensaries and delivery services reduced odds of availability of tobacco products associated with blunts. These relationships may be explained by economic equilibrium theory . That is, tobacco stores may service demand for products associated with marijuana use when supply through medical marijuana dispensaries and delivery services is low. Also, tobacco stores that sell products associated with blunts and medical marijuana dispensaries and delivery services may serve different types of marijuana users and therefore emerge in different types of business. Some research suggests that blunts use is a distinct sub-cultural formation associated with hip hop or rap music and with distinct configuration of rituals, jargon, and drug use norms .

Results of this study should be considered in light of several limitations. First, the cross sectional design of the study limited our ability to make directional inferences about relationships between the community-level factors and availability. For example, prevalence of adult marijuana/hashish use can be a proxy of community norms or it can be a result of availability of marijuana and marijuana products through density of medical marijuana dispensaries and delivery services. Also, the study included only selected tobacco outlets in midsized cities. Including rural communities and a larger sample of tobacco outlets may help to more closely explore the relationships between neighborhood demographics and availability. Third, it is possible that our community-level measures do not capture societal level influences related to normalization of marijuana use comprehensively. Other studies should include other variables related to popular culture and more direct measures of adult beliefs. Finally, information about individuals’ blunts use in these communities was not available for the study. Prevalence of blunt smoking in regions of California is unknown. Such information is only available from of a qualitative study of Southeast Asian Americans in two communities in San Francisco Bay Area. In that study, 62% of youth and young adults and 10% of adults reported lifetime blunts use . This limits our understanding of the relationships among community norms, medical marijuana policy, availability of tobacco products associated with blunts and actual blunts use. Despite these limitations, results of this study suggest the important role that community norms that support marijuana use or legalization of medical marijuana and medical marijuana policy may play in increasing availability of tobacco products associated with blunts. Since blunts have become popular over time and expanded into growing number of racial/ethnic groups , these results may be of particular importance to different communities in California and elsewhere. Tobacco and marijuana policymakers should be aware of the larger social contexts of blunts use and availability and the importance of considering societal-level influences related to normalization of marijuana use to reduce blunts use and/or other forms of concurrent use of tobacco and marijuana.

Similarly, results of this study also suggest the importance of studying blunts use and availability within the larger social contexts of marijuana use, related policies and community norms to better inform policies to reduce blunts use and/or other forms of concurrent use of tobacco and marijuana.In January 2020, the United States Food and Drug Administration finalized a policy to prioritize enforcement against cartridge-based e-cigarettes in flavors other than tobacco and menthol, effective February 1, 2020 . At the time,indoor cannabis growing no e-cigarette product was authorized for sale in the United States, meaning that no e-cigarette was being sold with legal authorization. However, the FDA had exercised enforcement discretion to defer authorization requirements, effectively allowing all e-cigarettes into the marketplace. The FDA announcement cited “epidemic levels” of youth e-cigarette use , particularly use of mint and fruit flavors and cartridge-based systems , such as those sold under the JUUL brand, in which single-use cartridges, or pods, are swapped in and out of a reusable device. The policy goal was to focus on products most attractive to youth. Companies that did not cease manufacture, distribution and sale of prioritized products within 30 days “risked FDA enforcement actions ,” but those enforcement actions were not delineated. The policy was criticized for vague product definitions and for excepting menthol, refillable, and disposable e-cigarette products increasingly popular among youth . The policy was defended as providing flexibility to pursue action against any e-cigarette company selling products that target youth . E-cigarettes are the most commonly consumed tobacco product among adolescents . Flavors in e-cigarettes and other tobacco products and a cooling sensation from added menthol may increase product appeal and mask harshness, motivating youth experimentation and continued use . Fruit flavors and sweet/ dessert flavors are considered particularly popular among young e-cigarette users; however, combination fruit-ice flavors and mint flavors are also used commonly . While recent surveillance indicates a possible decline in e-cigarette use prevalence among adolescents, 80% of e-cigarette users report using flavored products . Emerging data also suggest that flavored and pod-based product use continued to be normative among young e-cigarette users in the months following the FDA enforcement prioritization policy. The 2020 National Youth Tobacco Survey , conducted from January to March , demonstrated that high school e-cigarette users most commonly used pod devices and fruit , mint , menthol , or sweet flavors.

