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Researchers are often interested in estimating the effect of sustained use of a treatment on a health outcome. However, adherence to strict treatment protocols can be challenging for individuals in practice and, when non-adherence is expected, estimates of the effect of sustained use may not be useful for decision making. As an alternative, more relaxed treatment protocols which allow for periods of time off treatment (i.e. grace periods) have been considered in pragmatic randomized trials and observational studies. In this article, we consider the interpretation, identification, and estimation of treatment strategies which include grace periods. We contrast natural grace period strategies which allow individuals the flexibility to take treatment as they would naturally do, with stochastic grace period strategies in which the investigator specifies the distribution of treatment utilization. We estimate the effect of initiation of a thiazide diuretic or an angiotensin-converting enzyme inhibitor in hypertensive individuals under various strategies which include grace periods. [ABSTRACT FROM AUTHOR]

Many real‐life treatments are of limited supply and cannot be provided to all individuals in the population. For example, patients on the liver transplant waiting list usually cannot be assigned a liver transplant immediately at the time they reach highest priority because a suitable organ is not immediately available. In settings with limited supply, investigators are often interested in the effects of treatment strategies in which a limited proportion of patients receive an organ at a given time, that is, treatment regimes satisfying resource constraints. Here, we describe an estimand that allows us to define causal effects of treatment strategies that satisfy resource constraints: incremental propensity score interventions (IPSIs) for limited resources. IPSIs flexibly constrain time‐varying resource utilization through proportional scaling of patients' natural propensities for treatment, thereby preserving existing propensity rank ordering compared to the status quo. We derive a simple class of inverse‐probability‐weighted estimators, and we apply one such estimator to evaluate the effect of restricting or expanding utilization of "increased risk" liver organs to treat patients with end‐stage liver disease. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to determine the association of cannabis indicators with self-reported psychotic disorders in the U.S. general population.Methods: Participants were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309). Logistic regression was used to estimate standardized prevalences of past-year self-reported psychotic disorders within each survey and to evaluate the association of past-year self-reported psychotic disorders with indicators of nonmedical cannabis use (any use; frequent use [at least three times/week], daily/near-daily use, and DSM-IV cannabis use disorder) compared with those with no past-year nonmedical cannabis use. Whether the strength of associations differed between surveys was indicated by difference-in-difference tests (between-survey contrasts) and ratios of odds ratios between surveys.Results: Self-reported psychotic disorders were significantly more prevalent among participants with any nonmedical cannabis use than those without (2001-2002: 1.65% compared with 0.27%; 2012-2013: 1.89% compared with 0.68%). In 2001-2002, self-reported psychotic disorders were unrelated to either frequent use or daily/near-daily use. However, in 2012 - 2013, compared with nonusers, self-reported psychotic disorders were more common among participants with frequent use and those with daily/near-daily nonmedical cannabis use (2012-2013: 2.79% and 2.52%, respectively, compared with 0.68% among nonusers). Self-reported psychotic disorders were significantly more prevalent among participants with cannabis use disorder than nonusers in both surveys (2001-2002: 2.55% compared with 0.27%; 2012 - 2013: 3.38% compared with 0.68%). The strength of these associations did not change over time.Conclusions: Data from the U.S. general population, especially more recent data, suggest associations between self-reported psychotic disorder and frequent nonmedical cannabis use and cannabis use disorder. Clinicians and policy makers should consider these relationships when monitoring patients and formulating programs. [ABSTRACT FROM AUTHOR]

Observational studies reporting on adjusted associations between childhood body mass index (BMI; weight (kg)/height (m)2) rebound and subsequent cardiometabolic outcomes have often not paid explicit attention to causal inference, including definition of a target causal effect and assumptions for unbiased estimation of that effect. Using data from 649 children in a Boston, Massachusetts–area cohort recruited in 1999–2002, we considered effects of stochastic interventions on a chosen subset of modifiable yet unmeasured exposures expected to be associated with early (2; −1.39 units, 95% confidence interval: −1.63, −0.72) but weaker or no effects for other cardiometabolic outcomes. Our results clarify distinctions between algorithms and causal questions, encouraging explicit thinking in causal inference with complex exposures. [ABSTRACT FROM AUTHOR]

