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Background: Chemsex is the intentional use of drugs to enhance sexual activity. Chemsex drug use among men who have sex with men (MSM) is associated with sexual behaviors that increase sexually transmitted infection (STI) risks and adverse mental health outcomes. However, published data are largely based on MSM recruited from STI clinics. There are limited data about use of chemsex drugs among national samples of MSM in the United States. Using data from the American Men's Internet Survey (AMIS), we assessed the prevalence and correlates of use of chemsex drugs among sexually active MSM in the United States. Methods: We used data from the 2017 to 2020 AMIS cycles to examine the prevalence of chemsex drug use in the past 12 months among MSM. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) to compare chemsex drug use across demographic, behavioral, and mental health factors. Results: Of 30,294 MSM, 3,113 (10.3%) reported chemsex drug use in the past 12 months. Of the 3,113 MSM who reported chemsex drug use, 65.1% reported ecstasy use, 42.5% reported crystal methamphetamine use, and 21.7% reported GHB use. Factors associated with chemsex drug use included condomless anal sex (PR = 1.93, 95%=1.69–2.20), problem drinking (PR = 2.36, 95% = 2.13–2.61), bacterial STI test (1.84, 95% CI = 1.68–2.02) and probable serious mental illness (PR = 1.92, 95% = 1.76–2.09). Conclusion: Chemsex drug use is associated with behaviors that increase STI risk and mental distress among MSM. Health programs that serve MSM can consider screening for chemsex drug use and offering sexual and mental health promotion and risk reduction interventions when necessary. [ABSTRACT FROM AUTHOR]

Background: Research suggests flavor facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis ("co-use"), which is common among young adult smokers. This study's aim was to determine the role of the cigarillo flavor in co-use among young adults. Methods: Data were collected (2020-2021) in a cross-sectional online survey administered to young adults who smoked ≥2 cigarillos/week (N = 361), recruited from 15 urban areas in the United States. A structural equation model was used to assess the relationship between flavored cigarillo use and past 30-day cannabis use (flavored cigarillo perceived appeal and harm as parallel mediators), including several social-contextual covariates (e.g., flavor and cannabis policies). Results: Most participants reported usually using flavored cigarillos (81.8%) and cannabis use in the past 30 days ("co-use") (64.1%). Flavored cigarillo use was not directly associated with co-use (p = 0.90). Perceived cigarillo harm (β = 0.18, 95% CI = 0.06, 0.29), number of tobacco users in the household (β = 0.22, 95% CI = 0.10, 0.33), and past 30-day use of other tobacco products (β = 0.23, 95% CI = 0.15, 0.32) were significantly positively associated with co-use. Living in an area with a ban on flavored cigarillos was significantly negatively associated with co-use (β = -0.12, 95% CI = -0.21, −0.02). Conclusions: Use of flavored cigarillos was not associated with co-use; however, exposure to a flavored cigarillo ban was negatively associated with co-use. Cigar product flavor bans may reduce co-use among young adults or have a neutral impact. Further research is needed to explore the interaction between tobacco and cannabis policy and use of these products. [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]

Although studies have investigated the association between sexual violence (SV) victimization and substance use, few studies have examined the association between SV victimization and electronic vaping product (EVP) use among adolescents in the United States. The objective of this study was to examine the cross-sectional association between SV victimization and EVP use among adolescents. Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The outcome variable investigated was EVP use, and the main explanatory variable was SV victimization. Of the 28,135 adolescents, the prevalence of past 30-day EVP use and SV victimization was 22.7% and 10.8%, respectively. Controlling for other factors, adolescents who experienced SV had 1.52 times higher odds of being EVP users when compared to their counterparts who did not experience SV (AOR = 1.52, p <.001, 95% CI = 1.27–1.82). Other factors associated with EVP use included cyberbullying victimization, symptoms of depression, and current use of cigarettes, alcohol, and marijuana. Experiencing SV was associated with EVP use. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying the association between SV victimization and EVP use. In addition, school-based interventions that focus on sexual violence prevention and reducing substance use among adolescents are warranted. [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]

Background: Retention in treatment for individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is an area of concern in treatment outcome studies. The current study explores key variables related to retention in a group of women with comorbid PTSD and SUD enrolled in community SUD treatment randomized to eight weekly sessions of a trauma adapted mindfulness-based relapse prevention (TA-MBRP) or an integrated coping skills (ICS) group intervention. Methods: Two unadjusted and adjusted logistic discrete failure time (DFT) models were fit to examine associations between participants and the time (in weeks) to treatment completion status. Key covariates of interest, including time-varying PTSD Symptom Scale-Self Report (PSS) total score, time-varying Five Factors Mindfulness Questionnaire (FFMQ) total score, group assignment, baseline endorsements of substance use and demographics such as age, race and employment status were fit into the model.Results: In the adjusted PSS model, increased levels of PTSD symptom severity (PSS) scores at week 5 and 7 (PSS OR: 1:06: OR 1.13, respectively) were associated with higher odds of non-completion. In the FFMQ model, increased levels of FFMQ scores at week 6 (OR: 0:92) were associated with lower odds of non-completion. In both models, assignment to the ICS control group and unemployment were associated with lower odds of completion and baseline use of cocaine and sedatives were associated with higher odds of completion. Conclusion: Monitoring PTSD symptom severity and measures of mindfulness can inform providers on strategies to enhance retention early in treatment for individuals with comorbid PTSD/SUD. ClinicalTrials.gov # NCT02755103 [ABSTRACT FROM AUTHOR]

Many children grow up with adult alcohol misuse in the home. A clearer understanding of this exposure's long-term mental health consequences and the role of associated child maltreatment experiences and potential protective factors could guide relevant intervention strategies. To prospectively evaluate the association between living with adult alcohol misuse during childhood and major depressive disorder (MDD) during adulthood; whether child maltreatment explains the association; and whether sex, school bonding, or neighborhood bonding moderate the association. Participants and setting: This study used longitudinal data from 783 individuals followed from childhood to age 39. At grade 9, participants were asked whether they lived with adults who misused alcohol. Diagnostic assessments of MDD were conducted across three time-points during participants' thirties and participants were categorized as having met diagnostic criteria 0, 1, or 2 or more times. Ordinal logistic regressions found that children living with adult alcohol misuse showed greater chronicity of adult MDD (OR = 1.63; 95% CI: 1.05, 2.52). There was a 49% reduction in the odds ratio and the association was no longer statistically significant when child maltreatment was included in the model (OR = 1.32; 95% CI: 0.84, 2.07). No statistically significant moderation of associations was observed. Children exposed to adult alcohol misuse, and maltreatment often associated with this misuse, may be at risk for mental health challenges well into adulthood. Interventions that address childhood exposure to adult alcohol misuse and associated maltreatment may be important to mitigate long-term mental health challenges to exposed children. [ABSTRACT FROM AUTHOR]

Background: With 1 in 2 adult tobacco users being highly dependent on nicotine, population-based interventions specifically designed for this group are urgently needed. This study used data from a randomized trial to evaluate whether (1) Acceptance and Commitment Therapy (ACT) delivered via a smartphone application (iCanQuit) would be more efficacious for cessation of nicotine-containing tobacco products than the US Clinical Practice Guidelines (USCPG)-based application (QuitGuide) among highly nicotine-dependent adults, (2) the effect of treatment on cessation was mediated by increases in acceptance of cravings to smoke, and (3) treatment utilization and satisfaction differed by arm. Methods: A total of 1452 highly nicotine-dependent adults received the iCanQuit or QuitGuide application for 12-months. Cessation outcomes were self-reported complete-case 30-day abstinence of nicotine-containing tobacco products (e.g., combustible cigarettes, e-cigarettes, chewing tobacco, snus, hookahs, cigars, cigarillos, tobacco pipes, and kreteks) at 3, 6, and 12-month post-randomization timepoints, missing-as-smoking, and multiple imputation analyses. Acceptance of cues to smoke and satisfaction with the applications was also reported. Results: Participants who received iCanQuit were significantly more likely to report 30-day abstinence of nicotine-containing tobacco products than those who received QuitGuide at 12-months (24% vs. 17%; OR = 1.47 95% CI: 1.11, 1.95). iCanQuit participants utilized their application more frequently and reported greater satisfaction than those who received QuitGuide. Increases in participants' acceptance of cues to smoke mediated the intervention effect on cessation of nicotine-containing tobacco products. Conclusions: Among nicotine-dependent adults, an application-delivered ACT-based intervention was more engaging and efficacious than a USCPG-based intervention for cessation of nicotine-containing tobacco products. [ABSTRACT FROM AUTHOR]