In a May 2020 national online survey of adolescents and young adults, reusable pod/cartridge e-cigarettes and disposable e-cigarettes, such as those sold under the Puff Bar brand, were the most used devices, and mint, menthol, or ice was the most used class of flavors among both reusable and disposable users . Barshaped “fifth-generation” disposable devices, sometimes called “podmods” , do not actually contain pods, are not modifiable, and differ from first-generation “cigalike” disposable devices. This manuscript uses “modern disposable” to refer to these disposables and “reusable pod” to refer to reusable systems with single-use cartridges .The present study characterizes device type and flavor behaviors among young e-cigarette users approximately one year after the FDA policy announcement, allowing time for regulators, sellers, and users to adjust to the new policy. As the main goal of this study was descriptive, no numerical hypothesis was defined. Data are from a national online panel of e-cigarette repeated ever-users ages 14–20 years, conducted from March to April 2021. The investigation also examines participants’ e-cigarette flavor preferences and perceived access to flavors that they like. Finally, using latent class analysis , we classify participants according to their flavor preferences and examine how flavor preferences relate to sociodemographic characteristics, e-cigarette and other tobacco use behaviors, and reasons for e-cigarette use. Examining e-cigarette flavor preferences, rather than use behaviors alone, may help inform assumptions about how youth may respond to potential policies. Results are based on a national cross-sectional online survey of adolescents and young adults who reported e-cigarette ever use . Participants were recruited from existing, actively managed market research panels aggregated by a third-party vendor . Online research panels have gained wide use in behavioral health sciences research, including tobacco control research and with youth specifically . While panel members may not represent the general population, participants reflect a range of geography, age, income levels, and racial/ ethnic groups. For this investigation, panel members residing in the United States whose demographic profiles potentially matched study eligibility criteria were invited to complete a screener questionnaire to confirm their age and lifetime e-cigarettes use . A threshold of ≥3 times was set as an inclusion criterion to help assure that the study population included participants familiar with e-cigarettes from repeated use. Of 8860 completed screener questionnaires, 2712 participants met eligibility criteria and 2253 of these completed the survey. Surveys were administered from March 18 to April 25, 2021. Median completion time was 9 min. Participant incentives varied by panel but typically consisted of points redeemable toward merchandise, travel, or other awards. Before beginning the survey, potential participants were provided information stating that the survey was a research study and were informed of the study goals, its voluntary nature, and were asked to complete two items to confirm their comprehension. Signed informed consent was not collected to preserve anonymity. The University of California San Francisco Institutional Review Board approved all study procedures. All participants were provided with a list of 9 different tobacco products , 6 types of e-cigarette devices , marijuana, and alcohol and asked to endorse all of the products listed that they had ever used . The list included photographs and example brands. For each product ever used, participants reported how many days in the past 30 days they used that product . Past 30-day e-cigarette users were asked to endorse which e-cigarette flavors they had used in the past 30 days from a list . All participants, including e-cigarette non-users were asked, “Right now, how difficult or easy is it to find e-cigarettes or vapes in flavors that you like?” with 4 options . Participants were then asked how it is to find each of 8 specific e-cigarette flavors and how it is to find fruit, candy, fruit-ice, and/or dessert e-cigarette flavors from 5 specific sources . All participants were asked to respond to the prompt, “How much do you like the following flavors for e-cigarettes or vapes?” for 8 flavors .

SWM task accuracy and reaction time were calculated for SWM and simple attention conditions. Group differences in neuropsychological test scores and SWM task performance were examined with one-way ANOVAs. We followed up significant ANOVAs with Tukey’s all pairwise t-tests between the three groups. Imaging data were processed and analyzed using the Analysis of Functional NeuroImages package . We first applied a motion-correction algorithm to the time series data . Second, we correlated the time series data with a set of reference vectors that represented the block design of the task and accounted for delays in hemodynamic response , while covarying for estimated motion and linear trends. Next, we transformed imaging data to standard coordinates then resampled the functional data into 3.5 mm3 voxels. Finally, we applied a spatial smoothing Gaussian filter to account for anatomic variability. After processing functional data, we examined average BOLD response to the SWM task in each group using one sample t-tests, and determined regions that showed greater response to SWM relative to simple attention , reduced response during SWM relative to rest , and greater simple attention response than SWM response. We next compared response during SWM relative to simple attention between groups with ANOVAs, and performed pairwise comparisons between groups. We performed group comparisons on the whole brain, rather than discrete regions thought to be activated by the task, because previous studies by our group and others have suggested neural reorganization and use of alternate brain systems during working memory among individuals with AUD. To control for Type I error in group analyses, we required significant voxels to form clusters ≥1072 μl , yielding a cluster-wise α < .0167 . We utilized the Talairach Daemon and AFNI to confirm gyral labels for clusters.