The primary aim of the current study was to examine the prevalence and correlates of self-reported sexual assault (SA) perpetration, defined as nonconsensual sexualized touching or attempted or completed oral, vaginal, or anal penetration since starting college among men, women, and gender nonconforming (GNC) students. A secondary aim was to examine the prevalence and correlates of self-reported sexual encounters when the respondent was unsure that their partner consented (ambiguous consent). In spring 2016, 1,671 randomly sampled students (67% response rate) at two interconnected urban undergraduate institutions participated in an online survey about sexual experiences and personal and social contextual correlates. Prevalence estimates for SA perpetration and ambiguous consent were estimated and logistic regression was used to test bivariate associations between these two outcomes and a range of potential correlates. Approximately 2% of students self-reported any SA perpetration and 9% reported any ambiguous consent experiences since starting college. Pre-college SA perpetration, past-year SA victimization, belief in and use of nonverbal consent strategies, binge drinking, and depression symptoms were associated with higher odds of both SA perpetration and ambiguous consent while at college. Hookups were associated with higher odds of ambiguous consent; family social support was associated with lower odds of ambiguous consent. Findings of similar correlates for SA perpetration and ambiguous consent point to prevention programming focused on verbal consent strategies, alcohol harm reduction approaches, and pre-college interventions. [ABSTRACT FROM AUTHOR]

Suppose that I Y i is determined by the structural equation HT ht For HT ht and I i > 0, the average treatment effect (ATE) is HT ht regardless of I p i and I q i . Mats J Stensrud and Aaron L. Sarvet's contribution to the Discussion of 'Assumption-lean inference for generalised linear model parameters' by Vansteelandt and Dukes We congratulate Vansteelandt and Dukes (V & D) with their innovative and interesting article. [Extracted from the article]

Despite the burden of sexual assault on college campuses, few effective prevention programs exist. Understanding the socio-ecological context in which sexual assaults occur may illuminate novel pathways to augment prevention. We examined data from 349 students at two inter-connected urban universities who completed a population-based survey (N = 1,671) and described at least one incident of sexual assault victimization. Using latent class analysis of 13 incident, relationship, and social context characteristics, we identified three types of sexual assaults: Incapacitation, Known Assailant, both Drinking; Verbal Coercion, Partner/Friend, Private; and Unwanted Touching, Stranger, Public. Incapacitation, Known Assailant, both Drinking incidents often involved survivor incapacitation with someone known to the victim following a party. Verbal Coercion, Partner/Friend, Private incidents often involved verbal coercion and intimate partners, with others rarely present prior to the assault. Unwanted Touching, Stranger, Public incidents often involved unwanted touching and strangers in a public place. Findings suggest three distinct sexual assault types, defined by different incident, relational, and socio-contextual factors, and reinforce the importance of disaggregating sexual assault to tailor prevention programs more effectively. Campus policy-makers and providers should be aware that each type of assault may require different prevention approaches. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/doi/suppl/10.1177/0361684320964452 [ABSTRACT FROM AUTHOR]

Objective: To determine whether emotional and physical intimate partner violence (IPV) and financial adversity increase risk of incident homelessness in pregnancy and the post-partum period. Study design: Data were drawn from the Avon Longitudinal Study of Parents and Children, which starting in 1990 mailed questionnaires to 14,735 mothers in the UK, over 7 years from pregnancy onwards. Marginal structural models and multiple imputation were used to address time-varying confounding of the primary variables, testing for interaction between concurrent emotional/physical IPV and financial adversity, and adjusted for baseline age, ethnicity, education, partner's alcohol use, parity, depression, and social class. Results: Emotional IPV (HR 1.44 (1.13,1.84)), physical IPV (HR 2.05 (1.21,3.49)), and financial adversity (HR 1.59 (1.44,1.77)) each predicted a multiplicative increase in the discrete-time hazard of incident homelessness. We identified joint effects for concurrent emotional IPV and financial adversity (HR 2.09 (1.35,3.22)) and concurrent physical IPV and financial adversity (HR 2.79 (1.21,6.44)). We further identified a temporary decline in self-reported physical IPV among mothers during pregnancy and up to 8 months post-partum. Conclusions: Emotional and physical IPV and financial adversity independently and jointly increase the risk of incident homelessness. The effects of emotional and physical IPV are comparable to or greater than the risk of financial adversity. Homelessness prevention policies should consider IPV victims as high-risk, regardless of financial status. Furthermore, self-reported physical IPV declines temporarily during pregnancy and up to 8 months post-partum. Screening for IPV in this period may miss high-risk individuals. [ABSTRACT FROM AUTHOR]