Background: It is proposed that the use of dietary supplements might lead to the use of doping substances. This has been termed the gateway hypothesis. However, within an athletic sample, no research has examined the order in which these substances are consumed and what may explain the progression from dietary supplement use to doping. Objective: To identify whether dietary supplement use precedes doping and examine what moderates the dietary supplement-doping relationship. Methods: Competitive athletes (N=1,081, 42.0% female; Age=29.3±10.8 years) completed an online survey measuring dietary supplement use, doping use, doping subjective norms and age of using a supplement and/or doping substance. Results: Dietary supplement users were 11 times more likely to dope than non-users (OR=11.28, 95% CI = 2.72 to 46.77). Age for first use of a dietary supplement was younger than use of a doping substance (mean difference=-4.5±5.1 years old, p<0.001, d=0.90). Over three-quarters of doping users reported using a dietary supplement first (77.1%), whereas a small proportion of athletes started using dietary supplements and doping at the same time (12.5%) and some used doping substances before using dietary supplements (10.4%). Moderation analysis revealed that dietary supplement users may be more likely to dope because of a more favourable social acceptance of using prohibited substances than non-users. Conclusions: Data suggest that dietary supplement use is more likely to precede doping. However, not all doping users begin with using dietary supplements, which highlights the importance of measuring the temporal order of dietary supplement and doping use in future research. [ABSTRACT FROM AUTHOR]

Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic characteristics, type of used drug, and risky behaviors associated with ED use and hospitalization among patients with SRD. Methods: Studies in English published from January 1st, 1995 to April 30th, 2022 were searched from PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies on ED use and hospitalization among patients with SRD. Results: Of the 17,348 outputs found, a total of 39 studies met the eligibility criteria. Higher ED use and hospitalization among patients with SRD were associated with a history of homelessness (ED use: OR = 1.93, 95%CI = 1.32–2.83; hospitalization: OR = 1.53, 95%CI = 1.36–1.73) or of injection drug use (ED use: OR = 1.34, 95%CI = 1.13–1.59; hospitalization: OR = 1.42, 95%CI = 1.20–1.69). Being female (OR = 1.24, 95%CI = 1.14–1.35), using methamphetamine (OR = 1.99, 95%CI = 1.24–3.21) and tobacco (OR = 1.25, 95%CI = 1.11–1.42), having HIV (OR = 1.70, 95%CI = 1.47–1.96), a history of incarceration (OR = 1.90, 95%CI = 1.27–2.85) and injury (OR = 2.62, 95%CI = 1.08–6.35) increased ED use only, while having age over 30 years (OR = 1.40, 95%CI = 1.08–1.81) and using cocaine (OR = 1.60, 95%CI = 1.32–1.95) increased hospitalization only among patients with SRD. Conclusions: The finding outline the necessity of developing outreach program and primary care referral for patients with SRD. Establishing a harm reduction program, incorporating needle/syringe exchange programs, and safe injection training with the aim of declining ED use and hospitalization, is likely be another beneficial strategy for patients with SRD. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSWs) are at higher risk of HIV due to high-risk sexual and drug use related behaviors. This study characterized sexualized substance use among FSWs in Iran. Methods: In 2015, 1,337 FSWs were recruited from centers for vulnerable women and through outreach efforts in 13 major cities in Iran. Data were collected via face-to-face interviews from consenting FSWs on a range of socio-demographic and behavioral characteristics. The primary outcome of interest was sexualized substance use, defined as reporting alcohol or drug use before or during sex in the past month. Bivariable and multivariable modified Poisson regression models were used to assess the correlates of sexualized substance use. Adjusted prevalence ratio (aPR) and 95% confidence interval (CI) were reported. Results: The prevalence of sexualized substance use was 31.3% (95% CI: 28.7, 34.0). Inconsistent condom use during sex with clients in the past month (aPR = 1.31; 95% CI: 1.01, 1.71), regular (i.e., at least weekly in the past month) alcohol use (aPR = 2.87; 95% CI: 2.17, 3.80), regular opioid use (aPR = 2.09; 95% CI: 1.45, 3.02), regular stimulant use (aPR = 2.68; 95% CI: 2.12, 3.39), and self-reported HIV negative status (aPR= 1.88; 95% CI: 1.14, 3.10) were significantly and positively associated with sexualized substance use. Conclusions: Sexualized substance use was associated with riskier sexual behavior and self-reported HIV sero-negativity. Harm reduction messaging to FSWs needs to go beyond focusing on sexual health promotion and further highlight the risks associated with sexualized substance use. [ABSTRACT FROM AUTHOR]

Background: Recovery from substance use disorders (SUDs) requires sustained and purposeful support to maintain long-term remission. Methods: This study investigated the association between assessment of recovery capital, household chaos, delay discounting (DD) and probability discounting (PD), and remission status among individuals in recovery from SUD. Data from 281 participants from the International Quit & Recovery Registry (IQRR), an ongoing online registry that aims to study the recovery process, were included in the analysis. Results: Lower DD rates and higher recovery capital were found among those in remission compared to those not in remission after controlling for demographics. In contrast, the association of household chaos and PD with remission status were insignificant. Overall, DD accounted for 20% of the total effect between the recovery capital and the remission status. Conclusion: This study contributes to the understanding of recovery as a multidimensional process, supports DD as a behavioral marker of addiction, and suggests areas for future research. [ABSTRACT FROM AUTHOR]

Background: Opioid-related overdose deaths recently accelerated. In response, overdose education and naloxone distribution (OEND) has been implemented widely, though access remains sparse in rural Appalachia. Despite increasing OEND, risk factors for non-evidence-based overdose responses among the training-naïve remain unknown. Methods: We enrolled 169 adults who use prescription opioids non-medically and reside in rural West Virginia (August 2014-March 2015). Participants were interviewed about witnessing overdose (lifetime and prior-year), characteristics of the most recent overdose, responses to the overdose, and OEND acceptability. Logistic regression was used to assess factors associated with non-evidence-based responses to overdose. Results: Among the 73 participants who witnessed an opioid-related overdose, the majority (n = 53, 73%) reported any non-evidence-based responses. Participants were significantly more likely to report a non-evidence-based response when victims were unresponsive (OR = 3.36; 95% CI = 1.07, 10.58). Common evidence-based responses included staying with the victim until help arrived (n = 66, 90%) and calling 911 (n = 63, 86%), while the most common non-evidence-based responses were hitting or slapping the victim (n = 37, 51%) and rubbing the victim with ice or placing them in a cold shower or bath (n = 14, 19%). While most (n = 60, 82%) had never heard of OEND, the majority (n = 69, 95%) were willing to train, particularly those reporting non-evidence-based responses (n = 52, 98%). Conclusions: These findings underscore the need to expand access to OEND in rural communities and indicate OEND is acceptable to training-naïve individuals who use opioids in rural Appalachia. Given the "harm reduction deserts" in the region, approaches to expand OEND should be pursued. [ABSTRACT FROM AUTHOR]

