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Background: Co-use of cannabis and tobacco has become increasingly popular among young adults. Interactive voice response (IVR) based ecological momentary assessment (EMA) allows for measurement of behavior in or near real-time, but has limitations including non-compliance, missing data, and potential for reactivity (e.g., behavior change) from frequent assessments. Methods: This study examined tobacco and cannabis use characteristics and factors associated with IVR compliance and self-reported reactivity in 97 young adults who reported cannabis and tobacco co-use at baseline and completed daily IVR surveys of co-use behavior at three random times per day for 28 days. Results: Overall IVR compliance was 55%, with a modal compliance of 60%. Compliance rates did not differ across morning, midday, and evening surveys, but significantly declined over time. The sample was divided into high frequency responders (>70% calls completed, n=35) and low frequency responders (

Objective: Bisexual women drink more and have more alcohol consequences than heterosexual and lesbian women. This higher risk may in part be attributable to sexual orientation microaggressions. Drinking to cope motivations and alcohol demand may influence the association between microaggressions and alcohol use. The present study used a daily diary design to examine the association between microaggressions and same-day alcohol use (yes/no, quantity) and consequences, and if drinking to cope and alcohol demand moderate this association among bisexual+ (i.e., bi+) women. Method: Participants were 103 emerging adult bi+ women who completed a baseline assessment, including an alcohol purchase task to measure alcohol demand. Subsequently, participants reported their experiences of microaggressions, alcohol use, and alcohol consequences for 28 days. Multilevel model analyses were conducted. Results: Microaggressions were associated with a higher likelihood to drink and greater same-day alcohol use and consequences. The association between microaggressions and alcohol quantity was stronger for those who had a lower price associated with the highest expenditure (lower P max). For those who would stop drinking at lower price values (lower breakpoint), reported spending less overall on alcohol (lower O max), and had lower P max values, microaggressions were associated with more consequences. For those with higher breakpoint, O max, and P max microaggressions were not associated with consequences. Conclusions: Microaggressions may have a deleterious impact on alcohol use and consequences for bi+ women, particularly for those with lower alcohol demand. Clinicians should encourage bi+ clients to consider how microaggressions influence their drinking and support clients to engage in positive coping skills. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction Menthol cigarettes are popular among young adults and are disproportionately used by African American smokers. Menthol’s minty and cooling sensations have been hypothesized to enhance the appeal and reinforcement of smoking; however, differences in menthol’s subjective appeal across races have been inconsistent. This secondary data analysis examined differences in subjective appeal for smoking menthol versus non-menthol cigarettes between African American and White young adult smokers. Methods Young adults (ages 18–24) recruited from Amazon Mechanical Turk (December 2018–January 2019) completed an online survey of tobacco use behavior. Past year smokers (n = 1726) answered questions about subjective responses to smoking (reward, satisfaction, throat hit, craving reduction, and aversion). Results Significantly more African American (73.2%) compared to White (52.4%) smokers preferred menthol cigarettes (p < .001). Menthol smokers reported greater positive and negative subjective responses to smoking than non-menthol smokers. Positive and negative subjective response were both associated with greater smoking intensity and lower cigarette harm perceptions. Interactions of menthol preference and race on indices of subjective appeal also emerged. African American non-menthol smokers reported lower levels of satisfaction, reward, and craving reduction compared to White non-menthol smokers. Conclusions The relationship between menthol preference and subjective response to smoking differs by race. Menthol is rated as more appealing than non-menthol smoking, and appeal indices were linked to smoking intensity and lower harm perceptions, indicating greater abuse liability of menthol cigarettes. Policies that ban menthol cigarettes may have a particularly positive impact on the cigarette smoking of African American young adult smokers. Implications The FDA issued an Advanced Notice of Proposed Rule Making to examine the role menthol in tobacco products to inform regulations to restrict or ban flavors. This study showed that menthol smokers reported greater appeal to smoking than non-menthol smokers; and an interaction of race x menthol preference showed African American non-menthol smokers reported the lowest levels of appeal to smoking. Multiple indices of cigarette appeal were positively correlated with smoking intensity and lower cigarette harm perceptions, highlighting the addiction potential of menthol cigarettes. Findings suggest a menthol cigarette ban could help reduce tobacco use among young adults.

Moral injury is an array of symptoms theorized to develop in response to morally injurious events, defined as events that challenge one’s core moral beliefs and expectations about the self, others, and world. Recent measures of moral injury have distinguished self-directed moral injury (e.g., moral injury symptoms that emerge following the perpetration of morally injurious events) from other-directed moral injury, the symptoms of which are believed to stem from one’s response to actions that others have committed (e.g., within-rank violence, failures of leadership, and acts of betrayal committed by trusted others or institutions). Using a convenience sample of 154 primarily former military women, the present study examined if other-directed moral injury symptoms (e.g., anger, betrayal, and mistrust) associated with military experience would mediate the association between military sexual harassment and mental health and substance abuse symptoms. Results demonstrated that 85.8% ( n = 127) of the of this sample of women veterans reported experiencing sexual harassment during their military service. Using a single mediation model, we further demonstrated that other-directed moral injury mediated the association between sexual harassment experience and mental health symptoms. Given the percentage of women veterans who reported sexual harassment, these results suggest that additional training for military members, and particularly, military leaders, is necessary to begin to reduce sexual harassment. In addition, mental health providers who work with current and former military members should consider how other-directed moral injury may be associated with mental health symptoms among women veterans who have experienced sexual harassment while in the military.

Introduction: Current cannabis use is high in young adults (ages 18-24) and cannabis use disorder (CUD) rates have increased over the last decade. Subjective responses to one’s first use of cannabis may explain continued use, wherein more positive first use experiences influence progression to regular and problematic use. Sensation seeking is associated with cannabis use and may also influence cannabis problem severity. This study examined the relationship between subjective experiences at first cannabis use and sensation seeking on cannabis use behavior and CUD diagnosis. Method: Participants were 97 young adult current cannabis and tobacco co- users (55.7% male, 50.5% White) who completed the baseline survey of a longitudinal study examining daily patterns of tobacco and cannabis use and co-use. Participants completed the 4-item Brief Sensation Seeking Scale and indicated intensity of 15 sensations at first cannabis use (1 = not at all to 5 = intense): dizziness, lightheadedness, nausea, paranoia, confusion, happiness, anxiety, taste, smell, relaxation, energy, difficulty inhaling, coughing or choking, giddiness or laughter, and rush or “buzz.” Cannabis use outcomes included: (1) past 30-day number of days used cannabis; (2) past 30-day cannabis intoxication intensity (1 = not at all high to 10 = extremely high); and (3) likelihood of a CUD (score ≥ 12 on the Cannabis Use Disorder Identification Test- Revised). Analyses: A principal components analysis (PCA) reduced the 15 sensations into factors. Next, separate regression analyses (linear or binary logistic) were conducted to examine the associations of the PCA-derived factors and sensation seeking on the cannabis outcomes, controlling for gender, race, and age at first cannabis use. Results: Over half (61.9%) of the participants met criteria for a CUD. PCA results indicated a 4-factor solution: (1) “positive emotional experiences” (e.g., happy); (2) “negative physical experiences” (e.g., dizzy); (3) “negative emotional experiences” (e.g., paranoia); and (4) “taste and smell.” Regression results indicated greater negative physical experiences were associated with an increased likelihood of a CUD diagnosis (AOR = 1.93, p = .038) and lower average cannabis intoxication (b = -0.343, p = .049). Greater negative emotional experiences at first use were associated with less frequent cannabis use in the past 30 days (b = -2.043, p = .028). Conclusion: Negative emotional experiences associated with first use of cannabis may impede continued use. Negative physical experiences (e.g. nausea, lightheadedness) may be variable in perception, which could explain the inconsistent associations of this factor with CUD diagnosis and past 30-day use. Understanding subjective experiences of first cannabis use could be used as a treatment target by helping patients identify reinforcing sensations associated with their use, and guiding them to sober activities with similar sensations.

