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Background: People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. Methods: This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. Results: 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15–1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04–1.59) and among some subgroups. Conclusions: Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use. [ABSTRACT FROM AUTHOR]

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research. [ABSTRACT FROM AUTHOR]

Background: Polydrug use has been implicated in driving a "fourth wave" of the overdose crisis in North America, specifically through concurrent use of stimulants and opioids, especially fentanyl. In France, however, heroin has historically been and remains the easiest-to-access opioid, accounting for most drug treatment demand. Whether similar polydrug use is increasing in Western Europe remains understudied, despite severe health implications and potential inadequate public health responses. Methods: We take advantage of a nation-wide dataset containing information on all patients serviced in treatment centers in France from 2010 to 2020. We conduct Poisson regression to determine the main predictors of stimulant use among people who use heroin (PWUH) and opioids (PWUO) generally. Results: Heroin remains the primary opioid within drug treatment in France. A decreasing number of out-patients seeking treatment for heroin use has been accompanied by an increasing trend of stimulant use over time, most commonly with powder cocaine. Our results suggest a significant increase of crack cocaine use among the most vulnerable PWUH. Concurrent use of stimulants among PWUH was positively associated with use of alcohol, cannabis, unprescribed psychotropics and hallucinogens, and negatively with tobacco. Similar results were found for all in-treatment PWUO. Conclusions: Our results uncover heterogeneity in the profiles of PWUH that should be fully acknowledged to ensure better efficiency in substance use clinical practices and policy, while simultaneously drawing attention to trends in concurrent opioid-stimulant use outside North America. We advocate for an extension of the generalized risk framework and its implementation in prevention programs. [ABSTRACT FROM AUTHOR]

Background: More than half of individuals in the United States have had adverse childhood experiences (ACEs), which can result in physical and mental distress. ACEs has been linked with greater likelihood of harmful alcohol and drug use. Research has found that protective factors, such as social support, may potentially buffer against harmful substance use engagement among those who have experienced ACEs. The purpose of this study was to examine associations between perceived social support, ACEs, and alcohol and cannabis-related problems. Moreover, this study aimed to examine if specific domains of perceived social support (family, friends, and significant other) moderated the relationship between ACEs and alcohol and cannabis-related problems. Method: Validated measures of ACEs, perceived social support, and alcohol and cannabis problems were collected in a sample of 401 emerging adults via Prolific Academic (an online data collection platform). Results: Overall perceived social support and domains such as perceived family and friend social support moderated the relationship between ACEs and alcohol-related problems but not ACEs and cannabis-related problems. The association between ACEs and alcohol-related problems was strongest at low levels of perceived family and friend social support. Perceived social support was not associated with cannabis-related problems. Conclusions: Lack of social support is a potential risk factor for alcohol-related problems among emerging adults. Bolstering perceived social support from family and friends among those who have experienced ACEs may be beneficial in intervention and treatment efforts aiming to reduce harmful substance use in this population. [ABSTRACT FROM AUTHOR]

Background: As opioid overdoses continue rising, interventions are needed to expand naloxone carriage, an opioid overdose reversal agent. Use of fentanyl test strips (FTS) might promote naloxone carriage. This study examines the relationship between FTS use, perceived overdose risk, and naloxone carriage in Wisconsin, United States. Methods: In a survey of people who use drugs (n = 341) in southern Wisconsin, respondents were asked about FTS use, perceived overdose risk, and how often they (1) have naloxone, (2) have more than one dose of naloxone, and (3) the number of naloxone doses possessed currently. Likert responses were mapped to an integer scale. Ordinal and linear multivariable regression examined the relationship between FTS use and study outcomes while adjusting for respondent characteristics. Results: Most respondents were male (59.6%), identified heroin as their drug of choice (70.7%) and reported intravenous use (87.9%). In unadjusted models, FTS use was associated with more often having naloxone (OR: 2.10; p = 0.005), more often having multiple naloxone doses (OR: 2.98; p < 0.001), and possessing a greater number of naloxone doses (dose count difference: 2.85; p = 0.001). In adjusted models, FTS use was associated with more often having multiple naloxone doses (OR: 2.29; p = 0.005) and possessing a greater number of naloxone doses (dose count difference: 2.25, p = 0.020). Conclusions: Individuals who use FTS more often carry multiple doses relative to individuals who do not use FTS. Given that naloxone carriage is critical for reducing opioid overdose risk, expanding FTS use may offer a strategy to reduce opioid overdose rates via improved naloxone carriage. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, research has linked adverse childhood experiences (ACEs) to adult health-risk behaviors such as excessive alcohol use. Yet, few have investigated health-risk behaviors among Black college students. Research suggests that Black college students are at lower risk for hazardous drinking patterns, yet ACEs appear to alter the drinking patterns of Black students. Other studies have also shown depressive symptoms and coping-motivated drinking to predict greater alcohol consumption for this ethnic group. Objective: The current study investigated the relationship between ACEs and hazardous patterns of drinking, including frequency of alcohol use, binge, and heavy drinking episodes, using a sample of 282 Black students attending a historically black college/university (HBCU). Results: Depressive symptoms and coping drinking motives were tested as serial mediators between ACEs and the three drinking patterns. Results revealed a significant indirect effect of ACEs on the frequency of alcohol use, binge, and heavy drinking episodes, through depressive symptoms and coping drinking motives. Depressive symptoms also independently mediated the relationship between ACEs and heavy drinking episodes. Conclusion: The finding suggested that drinking perhaps serves as a maladaptive coping strategy to address underlying early life stress and depression for Black students. [ABSTRACT FROM AUTHOR]

Many people who have recently delivered a baby (puerperae) experience postpartum depression. The aim of this study is to examine nicotine dependence within the 5 years prior to delivery (ND5y) as a factor. Data from TriNetX Research Network platform were used. Analysis involved determining risk ratios of postpartum depression among puerperae with/without ND5y in umatched cohorts and propensity score matched cohorts. The unmatched sample included 1,460 (13.8%) postpartum puerperae with diagnosed ND5y and 9,138 (86.2%) postpartum puerperae without ND5yt. The matched sample included 1,362 participants with and 1,362 participants without ND5y diagnosis. The unmatched and matched risk ratios were 1.75 (95% Confidence Interval [CI]: 1.55, 1.98; p < 0.0001) and 0.68 (95% [CI]: 0.59, 0.79; p < 0.0001), respectively. Postpartum depression was associated with ND5y in the unmatched sample analysis, but not in the matched sample analysis. As a potential mechanism is unknown, it is possible that some of the matched variables have a shared mechanism with post-partum depression and matching may have masked the true relationship. Therefore, both the unmatched and propensity matched analyses are presented as both have important relevance and may spur future research with non-clinical-based data. [ABSTRACT FROM AUTHOR]

Background: Interventions are needed to increase access to tobacco treatment for people experiencing homelessness. We developed a community pharmacist-linked cessation program for adults experiencing homelessness that included one-time, pharmacist-delivered counseling and furnishing nicotine replacement therapy (NRT) for 3 months. Methods: We conducted a single-arm, uncontrolled trial of the pharmacist-linked intervention among adults experiencing homelessness recruited from three homeless shelters in San Francisco, CA. We asked participants to complete questionnaires at baseline and during 12 weekly follow-up visits. We obtained information on cigarette consumption, use of NRT, and quit attempts at each visit, and reported cumulative proportions during the study interval. We used Poisson regression and logistic regression, respectively, to examine factors associated with weekly cigarette consumption and quit attempts. We conducted in-depth interviews with residents to understand barriers to and facilitators of engagement. Results: Among 51 participants, average daily cigarette consumption reduced 55% from 10 cigarettes per day at baseline to 4.5 cigarettes at 13 wk follow-up, and 56.3% had CO-verified abstinence. Use of medications in the past week was associated with a 29% reduction in weekly consumption (IRR 0.71, 95% CI 0.67–0.74), and increased the odds of a quit attempt (adjusted odds ratio (AOR), 2.37, 95% CI 1.13–4.99). While residents benefited from engaging in the pharmacist-linked program to increase quit attempts, they felt that to sustain abstinence, longitudinal tobacco treatment was needed. Conclusions: A pharmacist-linked smoking cessation program at transitional homeless shelters can reduce structural barriers to cessation care and reduce tobacco use among people experiencing homelessness. [ABSTRACT FROM AUTHOR]