Background: The settings where we live shape our daily experiences and interactions. Social environment and physical setting characteristics may be particularly important in communal living services, such as recovery homes for alcohol and drug disorders. Objectives: This paper describes the measurement and mobilization of architectural characteristics in one type of recovery home, sober living houses (SLHs). The Recovery Home Architecture Scale (RHAS) is a 25-item measure comprised of six subscales designed to assess architecture in SLHs. Results: Using a sample of 528 individuals residing in 41 houses, we found the RHAS had good interrater reliability, factor structure, and internal consistency. The measure also showed modest construct validity. The RHAS was not associated with length of stay (LOS) but did interact with a measure of the social environment that predicted LOS, the Recovery Home Environment Scale (RHES). Conclusions: Future studies should include a more diverse sample of SLHs and assess how house management, recovery capital, and other factors work in concert with architecture. [ABSTRACT FROM AUTHOR]

Background: People from minoritized populations have historically been targeted by tobacco companies. Little is known about exposure to tobacco-related messages among military personnel from disadvantaged backgrounds. Objectives: The current study aimed to examine exposure to tobacco-related messaging across many nicotine products and through a variety of mediums (i.e., family, friends, advertisements, event promotions, social media) among diverse military populations and use one year later in a sample of young adults who recently enlisted in the U.S. Air Force. Methods: In this study, 8,901 U.S. Air Force trainees reported on demographics, tobacco use, and exposure to positive tobacco messages from social sources (i.e., friends, family, social media) and environmental sources (i.e., advertisements and promotions). Tobacco use was reported one-year later. Results: Compared to others of the same reported racial/ethnic background, Latino/a/x (Relative Risk Ratio [RRR] = 1.354, 95% CI: [1.145, 1.563]) and multiracial (RRR = 1.594, 95% CI: [1.173, 2.016]) participants who were exposed to positive tobacco messages from social sources were significantly more likely to report tobacco product use at one-year follow-up than those who were not exposed to social messages. Exposure to positive tobacco messages from environmental sources were not significantly associated with tobacco use one year later. Conclusions: Social messages may play an important role in increasing risk of tobacco use among some minoritized populations. Cultural as well as systemic factors could be addressed in future tobacco prevention programs to decrease the potency of positive tobacco-related social messages among Latino/a/x and multiracial communities. [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: The use of electronic cigarettes and cannabis has significantly increased in recent years, which raises public health concerns. There are also concerns about the association of these substances with drinking behaviors. The main objective of the present study is to examine the association of e-cigarettes and/or cannabis use with heavy episodic drinking (HED) among Ontario adults. Methods: The sample consisted of 5,564 adults from the Monitor Survey in 2018 and 2019. Cannabis and e-cigarette use reflected any use of the substances in the past 12 months. HED was defined as consumption of four/five or more drinks on a single occasion at least monthly in the past 12 months. Odds ratios (OR) were estimated from logistic regression models accounting for complex survey design and sociodemographic factors. Results: Overall, the prevalence of HED was 17.5% in 2018 and 2019. Among participants who reported both e-cigarette and cannabis use, about one-half (50.4%) reported HED at least monthly. Adjusting for covariates, the odds of HED were 5.71 (95%CI, 3.92–8.30) times higher among those who reported both e-cigarette and cannabis use compared to those who used neither substance. Conclusions: The use of e-cigarettes and cannabis are significantly associated with heavy episodic drinking among adults, indicating that those who engage in the dual use of e-cigarette and cannabis may be an important group to target with intervention programs. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare prevalence of JUUL use and JUUL risk perceptions between adolescents living in an urban area versus Appalachian areas of the U.S. Data were drawn from a prospective cohort study of adolescent males (the Buckeye Teen Health Study, or BTHS); our cross-sectional analysis used data from one timepoint, collected between January and December 2019 (N = 873). Chi-square tests and multivariable logistic regression compared JUUL use prevalence and risk perceptions between participants in an urban Ohio county and nine predominantly rural Appalachian Ohio counties. Over a quarter of the sample (29.2%) had ever used JUUL. In the unadjusted model, prevalence of JUUL use was similar between regions but Appalachian participants perceived JUUL as more harmful (p <.001) and more addictive (p =.04) than urban participants. In the adjusted model, region was not significantly related to current JUUL use (OR: 1.20, 95% CI: 0.77, 1.87) or ever JUUL use (OR: 1.15, 95% CI: 0.83, 1.60). JUUL use was similar between urban and Appalachian participants despite regional differences in risk perceptions. Interventions that only target risk perceptions may not be sufficient to prevent adolescent e-cigarette use, particularly in rural communities. [ABSTRACT FROM AUTHOR]

Background: Accurate assessment of prescription drug misuse (PDM) is critical among young-adult college students, a particularly high-risk group for this substance behavior. No studies have compared assessments of college students' reports of PDM obtained from their reporting in daily life (via ecological momentary assessment; EMA) to their retrospective accounts of PDM over the same period (via timeline follow-back interview; TLFB), an approach that is commonly used in substance use research. Purpose/Objectives: To determine day-level agreement and person-level agreement in college student reports of PDM in EMA versus TLFB methods. Methods: Participants were 297 college freshmen and sophomores (69% female) recruited based on misuse behavior in the past three months. PDM behaviors were captured in daily life using EMA for 28 days and TLFB administered during an in-person lab visit. Agreement was assessed at the person level (any PDM during the 28 days) and day level (PDM on a given day) using Cohen's kappa and percent agreement. Results: PDM was reported more frequently using TLFB compared to EMA. Person-level agreement between the two methods was good (k = 0.62, 95% CI: 0.53, 0.70), whereas day-level agreement was fair (k = 0.23, 95% CI: 0.19, 0.28). Agreement in stimulant misuse reported across methods was more consistent compared to reports of other medication classes. Conclusions: Findings offer implications for the assessment of college student PDM data in substance use research. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to test the interactive effects of negative urgency, state negative affect, and alcohol intoxication on intimate partner aggression (IPA) perpetration. Methods: Heavy drinkers who recently perpetrated IPA completed self-report measures of impulsivity, were administered an alcohol or control beverage, and completed a laboratory aggression task. State negative affect was assessed unobtrusively via the Facial Action Coding System. Results: Consistent with our prediction, negative urgency was significantly and positively related to IPA when state negative affect was also high, but this relation was not significant when state negative affect was low. Conclusions: These results have implications for understanding the role of negative affect and impulsivity in IPA perpetration and for understanding trait models of impulsivity in general. [ABSTRACT FROM AUTHOR]

As medical cannabis use increases in North America, establishing its safety profile is a priority. The objective of this study was to assess rates of emergency department (ED) visits and hospitalizations due to poisoning by cannabis, and cannabis-related mental health disorders among medically authorized cannabis patients in Ontario, Canada, between 2014 and 2017. This is a retrospective cohort study of patients who received medical cannabis authorization in Ontario, Canada, using data collected in participating cannabis clinics. Outcomes included ED visit/hospitalization with a main diagnosis code for: cannabis/cannabinoid poisoning; and mental/behavioral disorders due to cannabis use. Cox proportional hazard regressions were utilized to analyze the data. From 29,153 patients who received medical authorization, 23,091 satisfied the inclusion criteria. During a median follow-up of 240 days, 14 patients visited the ED or were hospitalized for cannabis poisoning—with an incidence rate of 8.06 per 10,000 person-years (95% CI: 4.8–13.6). A total of 26 patients visited the ED or were hospitalized for mental and behavioral disorders due to cannabis use—with an incidence rate of 15.0 per 10,000 person-years (95% CI: 10.2–22.0). Predictors of cannabis-related mental and behavioral disorders include prior substance use disorders, other mental disorders, age, diabetes, and chronic obstructive pulmonary disease. The results suggest that the incidence of cannabis poisoning or cannabis-related mental and behavioral disorders was low among patients who were authorized to use cannabis for medical care. Identified predictors can help to target patients with potential risk of the studied outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This cross sectional study was conducted to explore the moderating effect of sexual sensation seeking (SSS) on the association between alcohol/popper use before sex and multiple sexual partners (MSP) among men who have sex with men (MSM) in Guangzhou, China. Methods: From June 2017 to April 2018, MSM were recruited from a community-based HIV service center in Guangzhou, China; data on sociodemographics, sexual behaviors and SSS were collected. A product term of SSS and alcohol/popper use before sex was included in a multivariate logistic regression model to test the potential moderating effect of SSS on the association between alcohol/popper use before sex and MSP. Results: Among the 500 MSM included, individuals who reported alcohol use and popper use before sex, and MSP in the last six months accounted for 33.80%, 33.40%, and 60.40%, respectively. MSM with high SSS traits accounted for 54.80%. The association between popper use before sex and MSP was moderated by SSS (P for interaction = 0.007). A significant association between popper use before sex and MSP among MSM with low SSS traits (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.06 ∼ 8.67). But not among MSM with high SSS traits (OR = 1.37, 95%CI: 0.77 ∼ 2.43) were observed. However, no moderating effect of SSS on the association between alcohol use before sex and MSP were observed. Conclusion: The moderated analysis indicated that SSS should be taken into consideration when tailoring interventions to prevent popper use before sex to reduce the risk associated with MSP. [ABSTRACT FROM AUTHOR]