Significance: With the changing cannabis legalization landscape, it is important to assess how people may respond to new cannabis legalization policies to inform the effectiveness of such policies that balance public health with consumer needs and interests. Recent research compared intentions to use legalized cannabis among young adult never and ever cannabis users (Leung et al., 2020) and found 59% of never users and 41% of ever users intended to try cannabis if it were legal. However, past research has not examined differences in cannabis use intentions among different groups who report using cannabis for medical reasons versus non-medical reasons, even though past research has demonstrated the importance of differentiating the two groups (Roy-Byrne et al., 2015). As such, the present study aims to assess the unique correlates of responses to cannabis legalization across non-users, cannabis users without a license and cannabis users with a license. Method: Participants were adults living in Oklahoma (verified by self-reported zip code of residence) who participated in one wave of a 3-wave cross-sectional online survey (N = 5,248; 63.7%, non-past 30-day users, 15.8%, past 30-day cannabis users without a medical cannabis license, 17.8%, past 30-day cannabis users with a license) with an average age of 40.35 years. Participants were female (56.8%) and non-Hispanic White (70.3%). Participants completed measures related to past 30-day cannabis use, procession of a cannabis license, and were asked to “select all that apply” to a single item with 8 response options about how they would respond if recreational cannabis was legalized in their state. Results: Multivariable logistic regression models revealed significant differences in all 7 of the response options analyzed among non-users, cannabis users without a license and cannabis users with a license controlling for demographic characteristics (ps < .05; the 8th item “would use it less” was not assessed among non-users). Next, logistic regression models were examined in all 8 of the response options to compare cannabis users with a license and cannabis users without a license. Cannabis users with a license were more likely to report they would recommend cannabis to a friend or family member (AOR = 1.32, 95%CI: 1.04, 1.68), and they would use cannabis the same as they do now (AOR = 1.75, 95%CI: 1.43, 2.15). In contrast, cannabis users without a license were more likely to report they would use cannabis more than they do now (AOR = .44, 95%CI: 0.34, 0.57), they would use other types of cannabis (AOR = .62, 95%CI: 0.47, 0.80), and they would use cannabis more often to help treat their symptoms (AOR = .60, 95%CI: 0.47, 0.77). Conclusion: Findings support evidence of differences in how groups would respond to non-medical cannabis legalization with cannabis users without a license intending to use more cannabis. This greater use could become problematic as cannabis strands become more potent with non-medical legalization (Shover & Humphreys, 2019). Future research should continue to examine responses to non-medical cannabis legalization to inform cannabis harm prevention and policy changes related to legalizing non-medical cannabis.

BACKGROUND: Event-specific drinking occasions (e.g. holidays, special occasions, school breaks) have been associated with heavy drinking and negative alcohol-related consequences among college students. The current study extends prior research by examining understudied holidays and changes in protective behavioral strategy use during these event-specific drinking occasions. METHOD: Participants were 537 college students between the ages of 18 and 24 who retrospectively reported drinking in the past two weeks. Several alcohol use variables (e.g., frequency, quantity, heavy episodic drinking frequency), negative alcohol-related consequences, and protective behavioral strategies were assessed for the previous 14 days. Ten event-specific drinking occasions were coded for the 14-day reporting period. A series of Analysis of Covariance models were conducted to examine differences on alcohol use variables, negative consequences, and protective behavioral strategies for weeks that included an event-specific drinking occasion relative to a no holiday reference timeframe. RESULTS: Compared to the no holiday reference group, several event-specific drinking occasions (e.g., Labor Day, Martin Luther King Day) were associated with greater alcohol use, negative consequences, and protective behavioral strategy use. In contrast, other occasions were determined to be low-risk holidays (e.g., Veterans Day) when protective behavioral strategies were less frequently used. Some occasions (e.g., spring break) did not exhibit the expected clear pattern of risk. CONCLUSIONS: College students’ alcohol use, negative consequences, and protective behavioral strategy use vary across event-specific drinking occasions. Determining which event-specific drinking occasions are associated with risky alcohol use and the lowest use of harm reduction strategies is important for prevention and intervention programs.

Bisexual women report more physical and psychological health problems than lesbian women do, which may be attributed to greater sexual minority stress and less social support. However, many studies combine lesbian and bisexual women into a single group. The current study examined if sexual minority stress and social support mediated the association between women’s sexual identity (lesbian or bisexual) and health-related outcomes. A total of 650 U.S. young adult lesbian (n = 227) and bisexual (n = 423) women completed an online survey about sexual minority stress, social support, and physical and mental health problems. Bisexual women reported more physical and mental health problems. A sequential mediation model showed that bisexual women reported greater sexual minority stress than lesbian women, which in turn was associated with less social support, which was associated with more physical and mental health problems. Greater sexual minority stress and lower social support may help explain why bisexual women report more health-related problems than lesbian women. The results of the present study support the importance of examining risk and protective factors for health problems separately for lesbian and bisexual women. Health-related intervention programs that target sexual minority women may need to be tailored differently for lesbian and bisexual women.

In the present study, we tested the effectiveness of a Theory of Planned Behavior-based cyberbullying bystander video on three outcomes: joining the bully, helping the victim, and doing nothing as compared to a control group. University students (M = 23.68 years old; female = 78.7%), were randomly assigned to a cyberbullying bystander (n = 113) or an alcohol control (n = 112) video. The bystander video showed students defining and depicting four types of cyberbullying (malice, public humiliation, deception, and unwanted contact) with bystanders present and giving suggestions for positive responses when witnessing cyberbullying. Participants completed surveys prior to viewing the video, immediately following the video, and 1 month later. Positive attitudes, favorable injunctive norms, and perceived behavioral control regarding doing nothing when witnessing cyberbullying were significantly lower for the cyberbullying than control group immediately following the video. Further, the experimental group reported higher intentions to help the victim and lower intentions to do nothing when witnessing cyberbullying compared to the control group. Although mean differences for some of these effects were in the same direction at 1-month follow-up, no significant differences were found. Findings are discussed in terms of implications and future directions for cyberbullying intervention programs targeting improvements in bystander behavior.