Previous research has suggested that neuropsychological deficits among adult marijuana users are associated with lingering effects of recent use, and that these impairments dissipate with extended abstinence . To understand whether group differences in the current study relate to recent cannabis growers use, we performed post-hoc regressions within the MAUD group. First, we extracted the average fit coefficient for each MAUD participant from each cluster where we observed a difference between MAUD and control or AUD teens. Next, we used regression analyses to examine whether days since last marijuana use predicted brain response within each group difference cluster.Mental health in young adulthood is the strongest predictor of mental health in adulthood. Mental health vulnerabilities present in young adulthood can be exacerbated by marijuana use, thus potentially hindering or delaying a successful transition to adulthood. Considering motives of marijuana use may provide insight into the associations between marijuana use and mental health in young adults. The purpose of this dissertation was to: 1) understand the associations between motives of marijuana use and symptoms of depression, symptoms of anxiety, and overall psychological distress in young adults, and 2) examine whether these associations vary by gender. Data come from the Cannabis, Health and Young Adult Study , a longitudinal study of young adults, in Los Angeles, who use marijuana for medical and/or recreational purposes. Exploratory and confirmatory analyses were performed to validate the factor structure of the instrument used to operationalize motives of marijuana use for the study. Multiple linear regressions were used to determine how motives of use are associated to mental health outcomes. Indirect effects between motives of use and mental health outcomes through frequency of use were also assessed.

Finally, gender was tested as a moderator for both direct and indirect associations between motives of use and mental health outcomes. Results validate the factor structure of the amended Comprehensive Marijuana Motive Questionnaire. Furthermore, results indicate that the coping motive of use is positively, significantly associated with mental health outcomes. The motives of conformity, pain, and attention are indirectly associated with symptoms of depression through frequency of use. Gender influences the association between the motive of social anxiety with symptoms of depression and overall psychological distress whereas women who endorse this motive of use report more symptoms of depression and overall psychological distress than men. None of the moderated mediation analyses were significant. These results emphasize the importance of considering motive of use in the development of interventions targeting marijuana use and mental health in young adults. These findings also highlight the need for gender specific interventions as men and women engage in use differently, and with different consequences to their mental health.Mental health in young adulthood is the strongest predictor of mental health in adulthood. Mental health vulnerabilities present in young adulthood can be exacerbated by marijuana use, thus potentially hindering or delaying a successful transition to adulthood. Considering motives of marijuana use may provide insight into the associations between marijuana use and mental health in young adults. The purpose of this dissertation was to: 1) understand the associations between motives of marijuana use and symptoms of depression, symptoms of anxiety, and overall psychological distress in young adults, and 2) examine whether these associations vary by gender. Data come from the Cannabis, Health and Young Adult Study , a longitudinal study of young adults, in Los Angeles, who use marijuana for medical and/or recreational purposes. Exploratory and confirmatory analyses were performed to validate the factor structure of the instrument used to operationalize motives of marijuana use for the study.

Multiple linear regressions were used to determine how motives of use are associated to mental health outcomes. Indirect effects between motives of use and mental health outcomes through frequency of use were also assessed. Finally, gender was tested as a moderator for both direct and indirect associations between motives of use and mental health outcomes. Results validate the factor structure of the amended Comprehensive Marijuana Motive Questionnaire. Furthermore, results indicate that the coping motive of use is positively, significantly associated with mental health outcomes. The motives of conformity, pain, and attention are indirectly associated with symptoms of depression through frequency of use. Gender influences the association between the motive of social anxiety with symptoms of depression and overall psychological distress whereas women who endorse this motive of use report more symptoms of depression and overall psychological distress than men. None of the moderated mediation analyses were significant. These results emphasize the importance of considering motive of use in the development of interventions targeting marijuana use and mental health in young adults. These findings also highlight the need for gender specific interventions as men and women engage in use differently, and with different consequences to their mental health.The advent of combination anti-retroviral therapy has transformed human immuno deficiency virus infection and its effects on the central nervous system . HIV infection is now a chronic disease with multiple interacting causes of morbidity. Although neurocognitive impairment remains common in some HIV cohorts , neurocognitive deficits now tend to be milder than in the preART era. Identifying persons with milder NCI is more difficult than identifying frank dementia and tends to require comprehensive and costly assessments. Even the milder forms of NCI may be associated with problems with everyday functioning. This highlights the importance of identifying, assessing and intervening in HIV-infected persons at risk for impaired and/or worsening neurocognitive function. Ascertaining biomarkers of HIV-associated NCI is one promising approach to detecting those at risk for NCI, particularly if these biomarkers are obtained as part of routine clinical care. Clinical investigation of biomarkers is also relevant to improve understanding of the biomedical mechanisms underlying NCI in the ART era. The Veterans Aging Cohort Study Index was developed as a composite marker of disease severity among HIV-infected persons based on routine clinical blood tests. It integrates age,“traditional” biomarkers of HIV disease and “nontraditional” biomarkers, including markers of renal and liver function, anemia,grow rack and hepatitis C virus coinfection. The VACS Index has been consistently associated with increased risk of death in HIV-infected persons. It has also been linked to poor health outcomes, including increased risk for hospitalizations and medical intensive care unit admissions,fragility fractures,frailty, and concurrent extremity strength. Prior work by our group found the cross-sectional association of the VACS Index with NCI to be significant but small, and particularly weak among Hispanics.The overall goal of the present study was to extend prior cross-sectional findings to examine the ability of the VACS Index to predict neurocognitive change and incident NCI in a large and well-characterized cohort of HIV-infected persons.