Research suggests that virtual reality (VR) experiences can be helpful as adjunctive tools in psychotherapy for some mental health conditions. VR is a computer-generated experience that produces a feeling of being immersed in a different environment. VR experiences could be useful in the treatment of substance use disorders, and several are currently being tested. However, few psychotherapists report using VR experiences in their practices, even when doing so is well-supported. Understanding key barriers and concerns about using VR among drug/alcohol counselors is important to ultimately encouraging adoption. Licensed counselors (N = 101) who provide treatment to clients with substance use disorders were recruited via email Listservs, professional organizations, and social media. Participants viewed a 15-minute educational video about VR and then completed a survey of their views about using it with their clients. Most clinicians (82%) believed they would be likely to use a VR experience in drug/alcohol counseling, and 81% believed it would be appropriate for most of their clients. A minority (19%) noted important concerns, including that their clients may be skeptical of it (15%), cost (14%), and space (10%). Those who had cost and space concerns were less likely to report high use intentions (OR = 0.29 and OR = 031, both p <.05, respectively). Findings suggest that addictions counselors are eager to use VR, but key barriers should be addressed. VR developers should incorporate features to encourage trust among users, design experiences for small spaces, and explore ways of supporting the purchase of VR systems for counselors. [ABSTRACT FROM AUTHOR]

Illicit opioid use in pregnancy is associated with adverse maternal, neonatal, and childhood outcomes. Opioid substitution is recommended, but whether methadone or buprenorphine is the optimal agent remains unclear. We searched EMBASE, PubMed, Web of Science, Scopus, Open Gray, CINAHL and the Cochrane Central Registry of Controlled Trials (CENTRAL) from inception to April 2020 for randomized controlled trials (RCTs) and cohort studies comparing methadone and buprenorphine treatment for opioid-using mothers. Included studies assessed maternal and or neonatal outcomes. We used random-effects meta-analyses to estimate summary measures for outcomes and report these separately for RCTs and cohort studies. Of 408 abstracts screened, 20 papers were included (4 RCTs, 16 cohort, 223 and 7028 participants respectively). All RCTs (4/4) had a high risk of bias and median (IQR) Newcastle Ottawa Scale for cohort studies was 7.5 (6–9). In both RCTs and cohort studies, buprenorphine was associated with; greater offspring birth weight (weighted mean difference [WMD] 343 g (95% CI: 40–645 g) in RCT and 184 g (95% CI: 121–247 g) in cohort studies); body length at birth (WMD 2.28 cm (95% CI: 1.06–3.49 cm) in RCTs and 0.65 cm (95% CI: 0.31–0.98 cm) in cohort studies); and reduced risk of prematurity (risk ratio [RR] 0.41 (95% CI: 0.18–0.93) in RCTs and 0.63 [95% CI: 0.53–0.75] in cohort studies) when compared to methadone. All other clinical outcomes were comparable. Compared to methadone, buprenorphine was consistently associated with improved birthweight and gestational age, however given potential biases, results should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Recreational cannabidiol (CBD) is frequently promoted as a medicinal or therapeutic cannabis product worldwide. Nationwide population-based data on awareness and use of recreational CBD are currently lacking. This study estimates the prevalence of recreational CBD awareness and use among the population in Germany. It also explores potential associations with socio-demographic characteristics, tobacco smoking, and e-cigarette use. We used data from a cross-sectional household survey (German Study on Tobacco Use, DEBRA) fielded across two waves in October-November 2020 and February-March 2021. Data were collected using computer-assisted face-to-face interviews among participants aged ≥14 years (n = 4026). Outcome variables were CBD awareness (yes/no) and CBD ever use (yes/no). The sample was weighted to ensure representativeness of the prevalence estimates. Associations with socio-demographic variables, tobacco smoking, and e-cigarette use were assessed using multivariable logistic regression. Approximately half of the population in Germany (48.3%, 95% CI: 46.8-49.9) was aware of recreational CBD products, and 4.3% (95% CI: 3.7-5.0) had ever used them (including 1.1% current users). Awareness was associated with younger age, higher education levels, female sex, living in urban regions, no migration background, tobacco smoking, and e-cigarette use. Ever use was associated with higher education levels, living in urban regions, tobacco smoking, and e-cigarette use. Awareness of recreational CBD products is high but ever use is currently low in Germany. Given the uncertain legal framework regarding the marketing of recreational CBD products, the changing retail landscape, and potential harms of CBD use, structured monitoring is warranted for public health purposes. [ABSTRACT FROM AUTHOR]

To evaluate the association between suicidal behaviors and binge drinking among Brazilian adolescents. A cross-sectional study was conducted with 2,476 students 14 to 19 years of age from 26 public high schools in the city of Olinda, Brazil. Data collection occurred between March and June 2018 through the self-administered Youth Risk Behavior Survey. Descriptive analysis and Poisson regression (p < 0.05, 95%CI) were performed. The prevalence of suicidal ideation, planning and attempt in the previous 12 months was 23.7%, 17.4% and 13.5%, respectively. Suicidal ideation was associated with binge drinking one to two days (PR:1.053, 95%CI:1.011-1.096) and ≥ three days in the previous 30 days (PR:1.069, 95%CI:1.016-1.125), sadness/hopelessness in the previous 12 months (PR:1.313, 95%CI:1.267-1.360), a report of family physical aggression in the previous 12 months (PR:1.111, 95%CI:1.068-1.155), the female sex (PR:1.082, 95%CI:1.049-1.115) and a non-nuclear family (PR:1.037, 95%CI:1.004-1.071). Suicidal planning was associated with sadness/hopelessness in the previous 12 months (PR:1.257, 95%CI:1.214-1.302), report of family physical aggression in the previous 12 months (PR:1.110, 95%CI:1.065-1.156) and the female sex (PR:1.072, 95%CI:1.041-1.104). Suicide attempt was associated with binge drinking ≥ three days in the previous 30 days (PR:1.062, 95%CI:1.008-1.119), sadness/hopelessness in the previous 12 months (PR:1.202, 95%CI:1.161-1.244), report of family physical aggression in the previous 12 months (PR:1.105, 95%CI:1.060-1.153) and the female sex (PR:1.064, 95%CI:1.034-1.095). The Catholic (PR:0.938, 95%CI:0.899-0.979; PR:0.925, 95%CI:0.888-0.9865; PR:0.937, 95%CI:0.899-0.977) and Evangelical (PR:0.956, 95%CI:0.922-0.992; PR:0.954, 95%CI:0.919-0.991) religions acted as a possible protective factor against suicidal behaviors. Suicidal ideation and attempt were associated with binge drinking. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the relationship between the students' combined belonging and binge drinking. Combined belonging was defined as a combination of both subjective (perceived belonging) and objective (participation in school activities) measures of belonging. Participants: The sample included 33,360 college students enrolled in U.S. States collegiate institutions. Methods: Data were obtained from an online survey through the Healthy Minds Study from 2018 to 2019. Logistic regression models estimated odds ratios and corresponding 95% confidence intervals. Results: Overall, 39.3% of students met criteria for binge drinking. Combined belonging had the highest odds of binge drinking compared to their counterparts. Being 21 and 22 years of age was the strongest risk factor for binge drinking. Conclusions: Interventions should be tailored to include objective and subjective measures of belonging to effectively reduce college binge drinking. [ABSTRACT FROM AUTHOR]