Sexual minority women experience greater health disparities relative to heterosexual women, which is thought to be due to unique stressors related to their sexual identities. Daily diary or momentary assessments may provide a more nuanced approach to understanding how sexual minority stressors relate to health behaviors than cross-sectional studies provide. To date, there is no validated measure to examine daily sexual minority stressors. A recent pilot study developed a brief (8-item) measure for assessing sexual minority stressors in self-identified lesbian or mostly lesbian women (Heron et al., 2018). Although an optimal number of items were generated to best capture the daily experiences of lesbian women, psychometric examination and validation of this new measure is necessary. Using multilevel confirmatory factor analysis among a fully scaled sample of sexual minority women, the present study established that the Daily Sexual Minority Stressors Scale has good model fit as a unidimensional measure (i.e., one factor at each level of analysis). Intraclass correlations indicate the majority of variation (57%) is within person. Additionally, we established convergent and discriminant validity using similar measures (single-item assessment, general stressors, negative affect, history of discrimination, and heterosexism). Finally, criterion validity was supported. At the daily level, experiencing daily sexual minority stressors was associated with a significantly greater likelihood of drinking alcohol that day. Experiencing more daily sexual minority stressors during the study period was significantly associated with a history of harassment and discrimination, victimization, isolation, vigilance, and also with acceptance concerns, difficult processes, and internalized homonegativity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30-days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self-reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30-days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30-days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30-days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.

It has been well documented that alcohol use is a risk factor for sexual assault. However, few studies have examined how alcohol use is associated with sexual coercion experiences. Furthermore, off-campus parties and bars are drinking locations where alcohol use is high among college students. It is important to determine other risk factors, such as the drinking location, that may affect alcohol use and sexual coercion. The current study examined whether alcohol use (drinks per week and binge drinking) mediated the association between drinking location frequency (off-campus party and bar/restaurant) and experiencing sexual coercion in the past 30 days. Participants were N = 295 young adult ( Mage = 21.17 years, SD = 2.70) undergraduate women who reported drinking at least once in the past 30 days and completed an online survey. Results revealed that 88 (29.8%) participants experienced sexual coercion in the past 30 days. Participants who experienced sexual coercion in the past 30 days reported greater drinks per week, were more likely to binge drink, and reported drinking more frequently at off-campus parties than those who had not experienced sexual coercion. Drinks per week significantly mediated the relationship between drinking location frequency (off-campus party and bar/restaurant) and sexual coercion. Specifically, more frequent drinking at off-campus parties and bars/restaurants was associated with greater drinks per week, which in turn was related to experiencing sexual coercion in the past 30 days. Binge drinking significantly mediated the association between frequency of drinking at a bar/restaurant and sexual coercion, but not off-campus drinking frequency. Findings suggest that college student alcohol interventions that target harm reduction should consider including information about how the drinking location may intersect with alcohol use to increase risk for sexual coercion.

Research indicates that One Stop Service Centers may not be universally accessible as required by law. This article includes an overview of the Workforce Innovation and Opportunity Act (WIOA) and the results of two surveys: a statewide survey of persons with disabilities (customer survey) and a self-report checklist (provider survey) of One Stop system administrators and staff. The surveys assess perspectives on the accessibility of One Stop services for persons with disabilities. Findings suggest that improvements in the areas of outreach, staff training, and environmental adaptations may make the One Stops more accessible and user-friendly. The article provides implications for rehabilitation counselors and presents strategies for conducting a comprehensive program evaluation, which may improve access and service delivery within One Stop Service Centers.

Moral injury is hypothesized to develop from witnessing or engaging in events that violate one's beliefs about themselves and has been shown to be associated with negative mental health symptoms. Although there has been an increase in research examining moral injury among military veterans, mechanisms that link moral injury to mental health outcomes are not well understood. The present study examined rumination subcomponents (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) as possible mediators of the associations between moral injury (both self-directed and other-directed symptoms) and negative mental health symptoms (i.e., depression, anxiety, suicidality, sleep disturbance, memory problems, and posttraumatic stress disorder symptoms). Participants were 189 combat wounded veterans (180 men; Mean age = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability (n = 176, 93.1%), with the average participant reporting a 90% total VA disability ranking, and most participants had received a purple heart (n = 163, 86.2%). Within our comprehensive mediation model, we found eight significant mediation effects with the most consistent mediator being problem-focused thoughts. Specifically, both self-directed and other- directed moral injury were associated with increased problem-focused thoughts, which in turn was associated with higher reported symptoms of depression, anxiety, and posttraumatic stress disorder. Taken together, rumination, and in particular, problem-focused thoughts, is relevant to understand the increased vulnerability of military veterans to exhibit poor mental health outcomes when experiencing moral injury.

Purpose: Health disparities have been identified between groups of diverse young sexual minority women (SMW) and heterosexual women. This approach may generate sufficient group sizes for statistical analyses but obscures important differences. Moreover, some young women may not identify as “lesbian” or “bisexual” but somewhere in between. This study examined health and sexual minority identity-specific outcomes among three groups of SMW—women who identify as “exclusively lesbian,” “mostly lesbian,” and “bisexual.” Methods: Participants were 990 young (18–30 years old) SMW (exclusively lesbian: n = 305, mostly lesbian: n = 133, bisexual: n = 552) who completed an online survey, including information about mental and physical health symptoms, hazardous drinking, and identity uncertainty. Those who reported alcohol use in the past 30 days responded to questions about their alcohol use and alcohol-related negative consequences. Results: Controlling for demographic differences, health outcomes varied significantly by identity. Mostly lesbian and bisexual women reported the most depression, anxiety, and physical health symptoms; mostly lesbian women reported the highest levels of hazardous drinking. Among those who reported drinking, mostly lesbian women drank the most frequently and reported the most alcohol-related consequences. Mostly lesbian women reported the most identity uncertainty. Conclusion: Mostly lesbian women were similar to bisexual women on several health outcomes. They appear unique, however, in drinking behavior and identity uncertainty. Collapsing across identities in health research may affect outcomes.

Background Impulsivity is positively associated with alcohol use. However, scant research has used person-centered approaches to examine how patterns of impulsivity facets may be associated with alcohol-related outcomes. Consequently, the present study sought to (1) identify latent groups of individuals who share similarities based on the five facets of impulsivity assessed using the UPPS-P scale (positive urgency, negative urgency, premeditation, perseverance, and sensation seeking) and (2) examine differences between latent profiles on alcohol use (i.e., typical alcohol quantity, typical alcohol frequency, binge frequency), alcohol consequences, and drinking motivations. Methods Participants were 360 (M age = 21.83; 78.9 % female; 49.4 % racial/ethnic minority) college students who reported weekly drinking over the prior 30 days. They completed questionnaires of impulsivity, alcohol use behaviors, alcohol consequences, and drinking motivations. Latent profile analysis was used to identify classes based on the five UPPS-P facets as indicators. Results Results revealed that three classes best fit the data: Highest UPPS-P (14.4 %); Moderate UPPS-P (56.9 %); and Lowest UPPS-P (28.6 %). Profiles did not vary on drinking behaviors (quantity, frequency, or binge frequency), but significant differences were observed on alcohol consequences and drinking motivations, specifically coping and conformity motives. Conclusions Our data demonstrated that UPPS-P facets tend to cluster together, and patterns may pose risk for consequences and negative motives for drinking. The current study contributed to the conceptualization of impulsivity by identifying specific impulsivity typologies that may be used to target individuals at elevated risk for alcohol consequences.