Background: In the U.S., 9.3% of young adults currently vape. However, little is known about how vaping identity (i.e., internalizing vaping as an important part of oneself) can influence young adults' e-cigarette perceptions. The purpose of this study was to examine the association between vaping identity and e-cigarette perceptions among young adults. Methods: Young adults who vape (N = 252, Mage = 24.7) were recruited to participate in an online survey assessing a trusted source of health information, e-cigarette harm perceptions, and intentions to abstain from vaping. We estimated associations between vaping identity on outcomes and the interaction of vaping identity and combustible cigarette use on outcomes. Results: Participants with higher vaping identity reported lower trust in government health agencies and a doctor, and higher trust in the tobacco industry and e-cigarette industry (ps < 0.05). Those with higher vaping identity also reported lower e-cigarette harm perceptions and intentions to abstain from vaping (ps < 0.05). Conclusions: Findings show that higher vaping identity is associated with greater trust in the tobacco industry, lower trust in health experts, lower e-cigarette harm perceptions, and lower intentions to abstain from using e-cigarettes. This suggests that efforts to reduce vaping among young adults may need to leverage messages that reduce the credibility of the tobacco industry and prevent nonsmoking young adults from developing a vaping identity. [ABSTRACT FROM AUTHOR]

Epidemiologic studies commonly recommend the integration of harm reduction programs with health and social services to improve the well-being of persons who inject drugs (PWIDs). This study identified service utilization clusters for PWIDs attending a syringe exchange program (SEP) in 2017 to better understand in-house service usage. We applied Multiple Correspondence Analysis and Hierarchical Clustering on Principal Components to classify 475 PWIDs into clusters using anonymized, SEP records data from New York. Multinomial logistic regression was used to identify sociodemographic and program engagement correlates of cluster membership. Only 22% of participants utilized at least one service. We identified three clusters of service utilization defined by 1) Nonuse; 2) Support, Primary Care, & Maintenance service use; and 3) HIV/STD, Support, Primary Care, & Maintenance service use. Cluster 2 members were less likely to be living alone compared to Cluster 1 (AOR = 0.08, 95% CI: 0.04, 0.17) while Cluster 3 members were less likely to be White (AOR = 0.19, 95% CI: 0.07, 0.50) or living alone (AOR = 0.16, 95% CI: 0.06, 0.44) and more likely to be Medicaid recipients (AOR = 2.89, 95% CI: 1.01, 8.36) compared to Cluster 1. Greater than one SEP interaction, lower syringe return ratios, and being a long-term client increased the odds of service utilization. Overall, PWID clients had a low prevalence of in-house service use particularly those who live alone. However, higher service utilization was observed among more vulnerable populations (i.e., non-White and LGBT). Future research is needed to profile services used outside of the SEP. [ABSTRACT FROM AUTHOR]

Background: Routine healthcare access is critical to reduce drinking and its effects, yet little is known about Veteran and gender differences in routine healthcare access among unhealthy drinkers. The current study examined differences in routine healthcare access, stratified by Veteran status and gender, among a national sample of adults endorsing unhealthy drinking. Method: Using data from the Centers for Disease Control and Prevention's 2019 Behavioral Risk Factor Surveillance System National Survey, we identified adults who endorsed unhealthy drinking over the past month (N = 58,816; 41.4% female; 2.7% female Veterans). Bivariate and multivariable analyses modeled associations between gender, Veteran status, and their interaction in predicting routine healthcare access. All multivariable models adjusted for sociodemographic characteristics. Results: Veterans with unhealthy alcohol use reported high rates of routine healthcare access (e.g., >86% sought care in the past 2 years) and were less likely to experience a cost barrier to care (aOR = 0.75, 95% CI = 0.62–0.92). Females were more likely than males to report better access to care but also to experience a cost barrier (aOR = 1.2, 95% CI = 1.10–1.37). The interaction between Veteran status and gender was non-significant. Conclusions: Overall, healthcare access was better for Veterans and females with unhealthy alcohol use compared to civilians and males with unhealthy alcohol use. However, given that females were more likely to report a cost barrier, future implementation research aiming to improve equity in care may want to explore reasons for cost barriers and develop strategies to help reduce these barriers in order to eliminate gender disparities in primary care-based alcohol-related care. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate inequities in substance use disorder (SUD) diagnosis, opioid misuse, marijuana misuse, SUD treatment utilization, and utilization of university mental health services among sexual and gender minority (SGM) American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students. Data consisting of 8,103 AI/AN/NH students' responses to the American College Health Association's National College Health Assessment survey from fall 2015 through spring 2019 were utilized for this study. Multivariable logistic regression models were used to compare the odds of SUD diagnosis, opioid misuse, and marijuana misuse in SGM AI/AN/NH students to cisgender, heterosexual peers. Unadjusted odds of SUD treatment utilization and utilization of university mental health services were also evaluated. Compared to cisgender females, transgender (aOR = 4.43, 95% CI = 2.67–7.34) and gender diverse (aOR = 2.86, 95% CI = 1.61–5.07) students had significantly higher odds of SUD diagnosis. Similarly, significantly higher odds of SUD diagnosis were observed among sexual minorities, including gay/lesbian (aOR = 2.95, 95% CI = 1.71–5.09) and bisexual (aOR = 1.97, 95% CI = 1.30–2.99) students compared to heterosexual peers. Sexual minority students had significantly higher odds of utilizing university mental health services (uOR = 2.43, 95% CI = 1.22–4.84) than heterosexual peers. Odds of opioid misuse and marijuana misuse were also significantly increased among sexual minority students. AI/AN/NH college students who identify as SGM have higher odds of SUD diagnosis, opioid misuse, and marijuana misuse than their cisgender, heterosexual peers. These findings highlight the need to consider tailored programming for SGM AI/AN/NH students in substance use prevention and intervention efforts in U.S. college settings. [ABSTRACT FROM AUTHOR]

Background: Adverse childhood experiences are linked to a wide range of physical, social, sexual, and family dysfunctions. These experiences, such as smoking, may have negative health consequences. Objective: The goal of this study was to explain the desire to smoke in university students in Isfahan, Iran based on adverse childhood events and subjective socioeconomic status. Methods: This cross-sectional study was conducted on 450 young adults who were recruited randomly from Isfahan universities in 2020. To collect data, a checklist of adverse childhood events, craving for smoking, and a question about subjective socioeconomic status were used. Multivariate logistic regression was used to analyze the data. Results: According to the findings, 46.5 percent of all university students had at least one Adverse Childhood Experience, and 68.8 percent of all university students had some level of smoking craving. Controlling for demographic variables, respondents with one to five adverse childhood experiences (OR: 1.84; 95 percent of CI: 1.11–3.04) and six or more adverse childhood experiences (OR: 5.37; 95 percent of CI: 2.58–11.71) were more likely to crave smoking than respondents with no adverse childhood experiences. Furthermore, among all students, a higher subjective socioeconomic status reduced the likelihood of smoking by 19%. Conclusions and implications: It can be concluded that university students who have had adversity in their childhood are more likely to engage in high-risk behaviors like smoking. Because smoking is recognized as a coping mechanism for stressful events, it is suggested that personal, local, and national strategies aimed at young adults in Iran be developed. [ABSTRACT FROM AUTHOR]