Aims: Medical marijuana law (MML) enactment in the United States has been associated with increased cannabis use but lower traffic fatality rates. We assessed the possible association of MML and individual‐level driving under the influence of cannabis (DUIC) and also under the influence of alcohol (DUIA). Design and setting: Three cross‐sectional U.S. adult surveys: The National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991–1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001–2002), and the NESARC‐III (2012–2013). Participants: The total n was 118 497: 41 764, 41 184, and 35 549 from NLAES, NESARC, and NESARC‐III, respectively. Measurements Across the three surveys, similar questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule assessed DUIC and DUIA. Ever‐MML states enacted MML between 1991–1992 and 2012–2013 (overall period). Early‐MML states enacted MML between 1991–1992 and 2001–2002 (early period). Late‐MML states enacted MML between 2001–2002 and 2012–2013 (late period). MML effects on change in DUIC and DUIA prevalence were estimated using a difference‐in‐differences specification to compare changes in MML and other states. Findings From 1991–1992 to 2012–2013, DUIC prevalence nearly doubled (from 1.02% to 1.92%), increasing more in states that enacted MML than other states (difference‐in‐differences [DiD] = 0.59%; 95% CI = 0.06%–1.12%). Most change in DUIC prevalence occurred between 2001–2002 and 2012–2013. DUIC prevalence increased more in states that enacted MML 2001–2002 to 2012–2013 than in never‐MML states (DiD = 0.77%; 95% CI = −0.05%‐1.59%), and in two early‐MML states, California (DiD = 0.82; 95% CI = 0.06–1.59) and Colorado (DiD = 1.32; 95% CI = 0.11–2.53). In contrast, DUIA prevalence appeared unrelated to MML enactment. Conclusions: Medical marijuana law enactment in US states appears to have been associated with increased prevalence of driving under the influence of cannabis, but not alcohol. [ABSTRACT FROM AUTHOR]

Objective: Given changes in U.S. marijuana laws, attitudes, and use patterns, individuals with pain may be an emerging group at risk for nonmedical cannabis use and cannabis use disorder. The authors examined differences in the prevalence of nonmedical cannabis use and cannabis use disorder among U.S. adults with and without pain, as well as whether these differences widened over time.Methods: Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309) were analyzed using logistic regression. Risk differences of past-year nonmedical cannabis use, frequent (at least three times a week) nonmedical use, and DSM-IV cannabis use disorder were estimated for groups with and without moderate to severe pain, and these risk differences were tested for change over time.Results: Any nonmedical cannabis use was more prevalent in respondents with than without pain (2001-2002: 5.15% compared with 3.74%; 2012-2013: 12.42% compared with 9.02%), a risk difference significantly greater in the 2012-2013 data than in the 2001-2002 data. The prevalence of frequent nonmedical cannabis use did not differ by pain status in the 2001-2002 survey, but was significantly more prevalent in those with than without pain in the 2012-2013 survey (5.03% compared with 3.45%). Cannabis use disorder was more prevalent in respondents with than without pain (2001-2002: 1.77% compared with 1.35%; 2012-2013: 4.18% compared with 2.74%), a significantly greater risk difference in the data from 2012-2013 than from 2001-2002.Conclusions: The results suggest that adults with pain are a group increasingly vulnerable to adverse cannabis use outcomes, warranting clinical and public health attention to this risk. Psychiatrists and other health care providers treating patients with pain should monitor such patients for signs and symptoms of cannabis use disorder. [ABSTRACT FROM AUTHOR]