Background Little is known about the correlates of e-cigarette (EC) use among adults seeking smoking cessation treatment, and it is unclear how EC use affects smoking treatment outcomes. Methods Participants were 649 adult smokers enrolled in smoking cessation treatment. Participants completed a baseline (pre-quit) assessment with follow-up at 4-, 12-, and 26-weeks after a scheduled combustible cigarette (CC) cessation date. EC use was described before and after the CC cessation date, and the impact of baseline EC use on CC cessation at follow-up was evaluated. Results At baseline, 66.6 % of participants had ever-used ECs and 23.1 % reported past 30-day EC use. Past 30-day EC users were younger, more socioeconomically disadvantaged, more CC dependent, and less likely to report Black race compared to non-users. At the 4-, 12-, and 26-week follow-ups, 6.4 %, 7.4 %, and 8.1 % reported dual EC/CC use; and 2.7 %, 3.4 %, and 2.7 % had switched to exclusive EC use. Past 30-day EC use at baseline was not associated with CC cessation at any follow-up. However, among baseline past 30-day EC users (n = 150), using ECs ≥ once per week was associated with a lower likelihood of CC cessation at 26-week follow-up (adjusted OR 0.346, 95 % CI: 0.120, 0.997). Conclusion Findings indicated that dual users of CCs and ECs at baseline differed from CC-only users on sociodemographic and smoking characteristics. Baseline EC use did not impact smoking cessation overall. However, among past 30-day users, more frequent EC use at baseline adversely impacted longer-term cessation outcomes, perhaps due to greater baseline CC/nicotine dependence.

Background Alcohol and other drug use disorders co-occur with cigarette smoking and negatively impact cessation outcomes. Objectives This study examined the differential effects of current and lifetime DSM-IV drug diagnoses on the 6-month smoking outcomes of 84 untreated heavy drinking smokers who were motivated to quit smoking in the next 6-months. Methods Generalized estimating equations (GEE) assessed changes in nicotine dependence, readiness to quit smoking, and prevalence of heavy smoking from baseline to 6-months as a function of time, baseline drinking severity, and drug diagnosis. Results GEE models showed that nicotine dependence and prevalence of heavy smoking decreased over 6-months, irrespective of drug diagnosis and baseline alcohol consumption. Several 3-way interactions were found, showing differences in the rate of change over time in readiness to quit smoking and prevalence of heavy smoking as a function of current versus lifetime drug diagnosis and higher versus lower of baseline alcohol consumption. Conclusions/Importance: Drug diagnoses are common in risky drinking smokers, and significantly impede changes in smoking behavior and motivation to quit. Treatment planning for smoking cessation should include a thorough assessment of current and past drug use behavior to determine the impact on readiness to quit and quit success. Mechanisms of change in smokers with multiple substance use diagnoses should be examined.

Bisexual women drink more than lesbian and heterosexual women. However, few studies have examined factors that influence drinking among bisexual women. Although descriptive drinking norms are strong predictors of drinking, little research has examined how drinking norms influence alcohol use for bisexual women. The present study examined bisexual women's reports of descriptive drinking norms for bisexual, lesbian, and heterosexual women, and associations with their own frequency of alcohol consumption, quantity, binge drinking, and hazardous alcohol use. Participants were 179 self-identified bisexual women between 18 and 30 years old who reported past 30-day drinking. Participants perceived more frequent alcohol use for bisexual and heterosexual women as compared to lesbian women. Further, participants perceived higher alcohol quantity for heterosexual as compared to lesbian women, but norms for alcohol quantity did not differ between bisexual women and other groups. Descriptive drinking norms about bisexual women were positively related to participants' frequency of alcohol consumption, binge drinking, and hazardous alcohol use. In contrast, descriptive drinking norms about heterosexual women were negatively associated with participants' binge drinking and hazardous alcohol use. Findings document the importance of assessing drinking norms separately for bisexual, lesbian, and heterosexual women. Alcohol interventions that include information about drinking norms for bisexual women specifically may be more effective at reducing hazardous drinking.

Moral injury (MI) results from perpetration of or exposure to distressing events, known as morally injurious events (MIEs), that challenge moral beliefs and values. Due to the type of involvement in recent military conflicts, many veterans report MIEs that may cause dissonance and, in turn, MI. Although two existing measures assess MIEs, neither currently assesses the defining characteristics of MI (i.e., guilt, shame, difficulty forgiving self and others, and withdrawal). The present study reports the initial psychometric test of a modified version (Robbins, Kelley, Hamrick, Bravo, & White, 2017) of the Moral Injury Questionnaire - Military version (MIQ-M; Currier, Holland, Drescher, & Foy, 2015) in a sample of 328 military personnel (e.g., veterans, National Guard/reservists, active duty members). The MIQ-M was modified to assess both MIEs and the defining characteristics of MI. Exploratory factor analyses suggested a three-factor model of MIEs consisting of Atrocities of war, Psychological consequences of war, and Leadership failure or betrayal. The modified MIQ-M factors were correlated with defining characteristics of MI. In addition, each MIE factor and associated defining characteristics of MI were positively correlated with symptoms of posttraumatic stress disorder, depression, and anxiety, as well as substance use. The modified MIQ-M is a reliable measure of MI that is comprised of three subscales that are associated with, but distinct from, mental health outcomes. Although findings are promising, further research evaluating the applicability of the modified MIQ-M in clinical settings is required to establish construct validity of the defining characteristics and secondary manifestations of MI.

Introduction Dual use of little cigars/cigarillos (LCCs) with cigarettes is becoming more popular; especially among men, but infrequently studied. Dual tobacco users show a higher prevalence of health-risk behaviors such as drug and alcohol use, are likely exposed to higher levels of nicotine and tobacco-related toxicants, and have greater difficulty quitting and maintaining abstinence. This study examined the effects of alcohol use, and desire to quit smoking on dual use of LCCs and cigarettes among men and women. Methods Data utilized responses from a screening survey of 571 adult smokers. Basic demographic information, current cigarette use, desire to quit smoking, frequency of current LCC use, and alcohol and drug use were collected. Results Dual users were more likely to be male and younger, report drug use in the past 90-days, and have a lower desire to quit smoking. Regression analyses showed a 3-way interaction of gender, alcohol use frequency, and desire to quit smoking, such that men who drank alcohol more frequently who had a higher desire to quit smoking used LCCs more frequently than men with a lower desire to quit. Discussion Alcohol use may be a risk factor for men's dual use of LCCs and cigarettes among those who want to quit smoking. Implications for prevention and treatment are discussed.