Background: Social support can potentially attenuate the positive relationship between poor mental health and excessive drinking. The present study tried to understand: (1) whether there is a gender-specific relationship between poor mental health and excessive drinking; and (2) if and how social support moderates the relationship between poor mental health and excessive drinking. Methods: We analyzed the data from 2016 Behavioral Risk Factor Surveillance System (BRFSS; N = 33,705). Weighted data were stratified by gender and controlled for demographic variables. We assessed poor mental health and social support as correlates of heavy and binge drinking, followed by analyzing the moderation effect of social support X poor mental health interaction terms. Results: Poor mental health is linked with excessive drinking across genders. The interaction analysis shows that social support moderates the effect of ever having a poor mental health day in men's heavy drinking, but the interaction term is not significant in all other excessive drinking models, suggesting that social support may not buffer the negative impact of poor mental health on problem drinking, particularly among women. Conclusion: Individuals with greater mental health challenges are more likely to drink hazardously, regardless of gender. Those who have low level of social support and poor mental health, particularly men, are at risk for heavy drinking. Given the majority of the interaction results is not significant, the study provides limited support for the buffering role of social support between poor mental health and problem drinking. [ABSTRACT FROM AUTHOR]

Smoking is an important problem in adolescence. Early developmental trajectories are also associated with cigarette smoking. The present study aims to evaluate the separation-individuation process and use of transitional objects in daily smoker adolescents. The research included 97 adolescents who were daily smokers and 210 adolescents who were nonsmokers. Transitional object assessment questionnaire, strength and difficulties questionnaire- adolescent form(SDQ), children's depression inventory(CDI) and state-trait anxiety inventory for children(STAI-C), separation and individuation test of adolescence(SITA) were applied. SITA subscales scores of engulfment anxiety, need denial, and rejection expectancy was higher and separation anxiety, teacher enmeshment, nurturance seeking scores were statistically significantly lower in smoker adolescents than nonsmokers. In logistic regression analysis, separation anxiety(odds ratio [OR] 0.93; 95% confidence interval[CI] 0.87-0.98), teacher enmeshment(OR 0.93; 95% CI 0.88-0.98), practicing mirroring(OR 1.05; 95% CI 1.02,1.08) and rejection expectancy (OR 1.06 95% CI 1.02,1.11) were found to be predictors of daily smoking. The use of a childhood transitional object for feeling tired and the use of an adolescent transitional object for feeling anxious and tired was found to be significantly higher in smokers. There are some differences in the process of separation-individuation and the use of transitional objects in the smoker group. This suggests that early developmental characteristics may be associated with smoking. Further studies are needed to better understand the causal relationship between smoking and the separation-individuation process and transitional object use. [ABSTRACT FROM AUTHOR]

From the anti-tobacco and anti-marijuana campaigns of the twentieth century to the current controversies surrounding vaporizer use and the opioid epidemic, substances and substance use have been at the forefront of cultural, public health, and legal debates for decades. This work explores treatment outcomes among those with substance use disorders (SUD) by 1) comparing legal, semi-legal, and illegal drug types and their impact on treatment outcomes and 2) evaluating the extent that there exist discrepancies between those who need and those who receive treatment. Methods: Binary logistic regression models were employed with data from the 2018 National Survey on Drug Use and Health (NSDUH) to examine the relationship between type of SUD and treatment outcomes. Results: Results indicate that those with SUD to illegal drugs were generally more likely to report a need and receive treatment than those with SUD to a legal drug (alcohol use disorder). Those with SUD to some types of illegal drugs did not report more need, but in some cases reported more treatment. Additionally, analyses indicated that across treatment outcomes, those with marijuana use disorder (semi-legal drug) were less likely to report needing or receiving treatment than those with alcohol use disorder. Conclusions: This research examined the role of drugs' legal status and type of SUD in need for treatment and treatment received. The discrepancy between needing and receiving treatment suggests those with some types of SUDs may be pushed into treatment at higher rates based on the stigma surrounding the substance they use. [ABSTRACT FROM AUTHOR]

Beer remains the greatest source of per capita alcohol consumption in the United States, and increasing market availability and consumer demand for higher alcohol has meaningful public health consequences. Objectives: To determine whether apparent alcohol intake from beer changed among households over time, we used nationally-representative US Nielsen Consumer Panel purchasing data from 2004 to 2014, and incorporated information on percent alcohol by volume (ABV) to compute the number of standard drinks of alcohol consumed from beer as a result. Methods: We queried external data sources (e.g. official manufacture, consumer beer-related websites) to obtain beer-specific ABVs, merged this information with Nielsen consumer-level data, and calculated the average rate of beer and standard drink consumption per household per year. We used joinpoint regression to estimate annual percentage changes and annual absolute changes in intake over time, with separate piecewise linear segments fit between years if a significant deviation in trend was detected. Results: Higher alcohol content beer consumption increased steadily across the decade, accounting for 9.6% of total intake in 2004 compared to 21.6% of total intake by 2014. Standard drink intake from beer declined sharply post-2011 by 3.04% annually (95% CI: −5.93, −0.06) or by 4.52 standard drinks (95% CI: −8.69, −0.35) yearly – coinciding with several beer industry transitions, market share fluctuations, and consumer preference changes for beer occurring around that time. Conclusions: Despite consistent increases in higher alcohol content beer intake across the decade, households do not appear to be consuming more standard drinks of alcohol from beer as a result. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1928208. [ABSTRACT FROM AUTHOR]

There is an association between sports participation and substance use. However, there is some evidence that intramural sports in high school may not have the same effect. Therefore, the objective of this research was to examine the longitudinal associations between intramural participation in high school and substance use. Methods: This study used a three-year linked sample (2016-2018) of grade 9 and 10 (ages 13-17) Canadian high school students in the COMPASS (Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, Sedentary behavior) study (n = 7,845). Students reported their participation in intramurals over time (consistent, none, initiate, intermittent, and quit) and their substance use behaviors (binge drinking, cannabis use, cigarette use, and e-cigarette use). Mixed effects models were used. Results: 42% of students did not participate in intramurals. For binge drinking, male students who never participated had lower odds (0.66 [0.47-0.93]) compared to consistent intramural participators. Female (3.50 [CI: 1.34-9.16]) and male students (1.97 [1.28-3.02]) who did not participate in any intramurals were more likely to use cannabis than consistent participators. Male students who did not participate were also more likely to use cigarettes (1.81 [1.05-3.12]). No associations were found between intramural participation and e-cigarette use. Conclusion: Intramural participation may be associated with increased binge drinking among male high school students. More promisingly, consistent participation in intramurals may be protective against cannabis use among male and female students and cigarette use among male students. [ABSTRACT FROM AUTHOR]

Poor decision-making may represent a risk factor for adverse cannabis-related outcomes, whereas exercise has been linked to better executive functioning and substance use outcomes. This study examines the associations between self-reported exercise and cannabis use (CU) outcomes over 6 months among adolescents, and whether these are mediated by exercise-related effects on decision-making. Method: Participants were 387 adolescents aged 15–18 who completed two assessments 6 months apart. Self-reported past 6-month hours/week of exercise were assessed at baseline. At the 6-month follow-up, participants completed measures assessing past 6-month CU frequency, presence of CU disorder (CUD), and CU-related problems, as well as risky decision-making tasks (Iowa Gambling Task, Game of Dice Task, Cups Task), which were used to derive a latent construct of decision-making. We used prospective mediation to examine the role of decision-making in the relationship between exercise and CU outcomes. Results: More self-reported exercise at baseline predicted greater CU frequency at the 6-month follow-up, but did not predict the presence of a CUD, or cannabis-related problems. After controlling for confounds, baseline exercise did not predict better decision-making at follow-up. Decision-making did not predict CU outcomes, and indirect effects of decision-making were not significant. Conclusions: Contrary to hypotheses, adolescents reporting more exercise at baseline also reported higher CU frequency in our sample. This association may be explained by factors like sample characteristics or sports types, but more research is needed to explore this. Results did not support a mediating role for decision-making in the associations between exercise and CU outcomes. Supplemental data for this article can be accessed online at . [ABSTRACT FROM AUTHOR]