Background: Due to significant comorbidity and impairment associated with cannabis use and cannabis use disorder, understanding time trends in cannabis use and cannabis use disorder is an important public health priority.Objectives: To identify trends in cannabis use and cannabis use disorder overall, and by sociodemographic subgroup.Methods: Narrative review of published findings on trends in cannabis use and cannabis use disorders in data from repeated cross-sectional US general population surveys. In addition, in National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2002-2002) and NESARC-III (2012-2013) data, logistic regression was used to examine whether trends differed between subgroups of adults.Results: The review showed that in adults, cannabis use increased over the past decade overall and within sociodemographic subgroups (gender, age, race/ethnicity, income, education, marital status, urbanicity, region, pregnancy status, disability status), with greater increases in men and disabled adults. Most sources also indicated significant increases in cannabis use disorders. New analysis showed significantly greater increases in adult cannabis use and cannabis use disorder in men (p ≤ .0001); young adults (p < .05); Blacks (vs. Whites, p < .01); low income groups (p < .001); never-married p ≤ .0001), and urban residents (p < .05). In adolescents, cannabis use generally decreased, although recent increases were observed in older and non-White adolescents.Conclusion: Cannabis use and cannabis use disorder are increasing in adults, with specific sociodemographic groups at higher risk, and may be increasing in some adolescent subgroups. Studies should determine mechanisms for differential trends to provide information to policymakers and enable informed decisions on cannabis legalization and service planning. [ABSTRACT FROM AUTHOR]

Imai et al. (IJGHS) have conducted a timely experiment on evaluating a decision support algorithm. Suppose practitioners (qualitatively) find it desirable that using an algorithm that: reduces the marginal number of crimes, HT ht , reduces the number of failed detentions, HT ht , and increases the number of successful releases, HT ht . The motivation for these utilities, however, is to quantify "an NCA (NVCA or FTA)" ( HT ht ), and "an unnecessarily harsh decision" ( HT ht ). [Extracted from the article]

Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 6 Wittgenstein L. (1977). I He who understands [my propositions] finally recognizes them as senseless, when he has climbed out through them, on them, over them...must so to speak throw away the ladder, after he has climbed up on it. i [5], I Tractatus logico-philosophicus i Principal stratum estimands were once disparagingly compared to a "magic can opener" ([2]) - an allusion to a classic joke made on behalf of mathematicians and economists for their perceived tendency to assume into existence solutions to practical problems. Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC. [Extracted from the article]

Background: Research has documented multilevel risk factors associated with experiencing incapacitated sexual assault among undergraduate women. Less is known about multilevel risk factors associated with nonincapacitated sexual assault. This study examines and compares the different settings, coercion methods, and relationships in which incapacitated and nonincapacitated sexual assaults occur among undergraduate women. Materials and Methods: Our sample included 253 undergraduate women who reported experiencing sexual assault during college on a population-based survey of randomly selected students at two colleges in New York City in 2016 (N = 1671, response rate = 67%). We examined event-level data on their most significant sexual assault incident since entering college. Using multivariable statistical analysis, we identified situational contexts associated with incapacitated and nonincapacitated assault incidents adjusting for binge drinking, illicit drug use, and other confounding sociodemographic and psychosocial variables. Results: Almost half (47%) of women who experienced sexual assault reported being incapacitated due to alcohol or drugs during the most significant incident. Being at a party before the event and "acquaintance" perpetrators were associated with incapacitated sexual assault after adjusting for binge drinking and other confounders. Meeting a perpetrator through an Internet dating app or indicating the perpetrator was an intimate partner were each associated with nonincapacitated assault incidents. Perpetrator use of physical force and verbal coercion were also associated with nonincapacitated assault incident. Conclusions: The different situational contexts associated with incapacitated and nonincapacitated sexual assaults have important implications for the design of prevention strategies that will effectively target the diverse risk environments in which campus sexual assault occurs. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To conduct a systematic review and meta‐analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past‐month marijuana use prevalence among adolescents. Methods: A total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta‐analyzed. Estimates of MML effects on any past‐month marijuana use prevalence from included studies were obtained from comparisons of pre–post MML changes in MML states to changes in non‐MML states over comparable time‐periods. These estimates were standardized and entered into a meta‐analysis model with fixed‐effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F‐test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. Results: None of the 11 studies found significant estimates of pre–post MML changes compared with contemporaneous changes in non‐MML states for marijuana use prevalence among adolescents. The meta‐analysis yielded a non‐significant pooled estimate (standardized mean difference) of −0.003 (95% confidence interval = −0.012, +0.007). Four studies compared MML with non‐MML states on pre‐MML differences and all found higher rates of past‐month marijuana use in MML states pre‐MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non‐significant results, although limited heterogeneity may warrant further study. Conclusions: Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions. [ABSTRACT FROM AUTHOR]