Background Smoking marijuana in a cigar (blunt use) is gaining popularity in the U.S. Research suggests that blunt users differ from exclusive cigar or marijuana users on a variety of demographic and substance use factors. Misreporting of blunts and cigars is also common, particularly among young people, and may lead to inaccurate prevalence estimates. To determine subtype differences, this study investigated the prevalence and demographic, mental health, and substance use correlates of four mutually-exclusive groups of blunt, cigar, and marijuana past 30-day users (cigar-only, blunt-only, non-blunt marijuana, or dual cigar-blunt). Method Data were analyzed from the 2013 National Survey of Drug Use and Health. Results In weighted multinomial logistic regression models, respondents who were younger, Black, and who had used tobacco, alcohol, or other drugs in the past 30-days had the highest odds of reporting blunt-only or dual cigar-blunt use. Those reporting blunt-only and dual cigar-blunt use also endorsed a greater number of marijuana and alcohol use disorder symptoms compared to those reporting cigar-only and non-blunt marijuana use. Lower marijuana risk perceptions were associated with increased odds of marijuana use with or without blunts. Major depressive episode was uniquely associated with non-blunt marijuana use. With respect to misclassifiers, respondents who reported past 30-day blunt use but not past 30-day marijuana use were younger, Black, female, and had lower education and income. Discussion Those who report blunt-only and dual cigar-blunt use showed the most severe risk profiles. Communicating health consequences and risks of blunt use should be directed toward specific subgroups.

This cross-sectional study examined whether depressive symptoms strengthened the relationship between different forms of sexual coercion victimization and drinking to cope motivations, which was hypothesized to influence alcohol use. Participants were 214 female undergraduates who completed an online survey. Participants who experienced any lifetime sexual coercion and reported higher depressive symptoms were the most likely to report drinking to cope motivations, which in turn were associated with alcohol use. Depressive symptoms did not strengthen the relationship between specific forms of sexual coercion, drinking to cope, and alcohol use. Increasing emotion regulation strategies among sexual coercion victims may reduce drinking.

Introduction Interactive Voice Response (IVR) technology has become an increasingly popular and valid method for collecting Ecological Momentary Assessment (EMA) data on a variety of health-risk behaviors, including daily alcohol use and cigarette smoking, and for stimulating behavior change. However, very little research has evaluated the parameters of IVR compliance and reactivity in respondents who may have greater problem severity than samples previously examined in published IVR studies. This study examined the prevalence and correlates of use, receptivity and reactivity to IVR monitoring in 77 untreated risky drinking smokers who were motivated to quit within the next 6 months. Methods Respondents completed twice daily IVR assessments for 28 days and were re-assessed immediately after IVR to measure receptivity and reactivity to daily monitoring and six months post-baseline. Results Mean compliance rate was 70.6%, with a morning rate of 72.4% and an evening compliance rate of 68.9% out of all possible surveys. IVR assessments of drinking and smoking were significantly associated with baseline paper-pencil reports of the same. African-American participants and those who reported more daily stressful events were more compliant. Between the baseline session and the 6-month follow-up, 68% of the sample reported engaging in some form of smoking behavior change (50% reduction in CPD, a quit attempt, pastmonth continuous abstinence). Nearly 80% reported increased awareness of their behavior due to the IVR and 40% reported intentional behavior change from IVR monitoring. The odds of making a quit attempt at the 6-month follow-up were significantly higher among respondents who reported making purposeful changes to their smoking as a result of IVR monitoring (AOR=3.25, p

BACKGROUND: Given higher sexual victimization and greater alcohol use among bisexual women, a critical public health challenge is to understand within-group variation that may heighten or explain these associations in bisexual women. OBJECTIVES: The present study tested a moderated mediation model in which sexual coercion was hypothesized to be associated with alcohol-related consequences via drinking to cope motives in self-identified bisexual women who reported at least occasional binge drinking. Negative affect was hypothesized to moderate the sexual coercion-drinking to cope motives association. METHODS: Participants were a community sample of 107 self-identified bisexual women (age M = 20.97, SD = 2.11) who completed an online survey and reported at least one binge drinking episode as well as engaging in sexual activity in the past 30 days. RESULTS: Of these participants, 57 (53.3%) reported one or more experiences of sexual coercion in the past 30 days. Sexual coercion was associated with negative alcohol-related consequences via drinking to cope motives. Negative affect moderated the association between sexual coercion and drinking to cope motives such that the association was stronger among women with greater negative affect. CONCLUSIONS/IMPORTANCE: Methods of addressing vulnerability to sexual coercion and educating young bisexual women about the association between sexual coercion and potentially problematic affective coping through alcohol use are needed.

Traumatic Brain Injury (TBI) is a multi-faceted and complex injury with unique incidence, prevalence, and consequence that affects health, independent function, and participation in society. Curren tly, limited long-term funding sources are available to support the vocational rehabilitation needs of individuals with TBI. To improve our understanding of the diverse needs of this population, eight vocational organizations throughout Florida received community capacity-building grants awards. Through these grants, 81 individuals with TBI received vocational guidance counseling and disability adjustment services for a period of one year. Participants completed a project survey upon entry into and exit from the program, with a completion response rate of 48%. Results indicate that the participants' internal thoughts and beliefs about ability to work showed significant improvement after receipt of customized services. Survey findings suggest that the individuals who received tailored vocational guidance and disability adjustment services showed better adjustment to return to work.Keywords: Traumatic brain injury, vocational guidance counseling, disability adjustment counseling, community capacity-building, return to work.Persons with traumatic brain injury (TBI) encounter a number of barriers and challenges that impede vocational success. These include the complexities and characteristics of the injury itself, availability and appropriateness of services, constraints within the community and society, and the potential loss of benefits that may occur with vocational placement. Vocational guidance counseling helps individuals with TBI to understand their strengths and weaknesses and to construct successful rehabilitation plans that allow them to return to work.In this article, we first provide an overview of the difficulties faced by persons with TBI who want to return to work. We then describe and discuss pilot projects and community capacity-building efforts implemented in eight regions throughout the state of Florida during 2006 and 2007 with a goal of providing stakeholders with a better understanding of the unique vocational needs of persons with TBI. Finally, we suggest that our findings may inform the rehabilitation counseling profession and stimulate future research and replication.Brain InjuryA leading cause of disability and death in the United States is TBI. Approximately 1.7 million individuals sustain a TBI each year and over 3.2 million people are living with the long-term effects of this injury (Centers for Disease Control and Prevention, 2011; Corrigan, Selassie, & Langlois-Orman, 2012). Costs associated with medical treatment and lost earnings due to a TBI are estimated to be $76.5 billion in the United States (Coronado, McGuire, Faul, Sugeririan, & Pearson, 2012; Faul, Xu, Wald, & Coronado, 2010) and TBI often affects young adults in their economically productive years (Hart et al., 2010; Kissinger, 2008).Individuals who sustain a TBI may face many challenges such as functional deficits including physical, cognitive, and psychosocial limitations. These limitations typically result in dynamic consequences that negatively affect one's ability to live an independent and productive life (Andelic, Stevens, Sigurdardottir, Arango-Lasprilla, & Roe, 2012; Corrigan & Hammond, 2013; Hammond & Malee, 2013). Because of these challenges, individuals with TBI often experience on-going difficulty reintegrating into their community and returning to work after sustaining such an injury (Johnstone, Vessell, Bounds, Hoskins, & Sherman, 2003).Work is highly valued in our society. It often defines us as individuals and is a key indicator of successful community reintegration following TBI. Gainful employment provides social status, identity, and income (Degeneffe et al., 2008). Employment, for example, was a top priority for clients with TBI in a needs assessment conducted by the Brain Injury Association of Florida (BIAF; Bruce, 2005). …