Background/Purpose: Emerging adulthood is an important time where substance use often peaks. Neighborhood Latinx ethnic density could be protective against negative health behaviors. Most studies on neighborhood ethnic density have focused on census-level aggregate measures, however perception of the neighborhood ethnic density could differ from objectively measured neighborhood density. This study investigated the effects of neighborhood ethnic density, both perceived ethnic and objectively measured ethnic density, on hazardous alcohol use among Latinx emerging adults in Maricopa County Arizona and Miami-Dade County Florida by gender. Methods: 200 Latinx emerging adults residing in Arizona and Florida completed a cross-sectional survey. Inclusion criteria were being age 18-25, self-identify as Latinx, and currently living in Maricopa County or Miami-Dade County. Data were analyzed using multivariate logistic regression and moderation analyses. Results: There was a statistically significant difference between perceived and objective ethnic density (Kappa = 0.353, p < 0.001). When ethnic density was measured objectively, alcohol use severity was statistically significantly lower for individuals living in highly ethnically dense neighborhoods (OR: 0.34, 95% CI: 0.12, 0.92). However, this association was only found for women in moderation analyses. There was no statistically significant association between perceived ethnic density and alcohol use severity. Conclusion: The present study found a statistically significant decrease in alcohol use severity among Latinx emerging adults who live in highly ethnically dense neighborhoods after adjusting for covariates. Future research should investigate the potential mechanisms in which these neighborhoods protect against alcohol use severity among Latinx emerging adults. [ABSTRACT FROM AUTHOR]

Purpose: Intimate partner violence (IPV) is prevalent in the U.S., and has many physical and mental health implications. While several studies have explored the impact of IPV experience on individuals, less is known about which factors are predictive of IPV victimization. Method: The current study examined the extent to which substance use, self-efficacy, and differentiation each predicted experiences of IPV among women seeking treatment for a substance use disorder using a multinomial logistic regression analysis. Results: Results showed that women who reported lower levels of differentiation were significantly more likely to experience IPV. However, no other significant IPV predictors were found. Conclusions: Current findings suggest that differentiation may be an effective therapeutic target for IPV prevention. [ABSTRACT FROM AUTHOR]

Background: Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions. Objectives: This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship. Methods: Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS. Results: Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03-.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031-.179; men: 95% CI:.003.-.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity. [ABSTRACT FROM AUTHOR]

Background: Adverse childhood experiences (ACEs) have been associated with negative adult health outcomes, including alcohol misuse. The impact of ACEs on alcohol use may vary by gender, with ACEs impacting women more than men in coping with adulthood stressors. Objectives: The objective of this study is to examine the gender-specific relationships between ACEs and self-reported binge drinking and heavy drinking in adulthood among South Carolina residents. Methods: This study analyzed a sample of 8492 respondents who completed the 2014 or 2015 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey. Logistic regression was used to examine the impact of types and the number of ACEs on binge drinking and heaving drinking in adulthood. Results: Thirty-seven percent of men and 22.8% of women survey respondents reported binge drinking and 12.2% of men and 4.1% of women reported heavy drinking. Almost all categories of ACE were associated with increased odds of reporting binge and heavy drinking; household mental illness had the greatest odds for men (aOR 1.31, 95% CI 1.30-1.33) and emotional abuse had the greatest odds for women (aOR 1.42, 95% CI 1.40-1.43). Men and women with four or more ACEs had greater odds of reporting binge and heavy drinking compared to their counterparts. Conclusions/Importance: Given the potential for negative outcomes associated with alcohol misuse and transmission of risky alcohol-related behaviors from parent to child, strategies that utilize a multigenerational approach could have a large impact on population health. [ABSTRACT FROM AUTHOR]

Background: Adult waterpipe smokers are at increased risk of obesity. However, it is unclear if adolescents, who are at the epicenter of the global waterpipe epidemic, are at similar risk. Objective: Therefore, the current study examined the waterpipe smoking relationship with obesity among adolescents. Methods: A sample of 2,313 boys and girls in grades 7-10 were surveyed about waterpipe and cigarette use in Jordan. Weight, body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio were measured. Obesity indices were assessed as a function of smoking status (never used tobacco, current waterpipe only, current cigarettes only, and current dual smoking) as well as frequency of use of each tobacco product. Results: About 51.5% of adolescents smoked waterpipe whereas 29.8% were overweight/obese. Students who smoked waterpipe weekly had twofold greater odds of being obese than never-smokers (OR = 2.14; 95% CI = 1.08-4.21). Approximately 12% of students currently smoked waterpipe but not cigarettes, 2% smoked cigarettes but not waterpipe, and 11% smoked both. Body weight and age- and gender-specific BMI were greater for waterpipe and dual users compared to never users, especially for dual vs. never users (58.6 ±.8 vs. 55.6 ±.4 and.48 ±.07 vs..29 ±.03, respectively; p <.005). Conclusions: For dual users, greater frequency of tobacco use was associated with greater weight and BMI. Waterpipe and dual use is associated with greater obesity, BMI, and body weight among Jordanian adolescents. Given the rising epidemics of both tobacco use and obesity among Middle Eastern adolescents, the clustering of these risk factors warrants public health action. [ABSTRACT FROM AUTHOR]

Background: Increasing rates of marijuana use and high rates of depression among females are major public health concerns and ambiguous study results suggest a complex association between the two. Inconsistent findings may be due to differences in sample characteristics (e.g., females vs. males) and result from differences in the relationship over time (i.e., across developmental stages). Objectives: Presently, the extent to which the relationship between depression and marijuana use differed for females in emerging adulthood, compared to young adult females, was examined. Methods: Two hundred forty females (mean age = 23.9 ± 3.4 years) from low-income urban neighborhoods completed a semi-structured HIV-risk interview, Beck's Depression Inventory II, and provided a urine sample that was tested for the presence of psychoactive drugs. Results: Approximately 35% tested positive for marijuana and 21% were experiencing depression. Results from unadjusted logistic regression analyses indicated a relationship between depression and marijuana use (OR = 2.1; 95% CI = 1.08-3.93). African Americans had higher odds of testing positive for marijuana, compared to Whites (OR = 4.6; 95% CI = 2.52-8.68). In the full model, the relationship between depression and marijuana use did not differ by developmental stage. Conclusions: Interventions aimed at reducing depression may prove beneficial for decreasing marijuana use among females between 18 and 29 years of age residing in disadvantaged communities. However, more research is needed to identify risk factors for marijuana use and to explicate the relationship between marijuana use and depression. Special consideration should be given to African American females. [ABSTRACT FROM AUTHOR]

Background: Although people who inject drugs (PWID) have been described as frequent users of emergency services, the majority of research is cross-sectional and involves records from a single emergency department (ED). Objectives: We describe characteristics of state-wide ED presentations in a cohort of PWID, and compare presentation rates to the general population. We also examine characteristics associated with frequent ED use. Methods: We used data from a retrospective linkage of public ED presentations from a cohort of 678 PWID between January 2008 and June 2013. Common principal diagnoses were described using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) chapter headings. The ED presentation trend was estimated using negative-binomial regression. Characteristics associated with frequent use of EDs were identified using generalized estimating equations (GEEs). Results: There were 3437 presentations over 4163.5 person-years (PY) and the most common principal diagnosis was injury, poisoning and other externalities (19%). ED presentations increased by 4% every six months (95% confidence interval (CI) 0.1%-0.8%) and were three times greater than the general population. A quarter (24%) of the cohort presented frequently, and they were more likely to have noninjury-related diagnoses and be aged below 30 years, and less likely to have nonurgent presentations and be male. Conclusions: PWID use EDs at a higher rate than the general population, and typically present with injuries and mental and behavioral disorders. Referrals to drug treatment, mental health, and social support services can improve patient care and reduce the burden on EDs. [ABSTRACT FROM AUTHOR]