Importance: No US national data are available on the prevalence and correlates of DSM-5-defined major depressive disorder (MDD) or on MDD specifiers as defined in DSM-5.Objective: To present current nationally representative findings on the prevalence, correlates, psychiatric comorbidity, functioning, and treatment of DSM-5 MDD and initial information on the prevalence, severity, and treatment of DSM-5 MDD severity, anxious/distressed specifier, and mixed-features specifier, as well as cases that would have been characterized as bereavement in DSM-IV.Design, Setting, and Participants: In-person interviews with a representative sample of US noninstitutionalized civilian adults (≥18 years) (n = 36 309) who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 to June 2013 and were analyzed in 2016-2017.Main Outcomes and Measures: Prevalence of DSM-5 MDD and the DSM-5 specifiers. Odds ratios (ORs), adjusted ORs (aORs), and 95% CIs indicated associations with demographic characteristics and other psychiatric disorders.Results: Of the 36 309 adult participants in NESARC-III, 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Odds of 12-month MDD were significantly lower in men (OR, 0.5; 95% CI, 0.46-0.55) and in African American (OR, 0.6; 95% CI, 0.54-0.68), Asian/Pacific Islander (OR, 0.6; 95% CI, 0.45-0.67), and Hispanic (OR, 0.7; 95% CI, 0.62-0.78) adults than in white adults and were higher in younger adults (age range, 18-29 years; OR, 3.0; 95% CI, 2.48-3.55) and those with low incomes ($19 999 or less; OR, 1.7; 95% CI, 1.49-2.04). Associations of MDD with psychiatric disorders ranged from an aOR of 2.1 (95% CI, 1.84-2.35) for specific phobia to an aOR of 5.7 (95% CI, 4.98-6.50) for generalized anxiety disorder. Associations of MDD with substance use disorders ranged from an aOR of 1.8 (95% CI, 1.63-2.01) for alcohol to an aOR of 3.0 (95% CI, 2.57-3.55) for any drug. Most lifetime MDD cases were moderate (39.7%) or severe (49.5%). Almost 70% with lifetime MDD had some type of treatment. Functioning among those with severe MDD was approximately 1 SD below the national mean. Among 12.9% of those with lifetime MDD, all episodes occurred just after the death of someone close and lasted less than 2 months. The anxious/distressed specifier characterized 74.6% of MDD cases, and the mixed-features specifier characterized 15.5%. Controlling for severity, both specifiers were associated with early onset, poor course and functioning, and suicidality.Conclusions and Relevance: Among US adults, DSM-5 MDD is highly prevalent, comorbid, and disabling. While most cases received some treatment, a substantial minority did not. Much remains to be learned about the DSM-5 MDD specifiers in the general population. [ABSTRACT FROM AUTHOR]

Sexual assault on college campuses is a public health issue. However varying research methodologies (e.g., different sexual assault definitions, measures, assessment timeframes) and low response rates hamper efforts to define the scope of the problem. To illuminate the complexity of campus sexual assault, we collected survey data from a large population-based random sample of undergraduate students from Columbia University and Barnard College in New York City, using evidence based methods to maximize response rates and sample representativeness, and behaviorally specific measures of sexual assault to accurately capture victimization rates. This paper focuses on student experiences of different types of sexual assault victimization, as well as sociodemographic, social, and risk environment correlates. Descriptive statistics, chi-square tests, and logistic regression were used to estimate prevalences and test associations. Since college entry, 22% of students reported experiencing at least one incident of sexual assault (defined as sexualized touching, attempted penetration [oral, anal, vaginal, other], or completed penetration). Women and gender nonconforming students reported the highest rates (28% and 38%, respectively), although men also reported sexual assault (12.5%). Across types of assault and gender groups, incapacitation due to alcohol and drug use and/or other factors was the perpetration method reported most frequently (> 50%); physical force (particularly for completed penetration in women) and verbal coercion were also commonly reported. Factors associated with increased risk for sexual assault included non-heterosexual identity, difficulty paying for basic necessities, fraternity/sorority membership, participation in more casual sexual encounters (“hook ups”) vs. exclusive/monogamous or no sexual relationships, binge drinking, and experiencing sexual assault before college. High rates of re-victimization during college were reported across gender groups. Our study is consistent with prevalence findings previously reported. Variation in types of assault and methods of perpetration experienced across gender groups highlight the need to develop prevention strategies tailored to specific risk groups. [ABSTRACT FROM AUTHOR]