© 2017 Elsevier B.V. Background and aims With no established standard for assessing tobacco dependence (TD) across tobacco products in surveys, the Population Assessment of Tobacco and Health (PATH) Study provides a unique platform for examining the psychometric properties and validity of multiple indicators of tobacco dependence across a range of tobacco products. Participants A U.S. nationally representative sample from the 32,320 adult Wave 1 interviews with analyses focused on 14,287 respondents who were current established users of tobacco products. Findings This analysis confirms a single primary latent construct underlying responses to TD indicators for cigarettes, e-cigarettes, cigars, hookah, and smokeless tobacco products. Mutually exclusive past year tobacco-user groups included: cigarette only (n = 8689), e-cigarette only (n = 437), cigar only (traditional, cigarillo, or filtered) (n = 706), hookah only (n = 461), smokeless tobacco only (n = 971), cigarette plus e-cigarette (n = 709), and multiple tobacco product users (n = 2314). Differential Item Functioning (DIF) analyses supported use of 16 of the 24 examined TD indicators for comparisons across tobacco users. With cigarette users as a reference (mean = 0.0, SD = 1.0), we observed a range of TD with hookah (mean = −1.71) and cigar (mean = −1.92) only users being the lowest, and cigarette plus e-cigarette product users being the highest (mean = 0.35). Regression models including sociodemographic factors supported concurrent validity with increased product use frequency and TD among cigarette-only (p

Background and aims Cogent arguments have been made against the need for biochemical verification in population-based studies with low-demand characteristics. Despite this fact, studies involving digital interventions (low-demand) are often required in peer review to report biochemically verified abstinence. To address this discrepancy, we examined the feasibility and costs of biochemical verification in a web-based study conducted with a national sample. Methods Participants were 600 U.S. adult current smokers who registered on a web-based smoking cessation program and completed surveys at baseline and 3 months. Saliva sampling kits were sent to participants who reported 7-day abstinence at 3 months, and analyzed for cotinine. Results The response rate at 3-months was 41.2% (n = 247): 93 participants reported 7-day abstinence (38%) and were mailed a saliva kit (71% returned). The discordance rate was 36.4%. Participants with discordant responses were more likely to report 3-month use of nicotine replacement therapy or e-cigarettes than those with concordant responses (79.2% vs. 45.2%, p = 0.007). The total cost of saliva sampling was $8280 ($125/sample). Conclusions Biochemical verification was both time- and cost-intensive, and yielded a relatively small number of samples due to low response rates and use of other nicotine products during the follow-up period. There was a high rate of discordance of self-reported abstinence and saliva testing. Costs for data collection may be prohibitive for studies with large sample sizes or limited budgets. Our findings echo previous statements that biochemical verification is not necessary in population-based studies, and add evidence specific to technology-based studies.

Traumatic Brain Injury (TBI) is complex and unique, encompassing a myriad of challenges for the person with the injury, rehabilitation counselors, and the survivor's family and friends. The challenges can affect work and family reintegration. Sustaining a TBI can result in familial strain as it affects the role and function of the individual with TBI in the family. Manifestations can include financial, psychological, and caregiver-related stress. Since individual and family coping mechanisms interrelate, it is important for rehabilitation counselors to appreciate theoretical constructs of family resiliency. This article explores the rehabilitation counselor's need to assess the connectedness of family resiliency and community reintegration outcomes in persons with TBI; it also underscores the importance of evaluating family-inclusive rehabilitative interventions.Keywords: Families, Traumatic Brain Injury, Coping, Family Resiliency, Community Reintegration, Rehabilitation CounselorsTraumatic Brain Injury (TBI) is a disability that rehabilitation counselors in the United States frequently encounter. On average, approximately 1.7 million people sustain a traumatic brain injury annually and TBI contributes to a third of all injury-related deaths in the United States (Faul, X, Wald, & Coronado, 2010). Further, approximately 3.2 million Americans, with secondary residual TBI disabilities, have long-term needs for assistance in performing their daily life activities (Corrigan, Selassie, & Langlois, 2010). Rehabilitation counselors and other healthcare professionals encounter and serve persons who have sustained a TBI; many of these are Veterans who have returned from war with combat-related brain injuries.TBI often results in a dramatic change in the individuals life-course, significant disruption in family functioning, diminution in earning potential and costly expenses over a lifetime (Finkelstein, Corso, & Miller, 2006; National Institutes of Health, 1998). Coping and adjustment to the initial injury and long-term care implications of TBI affects the individual, their family members, friends, and community (Dillahunt-Aspillaga et al., 2013; Groomes & Linkowski, 2007).Since individual and family coping mechanisms are often interrelated, rehabilitation counselors who serve clients with TBI may benefit from understanding constructs of family resiliency. The Resiliency Model of Family Stress, Adjustment, and Adaptation (McCubbin, Thompson, & McCubbin, 2001) illuminates the importance of family resources, coping mechanisms, and appraisal in the adjustment process. This article highlights the relationship between family resiliency and community reintegration outcomes in persons with TBI; it also offers guidelines for rehabilitation counselors to incorporate this knowledge into rehabilitative interventions. Key issues include connections between theory and practice, suggestions for projecting community reintegration outcomes, and the significance of specific coping mechanisms as related to resilient families in this population.TBI and Family StrainDue to the nature of its sudden onset and progression, TBI places high demands on the individual and family members during disability onset (Hassan, Wan-Fei, Abd Raman, Jamaludin, & Riji, 2012). Although often perceived as a static condition, growing evidence indicates that many types of brain injury, including TBI, are chronic and continue to change over time (Corrigan & Hammond, 2013). Chronic brain injuries represent an evolving disease process that negatively affects individuals with TBI and their families.Manifestations of behaviors and ability to achieve desired outcomes for persons with TBI often result in increased strains for caregivers and families. Frequent and interchangeable use of the terms "strain," "distress," "stress," and "burden" results in inconsistent definitions throughout the literature (Boycott, Yeoman, & Versey, 2013; Pearlin, Mullan, Semple, & Skaff, 1990). …

The negative reinforcement model of addiction posits that individuals may use alcohol to reduce with negative affective (NA) distress. The current study investigated the mediating effect of daily NA on the relationship between daily PTSD symptoms and same-day and next-day alcohol involvement (consumption and desire to drink) in a sample of 54 non-treatment-seeking female rape victims who completed 14 days of interactive voice response assessment. The moderating effect of lifetime alcohol use disorder diagnosis (AUD) on daily relationships was also examined. Multilevel models suggested that NA mediated the relationship between PTSD and same-day, but not next-day alcohol involvement. NA was greater on days characterized by more severe PTSD symptoms, and alcohol consumption and desire to drink were greater on days characterized by higher NA. Further, daily PTSD symptoms and NA were more strongly associated with same-day (but not next-day) alcohol consumption and desire to drink for women with an AUD than without. Results suggest that NA plays an important role in female rape victims’ daily alcohol use. Differences between women with and without an AUD indicate the need for treatment matching to sub-types of female rape victims.