Background:Despite substantial advances in the era of highly active antiretroviral therapy, HIV-positive persons are at high risk of tobacco-related disease and mortality. This study describes the prevalence and sociodemographic factors associated with current tobacco use among HIV-positive men and women 18 years and older receivingHIV care in Puerto Rico. Methods:Data fromthe 2009MedicalMonitoring Project (MMP) was used. A three-stage sampling designwas conducted to obtain annual crosssectional probability samples of HIV-infected adults in care. Factors associated with current tobacco use were identified using logistic regression models. All analyses were performed using STATA version 11.0. Results: The estimated prevalence of current cigarette use among the population was 29.0% (95%CI: 23.5%-35.2%), daily smoking was reported in 76.7% of them. Multivariate logistic regression models, showed thatmale drug users (injected and noninjected) were up to nine times more likely to be current smokers (OR = 9.9; 95%CI = 3.1, 31.5) as compared to nonusers. Conclusion: Findings highlight the need for smoking cessation strategies in this population, particularly among male HIV+drug users. [ABSTRACT FROM AUTHOR]

Background:Despite the opioid epidemic in the U.S., little data exist to guide postoperative opioid prescribing in Obstetrics & Gynecology (Ob/Gyn).Objective:To describe Ob/Gyn resident opioid prescription patterns in the U.S. and assess influential factors.Methods:An anonymous survey was emailed to Ob/Gyn residents in the U.S. between January–February 2015. Respondents reported the typical number of discharge narcotic tablets prescribed following six common procedures. Responses to questions addressed potential factors influencing prescription practices and knowledge about opioid abuse in the U.S. Residents who prescribed a number of discharge narcotic tablets in the top quartile were compared to those who never did. Logistic regression was used to identify factors associated with top quartile prescribers.Results:267 residents responded. Median number of discharge narcotics prescribed following cesarean section was 30 (IQR 28, 40) and after laparoscopic hysterectomy was 29 (IQR 20, 30). Factors associated with increased odds of prescribing in the top quartile included training in the West (aOR 3.15, 95% CI 1.05–9.45,p= 0.04) and agreeing with: “I prescribe postoperative narcotics to avoid getting reprimanded by attendings” (aOR 2.72, 95% CI 1.20–6.15,p= 0.02). Factors associated with decreased odds of prescribing in the top quartile included training in a community-based program (aOR 0.33, 95% CI 0.15–0.71,p= 0.005) and agreeing with: “I am conservative with the number of narcotics I prescribe after surgery” (aOR 0.34, 95% CI 0.17–0.71,p= 0.004). Conclusions/Importance:Opioid prescribing practices of Ob/Gyn residents are influenced by region of country, program-type, and factors related to hospital culture and personal insight. [ABSTRACT FROM PUBLISHER]

Background:Substance use disorder can increase the risk of suicide attempt. However, the relationship between substance use disorder and suicide attempt has yet to be explored among people who report compromised health, even though sick people are more likely to make an attempt.Objectives:Among people who report fair or poor health on the National Survey of Drug Use and Health (2006–2014;N= 502,467), I examined whether people with commonly occurring substance use disorders are more likely to attempt suicide than people without substance use disorders.Methods:Logistic regression was used to predict suicide attempt from presence versus absence of substance use disorder. Results:Among individuals reporting compromised health, those who had DSM-IV alcohol use disorders were 2.72 times (CI = 1.81–4.09,p<.001) as likely as people without SUD to attempt suicide, and people with prescription painkiller use disorders were 2.25 times (CI = 1.04–4.90,p<.05) as likely. Individuals with both alcohol and marijuana use disorders were 2.38 times (CI = 1.25–4.54,p<.01) as likely as people without substance use disorder to make an attempt, and people with both alcohol and cocaine use disorders were 3.15 times (CI = 1.16–8.60,p<.05) as likely.Conclusions/Importance:In order to help prevent suicide attempt among people who report compromised health, treatment programs that specialize in health, mental health, or substance abuse could address the drug-specific disorders that are most highly associated with the likelihood of suicide attempt. More research is needed that may underscore risk associated with other drug-specific disorders, or that substantiate the findings reported herein. [ABSTRACT FROM PUBLISHER]

Background: Social media platforms provide an indirect medium for encouraging e-cigarette use between individuals and also serve as a direct marketing tool from e-cigarette brands to potential users. E-cigarette users share information via social media that often contains product details or health-related claims. Objective: Determine whether e-cigarette use is associated with exposure to e-cigarettes on social media in college students. Methods: Data from a sample of 258 college students was obtained via a clicker-response questionnaire (90% response rate). Demographic, lifetime and current e-cigarette/cigarette use, and e-cigarette exposure via social media (peer posts or advertisements) were examined. Logistic regression was used to assess the relationship between lifetime and current e-cigarette use and viewing peer posts or advertisements on social media while adjusting for cigarette use and self-posting about e-cigarettes. Results: Overall, 46% of participants reported lifetime e-cigarette use, 16% current e-cigarette use, and 7% were current dual users of e-cigarettes and cigarettes. There were positive and significant associations between lifetime e-cigarette use and viewing peer posts (aOR = 3.11; 95% CI = 1.25–7.76) as well as advertisements (aOR = 3.01; 95% CI = 1.19–7.65) on e-cigarettes via social media after adjusting for cigarette use. Current e-cigarette use was only significantly associated with viewing peer posts via social media (aOR = 7.58; 95% CI = 1.66–34.6) after adjusting for cigarette use. Conclusions/Importance: Almost half of college students view peer posts and advertisements on e-cigarettes via social media. This exposure is associated with individual e-cigarette use. Continued efforts to examine online e-cigarette content are needed to help future interventions decrease e-cigarette use. [ABSTRACT FROM AUTHOR]

Introduction: The DSM-5 Tobacco use disorder diagnosis incorporates tobacco misuse, addictive behaviors and withdrawal symptomology. Tobacco use is bidirectionally associated with sleep pathology; however, no epidemiological studies have yet evaluated the associations between DSM-5 Tobacco use disorder and self-reported sleep disturbance. The current study aimed to evaluate health, medical and sleep-related factors among individuals within this diagnostic stratum. Method: A total of N = 36,177 adults who participated in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) were included for analyses. The adjusted odd ratios (AOR) for individual classifications of DSM-5 Tobacco use disorder among those with subjective sleep disturbances were used as the primary outcome measure and relevant demographic, clinical and medical factors were considered in all univariate and multivariable analyses. Results: Current and lifetime DSM-5 tobacco use disorder diagnoses were associated with poorer health and medical outcomes and higher rates of subjective sleep disturbances (all p < 0.001). Associations between current and lifetime DSM-5 tobacco use disorder and subjective sleep disturbances were maintained in multivariable analyses following adjustment for a range of health, lifestyle, and psychiatric factors (adjusted OR 1.11, 95%CI 1.00–1.23 and adjusted OR = 1.24, 95%CI 1.15–1.34, respectively); however, these relationships were fully explained by diagnoses of DSM-5 alcohol use disorder. Conclusions: Data from this large, representative survey indicate that the association between DSM-5 Tobacco use disorder and sleep disturbance is explained by underlying diagnoses of DSM-5 alcohol use disorder. Multifaceted substance abuse treatment protocols may improve treatment outcomes for affected patient groups. [ABSTRACT FROM AUTHOR]