Unintentional drug overdose has increased markedly in the United States. Studies document an association between psychiatric disorder and unintentional overdose; we extend this research through a preliminary test of a causal model of recurrent injection drug use mediating this relationship. In a cross-sectional study of 241 adults in New York City with a possible current substance use disorder, we conducted conventional and Imai's mediation analyses to examine if psychiatric disorder is associated with increased prevalence of ever overdosing and if recurrent injection drug use mediates this association. Our cross-sectional data permit the first step of assessing causal models: testing if statistical associations are consistent with the model. Fifty-eight percent of the sample endorsed previous psychiatric disorder diagnosis and 35.7% reported ever overdosing. Imai's mediation analysis showed that, adjusting for covariates, the total association between psychiatric diagnosis and ever overdosing (adjusted prevalence difference [aPD] = 0.16, 95% CI 0.04–0.28) was composed of a direct effect (aPD = 0.09, 95% CI −0.03 − 0.21, p = 0.136) and an indirect effect (aPD = 0.07, 95% CI 0.02–0.13). Recurrent injecting drug use contributed to 42% (ratio of indirect effect to total effect; 95% CI 12 − 100%, p = 0.02) of the association between psychiatric diagnosis and ever overdosing. Conventional mediation analysis produced similar results. Our results provide a warrant for taking the necessary next step for assessing a causal model using longitudinal data, potentially providing a strong rationale for intervening on psychiatric disorders to stem overdose. [ABSTRACT FROM AUTHOR]

BackgroundNorth American Indigenous (NAI) adolescents experience disproportionate harm related to substance use compared to non-Indigenous adolescents. Strengths-based approaches to substance use prevention and treatment are consistent with Indigenous conceptualizations of health, which tend to be holistic and incorporate more spirituality and community than mainstream Western conceptualizations. Despite this, little is known about how positive psychological characteristics that might confer protection relate to substance use among NAI adolescents. Thus, the present study aims to examine the relations among life satisfaction, subjective happiness, self-compassion, and cigarette, marijuana, alcohol, and other drug use. MethodsParticipants were 106 reserve-dwelling First Nation adolescents located in Eastern Canada (Mage= 14.6 years, 50.0% female) who completed a paper-and-pencil survey regarding their substance use and psychological characteristics for a larger community-based participatory research project. ResultsGreater life satisfaction was significantly associated with decreased odds of lifetime (OR = 0.88, 95%CI [0.81, 0.96]) and current cigarette smoking (OR = 0.90, 95%CI [0.82, 0.99]). Greater subjective happiness was significantly associated with decreased odds of current marijuana use (OR = 0.83, 95%CI [0.71, 0.97]). Although significantly correlated with lower lifetime use of other drugs, self-compassion was not significantly associated with lifetime or current odds of substance use after controlling for age, gender, and other positive characteristics. DiscussionThis is one of the first studies to evaluate positive characteristics and substance use in NAI adolescents. Results point to positive characteristics that may be useful in substance use prevention and suggest the need for further research to further elucidate these associations. [ABSTRACT FROM AUTHOR]

Concurrent use of e-cigarettes, cigarettes, and cannabis is common among adolescents, while illicit anabolic-androgenic steroid (AAS) use has recently been on the rise. Today, no known research has investigated the patterns of concurrent substance use and AAS use among adolescents in the United States. To determine the association between concurrent lifetime use of e-cigarettes, cigarettes, and cannabis and illicit AAS use among adolescents. Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 13,677) were analyzed in 2021. Four mutually exclusive categories of concurrent substance use (no use, any single use, any dual use, and triple use) were constructed, along with any lifetime AAS use. One logistic regression model was estimated to determine the association between concurrent substance use and lifetime AAS use. Compared to no use, lifetime triple use (adjusted odds ratio 3.95, 95% confidence interval 1.73–8.95) was associated with lifetime AAS use while adjusting for potential confounders. Findings underscore an overlapping pattern of problematic substance use that may be harmful for adolescents. Health care professionals should be aware of these patterns to improve substance use assessment protocols. [ABSTRACT FROM AUTHOR]

Recent prevalence estimates of cannabis use among individuals receiving medication treatment for OUD (MOUD) are lacking, and no study has characterized cannabis route of administration (cROA) in this population. These knowledge gaps are relevant because cannabis' effects and health outcomes vary by cROA and the availability and perceptions of cROA (e.g., vaping devices) are changing. The Vaping In Buprenorphine-treated patients Evaluation (VIBE) cross-sectional survey assessed the prevalence and correlates of cannabis use and cROA among adults receiving buprenorphine MOUD from 02/20 to 07/20 at five community health centers in Massachusetts, a state with legal recreational and medical cannabis use. Among the 92/222 (41%) respondents reporting past 30-day cannabis use, smoking was the most common cROA (75%), followed by vaping (38%), and eating (26%). Smoking was more often used as a single cROA vs. in combination others (p = 0.01), whereas vaping, eating, and dabbing were more often used in combination with another cROA (all p < 0.05). Of the 39% of participants reporting multiple cROA, smoking and vaping (61%), and smoking and eating (50%), were the most prevalent combinations. Nonwhite race (vs. white) and current cigarette smoking (vs. no nicotine use) were associated with past 30-day cannabis use in multiple logistic regression. Prevalence of past 30-day cannabis use among individuals receiving buprenorphine MOUD in Massachusetts in 2020 was nearly double the prevalence of cannabis use in Massachusetts' adult general population in 2019 (21%). Our data are consistent with state and national data showing smoking as the most common cROA. [ABSTRACT FROM AUTHOR]

In 2014, the Drug Enforcement Administration rescheduled hydrocodone combination products to Schedule II to reduce nonmedical use and diversion. The impact of rescheduling was assessed using quarterly data from 2011 through 2019 from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System Poison Center Program and IQVIATM Longitudinal Prescription Data. Trends and immediate changes in prescriptions dispensed and misuse exposures before and after rescheduling involving hydrocodone, oxycodone, and other Schedule II opioid analgesics were calculated using segmented regression. Hydrocodone prescriptions were stable pre-rescheduling, decreased by 2.7% (95% CI: −3.6%, −1.8%, p < 0.0001) per quarter post-rescheduling. Misuse exposures involving hydrocodone were decreasing by 3.2% (95% CI: −3.9%, −2.4%, p < 0.0001) per quarter pre-rescheduling and decreased by 4.9% (95% CI: −5.5%, −4.2%, p < 0.0001) post-rescheduling. Immediate decreases in hydrocodone prescriptions and misuse exposure rates in 2014Q4 compared to 2014Q3 were significant and different from oxycodone or other Schedule II opioids. Schedule II opioid analgesics prescriptions in aggregate were stable prior to rescheduling, decreased by 10.8% (95%CI: −14.0%, −7.6%, p < 0.0001) immediately after the rescheduling, and decreased by 2.3% per quarter (95% CI: −3.1%, −1.5%, p < 0.0001) subsequently. Misuse exposures involving these opioids were decreasing by 3.3% (95% CI: −4.1%, −2.5%, p < 0.0001) prior to rescheduling then by 2.8%, (95% CI: −3.4%, −2.2%, p < 0.0001) after rescheduling. The immediate change in misuse was not significant. Rescheduling corresponded with changes in hydrocodone prescribing and misuse not offset by increases in other Schedule II opioid analgesics. Misuse exposures for hydrocodone and comparators were decreasing prior to rescheduling with little change post-intervention. [ABSTRACT FROM AUTHOR]