We did so by examining the association between baseline VACS Index scores and subsequent neurocognitive change; whether longitudinal changes in the VACS Index corresponded to changes in neurocognitive function; and whether VACS Index scores predicted time to incident NCI in a subgroup of participants who were neurocognitively normal at baseline.Participants included 655 HIV-infected individuals followed for up to 6 years in National Institutes of Health–funded cohort studies at the University of California, San Diego, HIV Neuro behavioral Research Program from 14 April 1999 to 11 May 2012. Studies were approved by the university’s institutional review board. All participants provided informed consent for participation in these cohort studies and agreed for their data to be used for future studies assessing the impact of HIV on the nervous system. Exclusion criteria included histories of neurological or severe psychiatric conditions. Inclusion criteria were being HIV infected , having ≥2 study visits with valid global neurocognitive scores, having laboratory data available to compute the VACS Index within 3 months of neurocognitive data, being primarily English speaking, providing informed consent, and being free of sensory or physical problems that would interfere with neurocognitive testing. Forty-five percent of the sample had previously undergone neurocognitive testing.Routine clinical chemistry panels, complete blood cell counts, rapid plasma reagin, HCV antibody, and CD4+ T-cell counts were performed at a Clinical Laboratory Improvement Amendments–certified, or equivalent, laboratory. HIV RNA levels in plasma were measured by means of reverse transcription polymerase chain reaction . CNS penetration effectiveness was ascertained as described elsewhere . Self-reported data were gathered on duration of HIV infection, nadir CD4+ T-cell count, history of ART, and duration of current ART. HCV status was based on HCV antibody testing and/or self-report. The VACS Index was computed as described elsewhere, with higher scores indicating worse disease status.The neurocognitive battery comprised 15 measures covering 7 neurocognitive domains . Raw test scores were transformed into scaled scores adjusted for repeated testing,which were then converted into T scores adjusted for demographics. The adjusted T scores for each test were then averaged to derive global and domain T scores, which were used for analyses in the overall sample. To determine whether the VACS Index predicted time to incident NCI, we converted the adjusted T scores for each test into deficit scores, ranging from 0 to 5 and averaged these scores to derive global deficit scores. Consistent with previous studies, NCI was defined as a global deficit score of ≥0.50.We assessed current mood symptoms via the Beck Depression Inventory and used published cutoff scores to determine severity of depression symptoms. Current and lifetime history of major depressive and substance use disorders were obtained using structured diagnostic interviews that follow criteria of the Diagnostic and Statistical Manual of Mental Disorders. Presence of a “substance use disorder” was defined as meeting criteria for abuse or dependence for alcohol, cannabis, and any of the following substances: opioids, methamphetamine, cocaine, sedatives, and hallucinogens. Data on lifetime intravenous drug use were ascertained by self-report.Three analytic approaches were used. First, to evaluate effects of baseline VACS Index scores on changes in neurocognitive function over time, we used a mixed effects linear regression with subject-specific random intercepts and slopes, which assumes that participants have different baseline T scores and varying trajectories of change in T scores over time . The model regressed mean global T scores on time . Individual slopes were obtained from the model and used as outcomes in a linear regression with baseline VACS Index as predictor. The slopes estimated the average changes in global T scores with every year passed. A second set of analyses was used to evaluate the association of the VACS Index as a time-dependent predictor of longitudinal cognitive status based on adjusted T scores.Because the model on global T scores was significant, we investigated the association of the VACS Index as a time-dependent predictor with changes in domain T scores using a similar approach and evaluated the impact of potential covariates.