Background: Substance abuse is one of the most common health outcomes associated with adverse childhood experience, and poses a significant public health threat. Objectives: The purpose of this study is to demonstrate a relationship between adverse childhood experience and a substance use disorder using nationally representative data as well as to test whether religion moderates this relationship. Methods: We conducted a secondary analysis using data from the National Longitudinal Study of Adolescent to Adult Health (n = 11,279). Three types of adverse childhood experiences were considered; physical, emotional, and sexual abuse. Logistic regression was used to determine whether risk for developing an alcohol use, cannabis use, or other drug use disorder in adulthood increased as exposure to multiple types of adverse childhood experiences increased while controlling for prior substance use and other demographic variables that have shown associations with substance use. In addition, religiosity was investigated as a possible moderator of the relationship between adverse childhood experience and substance abuse. Results: The likelihood of developing a substance use disorder later in life increased as the score on the adverse childhood experience index increased. While religiosity did significantly reduce the likelihood of developing a substance use disorder, no moderating effects were observed. Conclusions/importance: This study underscores the long-term consequences of exposure to childhood adversity. [ABSTRACT FROM AUTHOR]

Objective: We analyze whether adverse childhood experiences predict weekly alcohol consumption patterns of Kenyan mothers and their partners. Method: Randomly selected respondents (n = 1,976) were asked about adverse childhood experiences and alcohol consumption patterns for themselves and their partners. Fixed effect models were used to determine odds of reporting weekly alcohol consumption and the number of beverages typically consumed, controlling for wealth, age, education, and partner alcohol consumption. Results: Cumulative adverse childhood experiences predicted higher odds of weekly alcohol consumption of the respondent and her partner. Childhood exposure to physical abuse, emotional neglect, and mental illness in the household significantly increased odds of weekly alcohol consumption by the respondent. More drinks consumed per typical session were higher among respondents with more cumulative adversities. Physical and emotional abuse significantly predicted number of drinks typically consumed by the respondent. Conclusions: To our knowledge, this is the first study to explore and find associations between adverse childhood experiences and alcohol consumption in Kenya. Consistent with high-income settings, exposure to childhood adversities predicted greater alcohol consumption among Kenyan women. [ABSTRACT FROM AUTHOR]

Background: Substance use is common among men who have sex with men (MSM) worldwide, and epidemiologic data suggest that alcohol/substance-using MSM are at greater risk for HIV. However, there are scarce data on substance abuse treatment programs (SATPs) for substance-using MSM.Objectives: We examined proportions of substance use as well as SATP availability and use. We used multivariable regression models, controlling for potential confounders, to examine behavioral and demographic correlates of SATP availability and use.Methods: This is a cross-sectional study of a multi-region, online sample of substance-using MSM.Results: In this sample, 75% were substance-using MSM of whom 36% reported at-least-weekly use. Substance use was most prevalent among respondents from Eastern Europe/Central Asia (86%) and Latin America (79%). Among substance-using MSM, 96% and 33% reported alcohol intoxication and other substance use, respectively; 11% reported having high SATP availability; and 5% reported using SATPs. Controlling for global region of origin and age, high SATP availability was associated with high access to HIV risk-reduction education (aOR = 3.19; CI = 1.48–6.89), mental health services (aOR = 2.53; CI = 1.32–4.83), and medical care (aOR = 2.32; CI = 1.12–4.80); less than college-level education (aOR = 0.32; CI = 0.18–0.54); and higher comfort levels with providers (aOR = 1.75; CI = 1.30–2.37). Controlling for substance use frequency and personal income additionally, using SATPs was associated with higher levels of connection to the gay community (aOR = 2.76; CI = 1.22–6.22).Conclusion: In this global sample of MSM, we found high alcohol intoxication and other substance use proportions. Few substance-using MSM report SATP availability, highlighting the need to develop novel substance use programs outside traditional treatment settings. [ABSTRACT FROM PUBLISHER]

Background: There is substantial empirical evidence that negative mood triggers smoking behavior, and less support for the similar effect of positive mood. However, the relationship between the intensity of mood and smoking remains relatively under-researched. Objectives: The present study explored the association between mood intensity and smoking behavior. Methods: Seventy-three ad libitum smokers recorded their mood and concurrent number of smoked cigarettes three times daily for one week using electronic diary application. Real time assessment in natural environment enabled greater reliability, validity and generalizability of the collected data. Results: We analyzed results using within-subjects approach and obtained significant growth trend in smoking behavior that concurred with the increase of mood intensity—smokers tended to increase their consumption of cigarettes when they were feeling either happy or sad in comparison to the situation when they were in neutral mood. Importance: These findings raise implications regarding the role of mood intensity in initiating smoking behavior. [ABSTRACT FROM AUTHOR]

Background: In Europe and the United States, family relationships and parenting behavior can influence youth substance use, but less is known about their influence in Latin American countries.Objective: To explore whether parenting behavior is associated with substance use among Latin American youth.Methods: A cross-sectional, school-based survey of middle-school youth (n= 3172) in three Argentinian cities queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Parenting behavior was assessed with previously validated items that tapped into demandingness and responsiveness, separately for mothers and fathers. Multilevel logistic regression models assessed associations between parenting behavior and substance use after adjusting for student characteristics, socioeconomic indicators, sensation seeking, and smoking amongst peers and family members.Results: Substance use prevalence was 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day binge drinking (≥5 drinks), and 8% for previous year illicit drug use (marijuana or cocaine). Greater maternal demandingness was independently associated with lower likelihood of current smoking (adjusted odds ratio [AOR] = 0.77; 95% confidence interval (CI): 0.64–0.92), current drinking (AOR = 0.81; 95% CI: 0.71–0.92), binge drinking (AOR = 0.77; 95% CI: 0.66–0.99, and drug use (AOR = 0.71; 95% CI: 0.61–0.83). No other parenting behavior were independently associated with substance use, except for paternal demandingness and binge drinking (AOR = 0.84; 95% CI: 0.74–0.97). For all outcomes, no interactions were found between parenting behavior and student gender.Conclusions: Among Argentine adolescents, maternal demandingness was the strongest and most consistent correlate of substance use, regardless of adolescent substance use behavior or gender. [ABSTRACT FROM PUBLISHER]

Background: Environmental factors may operate with individual ones to influence the risk of substance use. Research has focused on severe adverse consequences influenced by contextual variables. However, the literature on community level factors influencing substance use behaviors is relatively limited across Europe so far. Objective: We capitalized on data from a National survey, exploring individual and contextual characteristics, to study adverse consequences among people with substance use disorders. Methods: The impact of area-level deprivation on nonfatal overdose, hepatitis C or B infections, and major involvement with the criminal justice system, was explored. Logistic regression models with cluster-robust errors, modeling subject-level and area-level effects, were used. Results: Living in deprived and intermediate areas, as compared with affluent ones, was associated with greater likelihood of both nonfatal overdose and jail sentences longer than 6 months, though not of active viral hepatitis. Conclusions: Area-level deprivation may play an important role in determining adverse consequences in people with substance use disorders, also after controlling for individual-level characteristics. More research is needed to understand the aspects of social and physical environments that matter for drug outcomes before effective policy and research interventions can be developed. [ABSTRACT FROM AUTHOR]

Background: The rate of alcohol-impaired driving (AID) increases during the college years and students who have reported adverse rearing environments appear to be at increased risk for the development of alcohol and drug use behaviors. Alcohol and cannabis are the most commonly used drugs by college students, and these substances are particularly predictive of substance-impaired driving. Objectives: The present study aimed to investigate whether adverse rearing environment experiences and level of alcohol and cannabis use are related to the frequency of alcohol-impaired driving and whether anxiety might buffer or accelerate this effect. Methods: Data regarding adversity, drug use, anxiety, and AID were obtained from 1,265 students annually, from first to final year of college, over four waves (Mean Age at wave 1 = 18.5 years). Results: Structural equation modeling supported associations among childhood adversity, alcohol, cannabis, and anxiety symptoms. A significant mediation effect was found such that adversity was predictive of AID via alcohol use and cannabis use. Among men, anxiety symptoms accelerated the path from increased cannabis use and decelerated the path from increased alcohol use to AID frequency. Conclusions/Importance: Childhood adversity is a developmental risk precursor to drug use and AID, whereas anxiety might serve a risk or protective factor to AID, contingent on the drug used. [ABSTRACT FROM AUTHOR]