Background: Exposure to alcohol marketing is positively associated with alcohol consumption. However, few research studies have tested alcohol marketing's effect on other alcohol-related outcomes. Consequently, the current study sought to identify associations between exposure to alcohol marketing and alcohol-related consequences in young adults. Methods: A secondary analysis of the 2020 Rhode Island Young Adult Survey was conducted. Participants were lifetime drinkers (n = 390) who were 18 to 25 years old and lived in Rhode Island for at least part of 2020. Past 30 day exposure to 6 forms of alcohol marketing was assessed. Alcohol consequences were measured using 8 items from the Brief Young Adult Alcohol Consequences Questionnaire. Logistic regression models were adjusted for AUDIT score, age, race/ethnicity, gender, sexual orientation, employment status, and enrollment in school. Results: 92.3% of participants reported past 30 days exposure to any form of alcohol marketing. 43.6% of participants reported experiencing any alcohol-related consequence. Exposure to any form of alcohol marketing was positively associated with experiencing alcohol-related consequences (OR[95% CI] = 3.35 [1.19, 9.44]). After disaggregation by marketing type, only television exposure remained significantly associated with alcohol-related consequences (OR[95% CI] = 1.85 [1.06, 3.24]). Conclusions: Exposure to alcohol advertising on television may be positively associated with experiencing negative alcohol consequences in young adults. If confirmed, the findings may renew interest in strengthening alcohol marketing guidelines and regulations. [ABSTRACT FROM AUTHOR]

Background: Reproductive health research among women who use drugs has focused on pregnancy prevention and perinatal/neonatal outcomes, but there have been few investigations of miscarriage and abortion, including prevalence and associated factors. Methods: Using cross-sectional data from a sample of non-pregnant women receiving harm reduction services in Philadelphia in 2016–2017 we examined lifetime miscarriage and abortion (n = 187). Separately for both outcomes, we used modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for associations with each correlate. We also explored correlates of reporting both miscarriage and abortion. Results: Approximately 47% experienced miscarriage, 42% experienced abortion, and 18% experienced both. Miscarriage correlates included: prescription opioid misuse (e.g., OxyContin PR 1.82, 95% CI 1.23, 2.69); 40% increase in prevalence associated with housing instability, 50% increase with survival sex, and two-fold increase with arrest. Abortion correlates included: mental health (e.g., depression PR 2.09, 95% CI 1.18, 3.71), stimulant use (e.g., methamphetamine PR 1.83, 95% CI 1.22, 2.74), and drug injection (PR 1.76, 95% CI 1.03, 3.02); partner controlling access to people/possessions, physical and emotional violence; and a two-fold increase associated with survival sex and arrest. Experiencing both reproductive outcomes was correlated with mental health, opioid and simulant use, housing instability, survival sex, and arrest. Conclusion: Miscarriage and abortion was common among women with history of drug misuse suggesting a need for expanded access to family planning, medication-assisted therapy, and social support services, and for the integration of these with substance use services. Future research in longitudinal data is needed. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarette (e-cigarette) and cannabis (marijuana) use is rapidly increasing. Objectives: To report percentage prevalence and changes over time in current (past 30 days) e-cigarette, cannabis, and dual (concurrent) use in the population of reproductive age women (18–44 years old) in the United States. Methods: Our cross-sectional analysis involved data of 11, 004 women from Waves 1 to 3 of the Population Assessment of Tobacco and Health (PATH) Study (2013–2016). We estimated weighted percentage prevalence and 95% confidence intervals (CIs) and changes between 2013 and 2016 in current e-cigarette, cannabis, and dual use at each wave overall and across race/ethnicity, age, education, cigarette smoking status, alcohol use, and perceived mental health. Changes were reported as p for trend. Results: Between 2013 and 2016, e-cigarette use increased 13.6% (p for trend <.001) [15.2% (95% CI:14.2, 16.2) in 2013–2014; 22.2% (95% CI: 20.2, 24.3) in 2014–2015; and 28.8% (95% CI: 26.3, 31.3) in 2015–2016]; cannabis use increased 6.2% (p for trend <.001) [23.6% (95% CI: 22.1, 25.1) in 2013–2014; 28.5% (95% CI: 26.0, 31.0) in 2014–2015; and 29.8% (95% CI: 27.9, 31.1) in 2015–2016]; and dual use declined 0.3% (p for trend <.001) [5.8% (95% CI: 5.2, 6.3) in 2013–2014; 4.8% (95% CI: 3.7, 5.8) in 2014–2015; and 5.5% (95% CI: 4.2, 6.7) in 2015–2016]. Increases and declines in prevalence varied across sociodemographic characteristics, cigarette smoking status, alcohol use, and perceived mental health. Conclusions: Continued monitoring can capture further changes in prevalence and patterns to inform targeted public health intervention programs. [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]

Purpose: Homeless opioid treatment clients who transition into housing generally demonstrate better outcomes, but housing environments vary widely and may not benefit racial/ethnic minority populations equally. We sought to identify how race/ethnicity moderates the association between positive opioid treatment response and moving into dependent or independent living environments. Methods: We used the Treatment Episode Dataset-Discharges (2018–2019) to identify outpatient treatment clients who were homeless at admission and indicated heroin or other opioids as their primary drug of choice (n = 20,021). We defined positive treatment response as a reduction in opioid use between admission and discharge. We used multivariable logistic regression to model treatment response. We included an interaction between housing at discharge (remained homeless [reference], dependent living, or independent living) and race/ethnicity, and adjusted for relevant confounders. Results: Transitioning from homeless to dependent living was positively associated with treatment response among White (aOR = 3.57, 95% CI = 3.15-4.06), Hispanic (aOR = 2.11, 95% CI = 1.55-2.86), and Black clients (aOR = 1.79, 95% CI = 1.41-2.27), but no association was observed for homeless American Indian/Alaska Native clients. Transitioning from homeless to independent living was strongly associated with treatment response among all groups with the strongest association observed among White clients (aOR = 4.70, 95% CI = 4.26-5.19). Conclusions: Interventions aimed at improving OUD treatment outcomes among homeless clients should identify individual and structural factors that support moving into fully housed and independent living environments. Dependent living offers needed support during crises, but should be temporary and priority should be placed on independent, permanent, and autonomous living environments. [ABSTRACT FROM AUTHOR]

Opioid-related Emergency Department (ED) visits have surged over the past decade. There is limited data on ED utilization patterns of patients with opioid use disorder (OUD). An improved understanding of utilization may underscore missed opportunities for screening, intervention and referral. This was a retrospective 2:1 matched case-control study conducted at a single urban ED. Cases were patients with an opioid-related index ED visit from June 1, 2017 to May 31, 2018. Controls were patients with a non-opioid related index ED visit from June 1, 2018 to May 31, 2019. The primary outcome was the association between the number of ED visits in the 24-month period surrounding the index visit (12 months prior and 12 months following) and having an opioid-related index ED visit. There were a total of 224 cases. One or more visits preceding (OR: 1.63, 95% CI: 1.17, 2.26) and following the index visit (OR: 2.69, 95% CI: 1.91, 3.78) was significantly associated with case status. Following adjustment, a higher number of visits preceding (aOR: 1.24, 95% CI: 1.08, 1.43) and following the index visit (aOR: 1.39, 95% CI: 1.23, 1.57) remained significantly associated with case status. Patients with an opioid-related index ED visit had significantly higher rates of ED utilization 12 months before and after the index visit when compared to a matched control population. These findings suggest that there are significant opportunities for ED intervention and referral to treatment both prior to and following an opioid-related ED visit in this patient population. [ABSTRACT FROM AUTHOR]