Alcohol and smoking frequently co-occur and alcohol is a primary trigger for smoking behavior and relapse back to smoking. This study examined whether several indices of alcohol use behavior and consequences of use would be associated with changes in implicit alcohol-approach versus implicit cigarette-approach cognitions under cigarette deprived and non-deprived cognitions in 109 smokers who drank at risky or non-risky levels. An Implicit Association Task (IAT) measured how quickly respondents paired alcohol and cigarette pictures with approach and avoid words. Regression analyses examined the associations of quantity/frequency, proportion heavy drinking days, number of DSM-IV alcohol use disorder (AUD) symptoms, and risky drinking status to IAT scores under deprived conditions, controlling for IAT order effects, non-deprived IAT score, and deprived cigarette craving and withdrawal. Interactions with craving and withdrawal intensity were also examined. Results showed a significant positive association between proportion of heavy drinking days and stronger alcohol-approach than cigarette-approach motivations when deprived. There was also a conditional association of AUD symptoms to alcohol-approach motivations among respondents reporting more intense withdrawal when deprived. Alcohol quantity and frequency, as well as risky drinking status were unrelated to change in IAT scores. Findings suggest that cigarette deprivation may magnify motivation to drink, rather than smoke, among smokers who engage in more frequent bouts of heavy drinking and who report more alcohol-related problems. Results also show relative momentary and unconscious “preference” or choice for alcohol over cigarettes in some high-risk smokers, when cigarette craving and withdrawal are high.

Hookah tobacco smoking (HTS) has been increasing, particularly among young adults and has similar health effects compared to cigarette smoking. The link between HTS and poly-tobacco use is well documented, but fewer show an association between HTS and alcohol use. It is essential to identify factors that increase the risk for or addictiveness and consequences of HTS, given its growing prevalence. This study examined whether the association between HTS and poly-tobacco use differed as a function of age and alcohol consumption within in a sample of 1,223 adult cigarette smokers. Approximately 20% of participants reported HTS. Compared to non-users, hookah users were more likely to be male, highly educated, and to report drug and alcohol use, binge drinking, and poly-tobacco use but were less likely to be heavy smokers (>10 cigarettes per day). Regression analyses predicting number of tobacco products used (excluding cigarettes and HTS) indicated a three-way interaction of HTS, frequency of alcohol use, and age such that the association between HTS and number of tobacco products used was strongest for younger respondents who consumed alcohol more frequently. As observed in previous studies, alcohol is an important risk factor in the relationship between HTS and poly-tobacco use, particularly among younger cigarette smokers. The links between alcohol, HTS, and poly-tobacco use should be considered when developing HTS education and prevention materials directed toward younger cigarette smokers. Findings provide information relevant to FDA’s interest in the addiction potential of HTS and its link to poly-tobacco use.

Introduction Substance use and mental health are robustly associated with smoking and poor cessation outcomes, but not often examined in combination with menthol cigarette smoking, which is also associated with lower quit rates. This study identified classes of Black and White menthol and non-menthol cigarette smokers based on demographics, alcohol, drug, and other tobacco use behaviors. Material and Methods Using screening data from two studies, latent class analysis (LCA) was conducted to classify n = 1177 menthol and non-menthol cigarette smokers on demographic characteristics, heavy smoking, alcohol and drug use, desire to quit smoking, other tobacco product use, and use of psychotropic medication. Results Three latent classes were identified that differentiated smokers on substance use, menthol cigarette smoking, and other tobacco use behavior. One class consisted primarily of young adults who used a wide array of other tobacco products, reported the highest prevalence of other drug use, and showed the lowest desire to quit smoking cigarettes in the next 6-months. Class 2 comprised primarily of Black male menthol smokers, all of whom used cigarillos in addition to cigarettes, and who displayed moderate drug use. The third class was categorized as primarily older cigarette smokers, who engaged in very little other tobacco use or drug use, but who were most likely to self-report being prescribed psychotropic medication. Conclusions LCA allowed for the identification of distinct classes of smokers based on factors related to poor cessation outcomes, including menthol use, that have not previously been examined in combination. Interventions should target specific groups of smokers, rather than take a “one size fits all” approach.

Substance use disorders are common among persons with HIV/AIDS. This study examined the prevalence and correlates of the provision of four HIV services in a national sample of substance abuse treatment facilities.Data were from the 2011 National Survey of Substance Abuse Treatment Services.Prevalence estimates indicated that 28% of facilities offered HIV testing, 26% early intervention, 58% HIV/AIDS education, and 8% special programs for HIV/AIDS. Facilities offering inpatient substance abuse care were more than six times as likely to offer HIV testing but not more likely to offer any other type of HIV service. Facilities offering methadone treatment were 2.5 times more likely to offer HIV services.Given the high rates of substance use among persons with HIV, the prevalence of facilities offering HIV services was low in most domains, with different barriers identified in multivariable models. Integrating comprehensive HIV prevention, testing, and support services into programs that address substance abuse is needed.

INTRODUCTION: Alcohol administration studies assessing alcohol's deleterious effects on women's threat perception and response in potential sexual assault situations usually employ a moderate to high dose (.07% BAC or more) and measure alcohol's effects specifically on women's sexual decisions. The current study used a low dose (.03%, equivalent to about 1-2 drinks) to assess women's projected decisions on a different risky behavior: decisions to continue drinking and to drink higher amounts in a series of ecologically-valid sexual risk situations. METHODS: Young adult women (n=17; M age=21.8, SD=1.3, range 21-25) participated in a three-session double-blind within subjects 2 (type of scenario)×3( beverage) experiment, responding each time to 6 vignettes with an attractive man who was either Familiar or had Just Met her. In each session participants consumed a beverage (alcohol, placebo or water, random order) and projected emotional reactions and drinking decisions (likelihood and amount) in each of the 6 scenarios. RESULTS: Regardless of beverage, women predicted greater happiness, drinking likelihood, and drinking amount with "Familiar" men. However, there was also an interaction: they projected increased subsequent amounts in the.03% BAC (vs. water and placebo) condition differentially in the "Familiar" scenarios. CONCLUSION: When the woman is Familiar with the man in a risky sexual situation, just one drink may increase subsequent projected alcohol amount over that originally intended. Implications include a low dose as a possible prime for more drinking, increasing sexual assault risk. Language: en

Traumatic brain injury (TBI) is a major public health concern. Such injuries often result in dramatic changes in the individual's life-course due to the associated complex co-morbidities. Limited research exists on the use and expenditures incurred for behavioural healthcare services post-TBI. This study examined predictors of behavioural service use, incarceration and associated expenditures for individuals with TBI.Emergency Medical Services and Medicaid Claims data were used to identify individuals diagnosed with a TBI in Pinellas County, Florida, in FY 2005. Ten statewide and local administrative data sets from 2005-2008 were employed to determine subject's demographic characteristics, criminal justice encounters, behavioural health services use and associated expenditures. Average annual expenditures and use of mental health, substance abuse and criminal justice services over a 3-year period were determined.A total of 1005 individuals diagnosed with TBI were identified and, of these, 910 survived the 3-year period. Study participants were grouped into high and low behavioural health expenditure groups. Those in the high expenditure group were more likely to be male, white and to have received behavioural health services.This study provides new information about predictors of behavioural health service use and Medicaid expenditures for Floridians with TBI.