Background: Scientists have established that social networks influence adolescents' substance use behavior, an influence that varies by gender. However, the role of gender in this mechanism of influence remains poorly understood. Particularly, the role an adolescent's gender, alongside the gender composition of his/her network, plays in facilitating or constraining alcohol use is still unclear. Objectives: This study examined the associations among the gender composition of adolescents' networks, select network characteristics, intrapersonal and interpersonal factors, and alcohol use among a sample of adolescents in the United States. Methods: We assessed cross-sectional data from a 2010 study of 1,523 high school students from a school district in Los Angeles. Analyses of adolescents' network characteristics were conducted using UCINET 6; and logistic regression analyses testing the associations between gender composition of the network and alcohol use were conducted using SPSS 20. Results: Our results indicate that the gender composition of adolescents' networks in our sample is associated with alcohol use. Adolescents in predominantly female or predominantly male friendship networks were less likely to report alcohol use compared to adolescents in an equal/balanced network. In addition, depending upon the context/type of network, intrapersonal and interpersonal factors varied in their association with alcohol use. Conclusions/Importance: Based on these findings, we make several recommendations for the future research. We call for researchers to further examine gender as a risk factor for alcohol abuse, particularly within the complex interplay between gender and network contexts. [ABSTRACT FROM AUTHOR]

Background: Clinical studies of alcohol and drug treatment outcomes frequently apply participant eligibility criteria (EC), which may exclude real-world treatment seekers, impairing the representativeness of studied samples. Some research exists on the impact of EC on alcohol treatment seekers. Little is known about drug treatment and country differences. Objectives: We tested and compared the degree to which commonly used EC exclude real-world treatment seekers with problem alcohol and drug use in Sweden and Australia, and compared the impact of EC on outcomes. Methods: Two large naturalistic and comparative service user samples were used. Respondents were recruited in Stockholm County (n = 1,865; data collection 2000–2002), and Victoria and Western Australia (n = 796; in 2012–2013). Follow-up interviews were conducted after 1 year. Cross-tabulations, Chi-square (χ2) tests and logistic regressions were used. Results: Percentages of the samples excluded by individual EC ranged from 5% (lack of education/literacy) to 70% (social instability) among Swedish alcohol cases and from 2% (low alcohol problem severity) to 69% (psychiatric medication) among Australian counterparts; and from 2% (age 60+ years) to 82% (social instability) among Swedish drug cases and from 1% (age 60+ years) to 67% (psychiatric medication) among Australian counterparts. Country differences and differences across substances appeared independent of country effect. Co-morbid psychiatric medication, noncompliance, poly drug use, and low education EC caused positive 1-year outcome bias; whereas female sex and old age introduced negative outcome bias. Conclusions/Importance: Commonly used EC exclude large proportions of treatment seekers. This may impair generalizability of clinical research, and the effects of many EC differ by country and drug type. [ABSTRACT FROM AUTHOR]

Background: The association between using smartphone dating applications (apps) and substance use in conjunction with sexual activities was only examined in homosexual men. This association was poorly understood in heterosexual samples.Objective: To explore the association between using dating apps and alcohol, and use of recreational drug in conjunction with sexual activities in college students.Design: 666 students from four universities in Hong Kong were recruited in this cross-sectional study in the year 2015. Outcome measures included the use of dating apps, sexual history, and drug and alcohol use. Multivariable logistic regressions were employed.Results: The use of dating apps for more than 1 year was found to be associated with recreational drug use in conjunction with sexual activities (adjusted odds ratio: 7.23). Other risk factors of recreational drug use in conjunction with sexual activities included being bisexual/homosexual male, a smoker, and having one's first sexual intercourse at the age of less than 16 years. The use of dating apps was not a risk factor for alcohol consumption in conjunction with sexual activities. Risk factors for alcohol consumption in conjunction with sexual activities included being older, having monthly income more than HKD5,000, and a smoker. Furthermore, risk factors for alcohol consumption in conjunction with the last sexual activity included currently being in a dating relationship, a smoker, and having sex with a casual partner.Conclusions: Using dating apps is an emerging risk factor of drug misuse. Interventions for practising safe sex and preventing drug use should be targeted at dating app users. [ABSTRACT FROM PUBLISHER]

Background: Alcohol problems and internalizing symptoms are consistently found to be associated but how they relate to each other is unclear. Objective: The present study aimed to address limitations in the literature of comorbidity of alcohol problems and internalizing symptoms by investigating the direction of effect between the phenotypes and possible gender differences in college students. Method: We utilized data from a large longitudinal study of college students from the United States (N = 2607). Three waves of questionnaire-based data were collected over the first two years of college (in 2011–2013). Cross-lagged models were applied to examine the possible direction of effect of internalizing symptoms and alcohol problems. Possible effects of gender were investigated using multigroup modeling. Results: There were significant correlations between alcohol problems and internalizing symptoms. A direction of effect was found between alcohol problems and internalizing symptoms but differed between genders. A unidirectional relationship varying with age was identified for males where alcohol problems initially predicted internalizing symptoms followed by internalizing symptoms predicting alcohol problems. For females, a unidirectional relationship existed wherein alcohol problems predicted internalizing symptoms. Conclusions/Importance: We conclude that the relationship between alcohol problems and internalizing symptoms is complex and differ between genders. In males, both phenotypes are predictive of each other, while in females the relationship is driven by alcohol problems. Importantly, our study examines a population-based sample, revealing that the observed relationships between alcohol problems and internalizing symptoms are not limited to individuals with clinically diagnosed mental health or substance use problems. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated that experiencing interpersonal discrimination is associated with cigarette smoking. Few studies have examined the relationship between the effects of physical and emotional discrimination and cigarette usage, and none have examined this relationship among Black men. The aim of this study was to examine the association between the effects of physical and emotional discrimination and cigarette smoking. Methods: Data from the Indiana Black Men's Health Study, a community-based sample of adult Black men, was used to conduct multivariate logistic regression to examine the relationship between the physical and emotional effects of discrimination and smoking, net of healthcare and workplace discrimination, age, education, household income, and being married. Results: After adjusting for having an emotional response to discrimination, health care and workplace discrimination, age, education, household income, and being married, males who had a physical response to discrimination (e.g., upset stomach or headache) had higher odds of cigarette use (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.15–3.30) than men who did not have a physical response to discrimination. Conclusion: Findings from the study suggest that Black males may use cigarette smoking as a means to mitigate the stress associated with experiences of discrimination. Future research is needed further to explore if and how Black males use cigarette smoking to cope with unfair treatment. [ABSTRACT FROM AUTHOR]

Background: Few studies examining the cognitive effects of chronic cannabis use utilize research designs where examiners are blind to user status. Even in those that do, researchers may be able to guess the user status of participants, leaving these studies vulnerable to the expectancy effect confound.Objectives: The present study examined the ability of neuropsychologists (those who would conduct research on the cognitive effects of cannabis) to differentiate cannabis users and nonusers based on physical appearance from photographs.Method: We recruited 84 participants from an international neuropsychology listserv. The sample was 59.5% female and 95.2% Caucasian, with a mean age of 41.39 years (range 26–65). Each neuropsychologist rated 25 target faces (12 cannabis users, 13 nonusers) on a Marijuana Use Likelihood Index based upon individuals' photographs.Results: Results indicate a main effect of user group, as neuropsychologists ascribed higher ratings to cannabis users on the Marijuana Use Likelihood Index, suggesting they perceive them as more likely to be users, relative to nonusers. Results also demonstrated a main effect of gender, as males received higher user ratings than females, and a significant main effect of rater gender, as female raters were more likely to rate individuals as cannabis users relative to male raters.Conclusions/Importance: The results demonstrate the importance of assessing researchers' expectations when studying the effects of chronic cannabis use, as even those designs that keep examiners blind to participant user status may be vulnerable to expectancy effects if examiners are able to guess user status based upon appearance alone. [ABSTRACT FROM PUBLISHER]