Individuals high in positive urgency (i.e., impulsiveness stemming from high positive mood) may be more preoccupied with alcohol-related cognitions. Our aim was to examine how positive urgency, drinking preoccupation, and consumption patterns concurrently influence the endorsement of alcohol-related problems. We sampled 756 students enrolled in a large, public U.S. university, who completed a cross-sectional survey online. Their mean age was 19.6 (SD = 1.72), 71.3% identified as female, and participants largely identified as Caucasian (65.5%) and Hispanic/Latinx (22.1%). Self-report measurements of trait positive urgency and drinking preoccupation and retrospective data of alcohol use and alcohol-related problems were collected. A series of linear regressions tested for a hypothesized indirect effect between variables. We discovered an indirect effect in the relationship between positive urgency and alcohol-related problems via drinking preoccupation. A significant conditional effect showed that this relationship was influenced by past 30-day alcohol consumption, with the effect gaining strength as consumption days increased. Students with high positive urgency may be more engrossed with alcohol-related drinking cognitions, leading to negative consequences as their alcohol consumption increases. This potential association can inform tailored intervention plans for college student alcohol control, such as successfully managing intense positive moods and alcohol-related cognitions and triggers. [ABSTRACT FROM AUTHOR]

Background: This systematic review provides an overview of studies on latent classes related to the substance use among young adults (18–25 years). Identifying these classes helps to detect high-risk groups, setting a base for selective prevention. Methods: This systematic literature review included peer-reviewed studies (published up to February, 2021) that identified latent classes and investigated predictors of latent classes relating to the use of marijuana, alcohol and/or other substances within samples of young adults. Results: Twenty studies (sample sizes N = 171 to N = 21945) met the inclusion criteria. 14 studies identified 'low-level engagers', 'light alcohol and tobacco use', 'heavy alcohol and tobacco use' and 'heavy use/polysubstance use' classes. Four studies differentiated within the 'heavy/polysubstance' class and found 'traditional clubdrugs', 'hallucinogens' and 'wide-range illicit drugs' classes. Male gender and white race predicted membership of the 'heavy use/polysubstance use' class consistently across studies. Other predictors of polysubstance use that were consistent across studies were peer substance use, depressive symptoms, parental drinking and participating in an honor society. Conclusions: The investigated predictors of class membership provide insight into social settings and characteristics that predict heavy use or polysubstance use. They can contribute to the development of effective prevention interventions by allowing for a more targeted approach. [ABSTRACT FROM AUTHOR]

Background: Cannabis can induce negative outcomes among consumers with mental health conditions. This study examined medical help-seeking behavior, patterns of adverse effects, and perceived impacts of cannabis among consumers with and without mental health conditions. Methods: Data came from the International Cannabis Policy Study, via online surveys conducted in 2018. Respondents included 6,413 past 12-month cannabis consumers aged 16–65, recruited from commercial panels in Canada and the US. Regression models examined differences in adverse health effects and perceived impact of cannabis among those with and without self-reported past 12-month experience of anxiety, depression, PTSD, bipolar disorder, psychosis. Results: Overall, 7% of past 12-month consumers reported seeking medical help for adverse effects of cannabis, including panic, dizziness, nausea. Help-seeking was greater for those with psychosis (13.8%: AOR = 1.78; 1.11–2.87), depression (8.9%: AOR = 1.57; 1.28–1.93), and bipolar disorder (10.1%: AOR = 1.53; 1.44–2.74). Additionally, 54.1% reported using cannabis to manage symptoms of mental health, with higher rates among those with bipolar (90.8%) and PTSD (90.7%). Consumers reporting >1 condition were more likely to perceive positive impacts on friendships, physical/mental health, family life, work, studies, quality of life (all p <.001). Consumers with psychosis were most likely to perceive negative effects across categories. Conclusion: For conditions with substantial evidence suggesting cannabis is harmful, greater help-seeking behaviors and self-perceived negative effects were observed. Consumers with mental health conditions generally perceive cannabis to have a positive impact on their lives. The relationship between cannabis and mental health is disorder specific and may include a combination of perceived benefits and harms. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection has been increasing among people who inject drugs (PWID), younger than 30 years, and living in rural or suburban areas. We examined injection-related behaviors of young PWID to determine factors associated with HCV infection. From September 2013-May 2015, respondent-driven and snowball sampling were used in 3 suburban areas of Wisconsin to recruit PWID 18-29 years who reported injection drug use in the previous 12 months. Participants were tested for HCV antibody (anti-HCV) and reported injection-related behaviors/practices via self-administered computer-based survey. We calculated anti-HCV prevalence and assessed associated factors using multivariable logistic regression. Forty-two percent (117/280) of participants were male, 83% (231/280) were white, and median age was 23 years. Overall HCV prevalence was 33%, but HCV prevalence among males was 39%. Adjusting for age, sex, race/ethnicity, education, relationship status, insurance status and income, anti-HCV positivity was associated with higher injection frequency (> 100 times in the past six months) (aOR = 3.07; 95% Confidence Interval (95% CI): 1.72-5.45), ever shared syringes (aOR = 5.15; 95% CI: 2.52-10.51), past week/last use receptive rinse water sharing (aOR = 1.88; 95% CI: 1.06-3.33), past week/last use receptive filter sharing (aOR = 3.25; 95% CI: 1.61-6.54), reusing syringes (aOR = 1.91, 95% CI: 1.08-3.37), history of overdose (aOR = 8.82; 95% CI: 2.26-3.95), and having ever injected another PWID (aOR = 8.82; 95%CI 3.94-19.76). Anti-HCV positivity is associated with high-risk injection practices. Young PWID would benefit from access to evidence-based interventions that reduce their risk of infection, link those infected to HCV treatment, and provide education to reduce further transmission. [ABSTRACT FROM AUTHOR]

Electronic cigarettes (e-cigarettes) have become increasingly popular in the United States, including among cancer survivors, and the majority of users also endorse conventional cigarette usage. There has been little research on racial disparities of e-cigarette usage among this population. Using data from the National Health Interview Survey (2014–2018), trends in e-cigarette usage by smoking status was estimated among cancer survivors reporting a history of conventional cigarette use. Multivariable logistic regression analyses defined adjusted odds of e-cigarette usage including an interaction term between race*smoking status to assess whether the association between race and e-cigarette usage depended on smoking status. Among 8,199 cancer survivors with history of conventional e-cigarette usage, 1,422 (17.3%) also reported using of e-cigarettes. The majority (71.3%) of e-cigarette users were current (versus former) conventional cigarette smoking individuals. White race was associated with higher odds of e-cigarette usage (AOR 2.17, 95% CI 2.00-2.33, p < 0.001), however there was a statistically significant race*smoking status interaction term (p < 0.001) such that this association was only seen among current conventional smoking patients (AOR 1.96, 95% 1.67-2.70, p < 0.001; 50.6% vs. 33.7%). Among the oncology population, the majority of e-cigarette users also endorsed active conventional cigarette smoking. In particular, dual usage was highest among White cancer survivors suggesting that e-cigarettes may not be an efficacious tool for smoking cessation among this population. Our findings can can help inform targeted screening and counseling efforts among cancer survivors. [ABSTRACT FROM AUTHOR]

Although past studies have examined the adverse impact of sports- and physical activity-related concussions (SPACs) on health and mental health outcomes, there is a dearth of research investigating the association between SPACs and binge drinking and marijuana use. The objective of this study is to examine the cross-sectional association between SPACs and binge drinking and marijuana use among adolescents and whether symptoms of depression and suicidal ideation mediate this association. Data for this study came from the 2017 and 2019 National Youth Risk Behavior Survey. An analytic sample of 17,175 adolescents aged 14–18 years (50.2% male) was analyzed using binary logistic regression. Of the 17,175 adolescents, 13.7% engaged in binge drinking and 19.3% used marijuana 30 days preceding the survey date. Approximately one in seven (14.1%) adolescents had SPACs during the past year. Upon controlling for the effects of other factors, adolescents who had SPACs had 1.74 times higher odds of engaging in binge drinking (AOR = 1.74, p<.001, 95% CI = 1.47–2.06) and 1.42 times higher odds of using marijuana (AOR = 1.42, p<.001, 95% CI = 1.24–1.62) than those who did not have SPACs. Symptoms of depression and suicidal ideation explained 12% of the association between SPACs and binge drinking, and 19% of the association between SPACs and marijuana use. Understanding the association between SPACs and substance use and mental health could contribute to early identification of adolescents who may engage in substance use. [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]