Importance: Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time.Objective: To present national data on state MML and degree of change in the prevalence of cannabis use and disorders.Design, Participants, and Setting: Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC ("earlier period"). Late-MML states passed MML between NESARC and NESARC-III ("later period").Main Outcomes and Measures: Past-year illicit cannabis use and DSM-IV cannabis use disorder.Results: Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04).Conclusions and Relevance: Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public. [ABSTRACT FROM AUTHOR]

Purpose: While gender inequality has been a topic of concern for decades, little is known about the relationship between gender discrimination and illicit drug use. Further, whether this association varies by education level is unknown.Methods: Among 19,209 women participants in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005), we used logistic regression to test the association between gender discrimination (measured with four items from the Experiences of Discrimination instrument) and three outcomes: past-year illicit drug use, frequent drug use, and drug use disorders. We then tested whether associations differed by education level.Results: Gender discrimination was reported by 9% of women and was associated with past-year drug use [adjusted odds ratio (aOR) = 2.67; 95% confidence interval (CI) 2.17-3.29], frequent drug use (aOR = 2.82; CI 1.99-4.00), and past-year drug use disorders (aOR = 3.15; CI 2.16-4.61). All specific domains of gender discrimination (on the job, in public, with institutions, being called a sexist name) were associated with all drug use outcomes. The association between gender discrimination and past-year drug use was stronger among women with less than a high school education (aOR = 6.33; CI 3.38-11.85) compared to those with more education (aOR = 2.45; CI 1.97-3.04; p interaction < 0.01).Conclusions: Gender discrimination is consistently and strongly associated with illicit drug use and drug use disorders among U.S. women, with significantly higher odds for drug use among women with less than a high school education. Future research should examine whether explicitly addressing distress from discrimination could benefit women in drug treatment, especially among clients with lower educational attainment. [ABSTRACT FROM AUTHOR]

Background Heavy alcohol consumption can be harmful, particularly for individuals with HIV. There is substantial variability in response to interventions that aim to reduce drinking. Neighborhood drinking norms may explain some of this variability among HIV-infected patients. Therefore, we investigated whether neighborhood-level drinking norms modified response to alcohol intervention among HIV-infected heavy drinkers. Methods Heavily-drinking HIV comprehensive care patients ( n = 230) completed 1 of 3 brief alcohol interventions (an educational intervention, a motivational interviewing [ MI] intervention, or an MI intervention with a technological enhancement called HealthCall). Drinking was reported at baseline and end of treatment (60 days). Neighborhood-level drinking norms were obtained from a separate general population study. Results Patients' reductions in drinks per drinking day in response to MI (as compared with the educational control) were more pronounced in neighborhoods with more permissive drinking norms. In contrast, patients' reductions in drinks per drinking day in response to MI plus HealthCall did not significantly vary between neighborhoods with different drinking norms. Norms did not evidence significant interactions with intervention condition for 3 other exploratory drinking outcomes (drinking frequency, binge frequency, and maximum quantity). Conclusions Neighborhood-level drinking norms help explain differential response to an alcohol MI intervention among HIV-infected patients. This study suggests the utility of considering neighborhood context as an effect modifier of alcohol interventions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which addresses research regarding marijuana use trends among pregnant and nonpregnant reproductive-aged women in the U.S. in 2002-2014, and it mentions marijuana legalization and the claim that young women are at a greater risk for prenatal marijuana use.