Although Latino/Hispanic adolescent substance use is a growing research area in the United States, there is little research examining the prevalence and factors associated with adolescent cigarette smoking status in this population. A nationally representative sample of 5,929 middle and high Latino/Hispanic students in the 2009 US National Youth Tobacco Survey was selected to assess the prevalence and various risk and protective factors associated with cigarette smoking status. Results revealed one in five (20%) were experimental smokers, nearly one in eleven (8.5%) were occasional smokers, and 4% were regular smokers. Multinomial logistic regression analyses showed that, controlling for demographics, family members' smoking, refusal to smoke, school absence, and exposure to tobacco marketing were associated with experimental smoking; awareness of harmful effects of secondhand smoking, refusal to smoke, exposure to tobacco advertising, and receptivity to tobacco marketing were associated with occasional smoking; and refusal to smoke, school absence, and receptivity to tobacco marketing were associated with regular smoking. This study highlights the need to integrate various risk and proactive factors associated with different smoking status into practices and policies for Latino/Hispanic adolescent smokers. [ABSTRACT FROM PUBLISHER]

Background: Information on e-cigarettes among youth in the Russian Federation is lacking. Objective: We examined prevalence of and factors associated with youth e-cigarette use in the Russian Federation. Methods: A cross-sectional, anonymous survey, conducted among 716 (females 51.5%) high school students in three cities (i.e., Ufa, Sterlitamak, Karagaevo) within the Republic of Bashkortostan, Russian Federation in 2015, assessed e-cigarette use and its correlates (i.e., sex, age, ethnicity, family structure, parents' highest degrees, antisocial behaviors, stress coping strategies, lifetime cigarette, hookah, alcohol, and marijuana use). Results: Lifetime use of e-cigarettes was 28.6% and past-30-day use was 2.2%. Multilevel modeling showed that belonging to Tatar/Bashkir ethnicity relative to Russian ethnicity (OR = 1.60) and lifetime use of cigarettes (OR = 21.64), hookah (OR = 4.21), and alcohol (OR = 1.90) was associated with greater odds of lifetime use of e-cigarettes. Furthermore, use of social support coping strategies (i.e., utilizing parents for support) were associated with lower odds of lifetime use of e-cigarettes (OR = 0.94). Conclusions: Despite high lifetime e-cigarette use, past-30-day use was low. Greater knowledge of the reasons for e-cigarette discontinuation through continued surveillance is needed in the Russian Federation. Social coping strategies involving parents may inform e-cigarette use prevention. [ABSTRACT FROM AUTHOR]

Background: Few studies have compared characteristics of clients entering alcohol treatment who differ in their drinking goal preferences or have investigated the relevance of drinking goals as a predictor of treatment outcomes. Objectives: To investigate associations between baseline drinking goal preferences and client characteristics as well as treatment retention and outcomes among clients in outpatient alcohol treatment. Methods: Secondary data analyses on a longitudinal multicenter study investigating the effectiveness of outpatient alcohol treatment in Switzerland among 805 clients. Assessments were conducted at treatment admission, discharge, and at 6- and 12-month follow ups. At-risk drinking was assessed through the alcohol use disorders identification test. Treatment retention was defined as regular discharge with or without transition into another institution. Results: Clients aiming to abstain from drinking were more likely to be in retreatment, to be assigned to treatment by a health institution, to have no at-risk alcohol use, and to be already alcohol abstinent at the time of admission relative to clients who aimed to control their drinking. Clients without at-risk alcohol use at admission showed higher treatment retention when aiming for controlled drinking than for abstinence, while there was no difference in treatment retention among clients with at-risk use. Clients with at-risk use at admission were more likely to reach not-at-risk alcohol use status when aiming for alcohol abstinence than for controlled drinking. Conclusions: Drinking goals are associated with variables of alcohol use and treatment assignment. They have different effects on treatment retention and treatment outcomes according to alcohol use at the time of admission. [ABSTRACT FROM AUTHOR]

Background: The association between alcohol consumption and intimate partner violence (IPV) has been reiterated in numerous studies. Some authors have found higher levels of risk factors in intimate partner violence offenders (IPVOs) with alcohol problems than in IPVOs without such problems. Objective: The aim of this study is to analyze the relationship of contextual variables with harmful alcohol use in a sample of IPVOs. Method: This cross-sectional research analyzes data from 231 IPVOs. In addition to demographic data, information was collected on alcohol use, ethnicity, accumulation of stressful life events and perceived social support and rejection. The sample was divided into hazardous and nonhazardous alcohol users, according to the AUDIT test scale. Results: No differences were found between groups on demographic variables. The results of a hierarchical logistic regression analysis supplemented with ROC curves revealed that Latin American immigrants as opposed to Spanish nationality, accumulating stressful life events, and perceiving low social support significantly increased the likelihood of alcohol abuse, with adequate predictive power. Conclusion: Contextual variables such as ethnicity, accumulation of stressful life events, and lack of social support may explain harmful alcohol consumption. These variables should be taken into account in batterer intervention programs in order to reduce one of the most relevant risk factors of IPV: alcohol abuse. [ABSTRACT FROM AUTHOR]

Background: As of 2015, more than half of U.S. states have legalized, medicalized, or decriminalized marijuana. Objective: This study examined the prevalence and correlates of support for marijuana legalization in a national sample of young adults and the intention to use marijuana more frequently if it were legalized. Methods: Data were from Wave 7 (weighted N = 3532) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18–34. We assessed demographics, past 30-day substance (alcohol, tobacco, marijuana, other drug use), depression and anxiety, social smoking, marijuana harm perceptions (relative to cigarettes), and state-level marijuana policies as correlates of support for marijuana legalization and intentions to use marijuana more often if it were legalized. Multivariable models of correlates of support for legalization and intentions to use marijuana were conducted separately for the full sample and for nonmarijuana users. Results: Weighted estimates showed that 39% of the full sample and 9% of nonmarijuana users supported marijuana legalization. Multivariable models showed that lower marijuana harm perceptions and lifetime and past 30-day tobacco use were common predictors of support for marijuana legalization and intentions to use marijuana among non-users of marijuana. Conclusions/Importance: Over a third of the sample supported marijuana legalization. Tobacco use and perceptions that marijuana is less harmful than cigarettes were robust risk correlates of support for marijuana legalization and intentions to use more frequently among nonusers. Public health campaigns should target these factors to deter marijuana-related harm in susceptible young adults. [ABSTRACT FROM AUTHOR]

Background: Family relationships are widely recognized as playing a role in adolescent alcohol use. Although family relationships and parenting vary by culture, limited research has explored these relationships in Latin America. Objectives: We sought to determine which family factors are associated with adolescent alcohol use in Callao, Peru. Methods: Data come from a cross-sectional survey conducted in a public secondary school in Callao, Peru in 2007. A total of 180 11th grade students are included in the analysis. Our main outcome measure was problem drinking, defined as self-report of having ever consumed beer, wine, spirits, or hard alcohol to a point of drunkenness. Logistic regression was used to determine if odds of problem drinking varied by level of parental monitoring (knowledge of activities and whereabouts), positive family relationships, or family conflict, while controlling for demographic and peer variables. Results: Low levels of parental monitoring and low levels of positive family relationships were each associated with significantly higher odds of lifetime problem drinking in analyses adjusted for deviant peer affiliation along with sociodemographic variables (odds ratio (OR) = 4.2; 95% confidence interval (CI): 1.3–13.5; OR = 4.4; 95% CI: 1.5–13.0, respectively). Although family conflict was associated with elevated odds of lifetime problem drinking, this did not reach significance (adjusted OR = 2.01; 95% CI: 0.8–5.1). Conclusions/Importance: Interventions designed to prevent adolescent alcohol use in urban Peru may benefit from promoting positive family interactions and parental monitoring skills. [ABSTRACT FROM AUTHOR]