Background: Adverse childhood experiences (ACEs) are a major public health issue linked to negative health outcomes. Yet, few recent studies drawing on national data have examined the association between ACEs and binge drinking. Objective: The objective of this study was to examine the association between ACEs and binge drinking among adults in the United States and whether this association is dependent on sex. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 41,322 adults aged 18–64 years (50.7% male) from 17 states was analyzed using binary logistic regression. The outcome variable was binge drinking, and the main explanatory variable was ACEs. Results: Of the 41,322 respondents, 21.3% engaged in binge drinking. About 30% of the respondents had no ACEs and 23.9% had four or more ACEs. In the multivariable logistic regression, we observed that sex moderated the association between ACEs and binge drinking. Odds were 1.36 times higher for females who experienced two ACEs (aOR = 1.36 p <.05, 95% CI = 1.04–1.77) and 1.58 times higher for females who experienced three ACEs (aOR = 1.58 p <.01, 95% CI = 1.17–2.12) to engage in binge drinking. Other factors associated with binge drinking include younger age, non-Hispanic White, higher income level, higher education, not being married, being overweight, and history of cigarette smoking. Conclusion: The findings of this study underscore the importance of developing sex-appropriate screening and intervention strategies to support individuals exposed to ACEs and potentially mitigate negative health outcomes later in life. [ABSTRACT FROM AUTHOR]

Cannabis use among adolescents may have detrimental effects and use among this age group is increasing. It is important to understand how expansion of laws permitting cannabis sales may impact adolescent use. Much of the current research has explored how state-level policy decisions may impact adolescents' use behaviors; however, there is a gap in the understanding of how differences in local jurisdictional policies may also influence underage cannabis use. Procedures: The present study cross-sectionally assesses local variation in cannabis policies to explore the potential effects of local policy on underage use behaviors. Data were collected from (N = 1,573) adolescents representing 120 different localities across California, collected as a part of Project Cal Teens. Linear regression models were used to assess associations between local jurisdiction's allowance of retail sale of cannabis for adult-use and past 30-day use of non-medical (adult use) cannabis and perceived access to cannabis products. Local policy allowing cannabis retail was associated with adolescents' significantly higher past 30-day use of cannabis (β = 0.25 95% CI = 0.08, 0.42) and perceived access (β = 0.60 95% CI = 0.27, 0.94). Results highlight the impact of local cannabis policies on adolescent cannabis use and perception. Considering the effects of cannabis use on adolescent development, this is an important public health concern because 14 states have already legalized recreational retail sales and growing numbers of local jurisdictions are allowing the retail sale of recreational cannabis. [ABSTRACT FROM AUTHOR]

While research has assessed correlates of marijuana use, there has been less focus on predictors of differing levels of changes in use during young adulthood, a critical period for use/escalation. We examined changes in marijuana use and related sociocontextual predictors (e.g., earlier-onset substance use, parental use, college type). Using data from Georgia college students (ages 18–25 years) in a 2-year, 6-wave longitudinal study (64.6% female, 63.4% White), 2-part random-effects modeling examined use at any assessment and number of days used. Predictors of use status at any assessment included being male (OR = 1.87, 95%CI = [1.28–2.73]), Black (OR = 1.91, 95%CI = [1.15–3.19]), earlier-onset marijuana (OR = 2.63, 95%CI = [1.70–4.06]), cigarette (OR = 2.04, 95%CI = [1.19–3.48]), and alcohol users (OR = 1.49, 95%CI = 1.00–2.22]), parental tobacco (OR = 2.14, 95%CI = [1.18–3.86]) and/or alcohol use (OR = 1.55, 95%CI = [1.09–2.20]), and attending private (vs. public) institutions (OR = 1.68, 95%CI = [1.10–2.59]). Predictors of lower likelihood of use over time included being male (OR = 0.87, 95%CI = [0.77–0.98]), earlier-onset cigarette use (OR = 0.82, 95%CI = [0.68–0.98]), parental alcohol use (OR = 0.86, 95%CI = [0.77–0.97]), and private institution students (OR = 1.17, 95%CI = [1.02–1.34]). Predictors of more days used at baseline included being male (OR = 1.77, 95%CI = [1.40–2.23]), Black (OR = 1.42, 95%CI = [1.04–1.93]), earlier-onset marijuana (OR = 2.32, 95%CI = [1.78–3.01]) and alcohol users (OR = 1.29, 95%CI = [1.01–1.66]), and parental tobacco use (OR = 1.90, 95%CI = [1.32–2.73]). Predictors of fewer days used over time included being older (OR = 0.98, 95%CI = [0.97–1.00]), parental tobacco use (OR = 0.86, 95%CI = [0.78–0.95]), and attending private institutions (OR = 0.89, 95%CI = [0.83–0.93]). Intervention efforts can be informed by current findings that correlates of baseline use (e.g., being male, attending private institutions) also predicted less use over time, and one's earlier use and parents' use of various substances impacted young adult use. [ABSTRACT FROM AUTHOR]

To evaluate the odds for bipolar disorder (BP) mania and depression-related hospitalization due to cannabis use disorders (CUD). We conducted a cross-sectional study using the national inpatient sample (NIS), and included adult BP hospitalizations sub-grouped by manic (N = 209,785) versus depressive episodes (N = 170480). A logistic regression model was used to evaluate adjusted odds ratio (aOR) of association between CUD and BP-mania-related hospitalizations and was adjusted for demographics confounders, psychiatric comorbidities and other substance use disorders (SUD). Comorbidities were less prevalent in BP mania compared to BP depression: anxiety disorders (22.7% vs. 35.3%), PTSD (8.7% vs. 14.3%), and personality disorders (15.4% vs. 20.5%). Among SUD, methamphetamine (aOR 1.27, 95%CI 1.22 − 1.32) and CUD (aOR 1.53, 95%CI 1.50 − 1.56) had increased odds for hospitalization for BP mania. CUD increases the odds for hospitalization for BP manic episode by 53%. Due to the rising prevalence of cannabis use among patients with BP it is important to provide substance use counseling/psychoeducation and discourage cannabis use among youth to prevent long-term adverse consequences. [ABSTRACT FROM AUTHOR]

HIV pre-exposure prophylaxis (PrEP) is safe and effective for use in people who inject drugs (PWID), but PrEP is underutilized in this population. We assessed awareness of PrEP and correlates of interest in PrEP among PWID in Seattle, Washington. This study analyzed data from a 2019 survey of PWID at 3 Seattle-area syringe service programs (SSPs). We used descriptive statistics to compare PrEP-aware and unaware PWID and multivariable Poisson regression with robust standard errors to estimate adjusted prevalence ratios (APR) for interest in PrEP. Among 348 HIV-negative PWID, ≤1% were currently taking PrEP, 51% were PrEP aware and 46% were interested in PrEP. Interest in PrEP was inversely associated with prior PrEP awareness (APR 0.58, 95% CI 0.45 − 0.74); however, interest in PrEP was high among PWID meeting pre-specified risk criteria for HIV (APR 1.41, 95% CI 1.06 − 1.88). Our results suggest increasing awareness of PrEP may not be sufficient to promote PrEP uptake among PWID, and further efforts are needed to understand perceptions of risk for HIV, determinants of PrEP use, and to investigate successful strategies for PrEP implementation and delivery in this marginalized population. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.2012688. [ABSTRACT FROM AUTHOR]