Background. Individuals with traumatic brain injury (TBI) face many challenges when attempting to return to work (RTW). Vocational evaluation (VE) is a systematic process that involves assessment and appraisal of an individual’s current work-related characteristics and abilities.Objective. The aims of this study are to (1) examine demographic and employment characteristics of vocational rehabilitation providers (VRPs), (2) identify the specific evaluation methods that are used in the VE of individuals with TBI, and (3) examine the differences in assessment method practices based upon evaluator assessment preferences.Methods. This exploratory case study used a forty-six-item online survey which was distributed to VRPs.Results. One hundred and nine VRPs accessed the survey. Of these, 74 completed the survey. A majority of respondents were female (79.7%), Caucasian (71.6%), and holding a master’s degree (74.3%), and more than half (56.8%) were employed as state vocational rehabilitation counselors (VRCs). In addition, over two-thirds (67.6%) were certified rehabilitation counselors (CRCs). Respondents reported using several specific tools and assessments during the VE process.Conclusions. Study findings reveal differences in use of and rationales for specific assessments amongst VRPs. Understanding VRP assessment practices and use of an evidence-based framework for VE following TBI may inform and improve VE practice.

Objective Alcohol consumption, nicotine use, and major depressive disorder (MDD) are highly co-morbid. The negative reinforcement model of addiction would suggest that smokers may consume alcohol to relieve negative affective symptoms, such as those associated with MDD and withdrawal from nicotine. Over time, these behaviors may become so strongly paired together that they automatically activate a desire to use alcohol, even in the absence of conscious or deliberate intention. This study examined implicit alcohol cognitions in 146 risky drinking nicotine users (n = 83) and non-users (n = 63), to help uncover cognitive mechanisms that link drinking, nicotine use, and depression together. We proposed that nicotine users with a history of MDD would have stronger implicit motivations to drink than non-nicotine users without MDD. Method Participants were assessed on lifetime MDD (n = 84) or no MDD (n = 62), and then completed an Implicit Association Task designed to test the strength of associations between alcohol pictures and “approach” words. Results Regression analyses showed that implicit alcohol–approach attitudes were stronger among risky drinking nicotine users than non-users. Alcohol–approach motivations were also stronger among risky drinking nicotine users compared to non-users with a history of MDD; nicotine use was unrelated to implicit alcohol cognitions for risky drinkers without MDD. Conclusions Implicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.

This study examined the dimensionality of DSM-IV alcohol use disorder (AUD) criteria in a nationally representative sample of college students (N = 4,605) using latent variable techniques. We used data from the 2009 National Survey of Drug Use and Health and selected those who were currently enrolled in college and current drinkers. Confirmatory factor analysis provided support for a one-factor solution of the AUD criteria. Item Response Theory analyses indicated that the alcohol abuse and dependence criteria severity parameters were intermixed along the AUD severity continuum with high discrimination parameters. Findings support reformulating the current AUD diagnostic system for the DSM-V. Study's limitations are noted.

Problem drinkers may use alcohol to avoid negative mood states and may develop implicit cognitive associations between negative emotional states and reinforcing properties of drinking. Ironically, attempts to control drinking, such as among those high in drinking restraint, may inadvertently increase desire to drink and subsequent alcohol consumption, and this may be exaggerated under times of emotional distress when urges to drink are high. We examined whether individuals who are high on drinking restraint would demonstrate stronger alcohol-related thoughts elicited by stimuli that represent the desire to use alcohol, in response to stronger versus weaker negative mood arousal. Seventy hazardous drinkers completed measurements of drinking restraint, alcohol consumption, and consequences of use. After being randomized to view negative or positive pictures sets, participants completed an Implicit Association Task (IAT) to test differences in the strength of the association between desire to approach or avoid alcohol or water cues, and then a measurement of subjective craving following the IAT. Regression analyses showed that trait restriction, but not temptation, was positively related to IAT scores, after controlling for relevant covariates and explained 7% of the total variance. Trait temptation, but not IAT, predicted subjective craving. Negative affect was unrelated to IAT scores, singly or in conjunction with measures of drinking restraint, contrary to predictions. In sum, implicit alcohol cognitions are related to attempts to restrict drinking, but not temptation to drink, and are less strongly influenced by mood state.

Introduction Despite the strong relationship between smoking and health-related consequences, very few smokers quit. Heavy drinking is a significant risk factor for health consequences, and is implicated in persistent smoking and less success at quitting smoking. Self-efficacy (SE) to abstain from smoking is an important determinant of smoking outcomes and may link alcohol use to poor quit rates. Even though research has demonstrated a strong association between drinking and smoking, and the multiplicative effect of these substances on cancer-related, heavy-drinking smokers has been largely ignored in the literature. Further, research has not taken advantage of innovative methods, such as ecological momentary assessment, to capture the impact of daily factors on smoking cessation outcomes in this particular group. The proposed study identifies daily changing factors that impede or promote SE and future smoking cessation efforts in risky-drinking smokers. Methods and analysis This is an observational study of 84 regular smokers (≥10 cigarettes per day) who drink at risky levels, report a desire to quit in the next 6 months, and show no evidence of psychiatric disturbance, severe history of alcohol withdrawal or drug dependence (excluding nicotine and caffeine). Participants report on their smoking, alcohol consumption and SE related to smoking twice a day for 28 days using interactive voice response (IVR) surveys. Multilevel regression and path models will examine within-person daily associations among drinking, smoking and SE, and how these variables predict the likelihood of future smoking behaviour at 1 and 6 months follow-up. Ethics and dissemination This protocol was approved by an accredited Institutional Review Board. The findings will help us understand the factors that promote or impede smoking cessation among a high-risk group of smokers (heavy-drinking smokers) and will be disseminated through peer-reviewed journal articles and presentations at national conferences.

Sustaining a Traumatic Brain Injury results in familial strain due to the significant impact the injury has upon the role and function of individuals and their families at home and in the community. Using the Stress Process Model of Caregiving, a caregiver needs assessment survey was developed and conducted to better understand the needs of individuals with a Traumatic Brain Injury and their caregivers. Survey results indicate that caregivers experience many challenges including unmet needs in areas of relational supports such as maintaining relationships, long-term emotional and financial support for themselves and the survivor, and the need for a patient or caregiver advocate. Implications for future practice are presented.