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BackgroundHIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents.ObjectiveTo address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless

Same-day alcohol and cannabis use is relatively common in adolescents and young adults, constituting a higher-risk behavior relative to single-substance use. However, the association between quantity of alcohol and cannabis use on co-use days is understudied. We examined the association between the quantity of alcohol and same-day cannabis use with a multilevel regression analysis in a sample of youth (16-24 years old) with risky alcohol use. Participants reported one or more days of alcohol and cannabis over the past month (N = 468). Quantity of cannabis use was highest on heavy drinking days [M = 0.91 grams, SD = 0.68] followed by moderate drinking days (M = 0.78 grams, SD = 0.63), and lowest on days without alcohol use (M = 0.74 grams, SD = 0.64, p < 0.001). In multilevel modeling analyses, adjusted for clustering within individuals, greater quantity of drinking on a given day was associated with greater cannabis use (estimate = 0.03, p < 0.001). When using alcohol and cannabis on the same day, greater alcohol use was associated with greater cannabis use. Preventing days of heavy use of multiple substances, particularly among at-risk drinkers, may complement interventions addressing co-use generally to prevent substance-related consequences.

Background: High-intensity drinking (HID; 8+ U.S. standard drinks for women, 10+ men) is initiated during adolescence/emerging adulthood, increasing risk for negative outcomes, including blackouts. We examined baseline data from a study of risky drinking youth to identify factors associated with HID. Methods: Risky drinkers (ages 16-24) were recruited online (positive 3-month AUDIT-C score) as part of a larger study to examine social media interventions for risky drinking. We used baseline survey data to examine HID in relation to demographics, substance use-related variables, and individual and social factors. Results: Among 931 risky drinkers, 29.8% reported past-month HID, and those with HID reported greater substance use and consequences. In multivariable analysis, HID was associated with male sex; greater social motives, impulsivity, and motivation; lower self-efficacy; and greater likelihood of not living with parents, drinking with important peers, and parental disapproval of posting drinking pictures. When examining age group interactions (16-20; 21-24), underage drinkers with high sensation-seeking scores and lower parental disapproval of posting drinking pictures on social media reported greater HID. Conclusions: Among risky drinking youth, male sex, social motives, impulsivity, higher motivation to and lower-self-efficacy to reduce drinking, living away from parents, more frequent drinking with important peers, and lower parental disapproval of posting drinking pictures on social media were positively associated with HID. Further, HID was associated with greater health consequences, underscoring the need for HID interventions. Such interventions may benefit from enhancing motivation and self-efficacy, particularly in social contexts, as well as increasing positive peer and leisure activities to reduce HID.

PurposeCannabis use is increasing among emerging adults (ages 18-25), necessitating the need for prevention interventions. Using a novel platform - social media - we developed an 8-week motivational interviewing and cognitive-behavioral intervention targeting cannabis use among emerging adults. Herein, we report on the feasibility and acceptability of the intervention in a pilot trial.ProceduresFor NCT04187989 we recruited N = 149 emerging adults who used cannabis (at least 3 times/week for the past month) using social media advertising. Their mean age was 21.0 years (SD = 2.2); 55.7% were female. Most were White (70.5%; 20.1% Black/African American, 9.4% Other races), with 20.1% identifying as Hispanic/Latinx. Participants were randomized to the 8-week intervention or an 8-week attention-placebo control condition, both delivered in secret Facebook groups by electronic health coaches (e-coaches). Follow-up assessments occurred at 3- and 6-months.ResultsThe intervention was well-received and follow-up rates were high; fidelity was good. Intervention participants rated e-coaches significantly higher in terms of helpfulness, warmth, etc., compared to control participants. Intervention participants were more likely to engage with and recommend the group. In terms of percentage reductions in cannabis outcomes, the intervention group evidenced absolute reductions over time in several measures of cannabis consumption across modalities. In an adjusted model, reductions in vaping days in the intervention group, relative to attention-control, reached statistical significance (p = .020, D =.40).ConclusionsThis social media intervention for emerging adults' cannabis use was feasible and acceptable in the target population warranting future testing in a fully powered trial.

PurposeAlcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth.ProceduresUsing social media advertisements to screen potential participants, we recruited 955 youth (ages 16-24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability.ResultsThe interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition.ConclusionsAmong this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentivized social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use.Trial registrationClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.

Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks underscore the importance of examining the impact of the COVID-19 pandemic in this population. Within a clinical trial (n = 36 received an intervention prior to data collection reported herein), we surveyed cannabis-using emerging adults (ages 18-25) about perceived COVID-19 impacts. Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the past 30) were enrolled and completed online surveys as part of either their baseline or 3 month assessment. COVID-19-related measures included symptoms, substance use, mood, etc. Participants were 57% female (mean age = 21, standard deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African American, and 10% of other races. Most participants (86%) reported quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), but none reported testing COVID-19 positive. Many respondents felt their cannabis use (35%-50%, across consumption methods) and negative emotions (e.g., loneliness, stress, and depression; 69.5%, 69.5%, and 61.8%, respectively) increased. They reported decreased in-person socialization (90.8%) and job losses (23.4%). Reports of increased cannabis smoking were associated with increased negative emotions. On an open-response item, employment/finances and social isolation were frequently named negative impacts (33.3% and 29.4%, respectively). Although cannabis-using emerging adults' reports of increases in cannabis use, coupled with mental health symptoms and social isolation, are concerning, the full impact of the pandemic on their health and well-being remains unknown. Future studies examining the relationship between social isolation, mental health, and cannabis use among young people are needed.

Understanding factors influencing risky drinking among emerging adults could enhance interventions to reduce adverse outcomes. As a motivational construct, the dualistic model of passion (i.e., obsessive passion: drinking is compelling and conflicts with other life activities/values; harmonious passion: drinking is an important, but not overwhelming, part of life) offers a novel explanation for persistent alcohol use. Yet, the dualistic model of passion has not yet been evaluated in this at-risk population. Therefore, we examined whether the variables proposed by the dualistic model of passion were associated with sex, binge-drinking, and alcohol-related consequences among young risky drinkers. We analyzed cross-sectional baseline data collected as part of an ongoing randomized controlled trial of emerging adults (n=327; M age=22.6, SD=1.1, range 21-24; 61% female; 76% White non-Hispanic) engaged in risky drinking (AUDIT-C score ≥ 4 females, ≥ 5 males) recruited nationally via social media advertisements. A path analysis revealed significant positive direct effects between obsessive passion and binge drinking and alcohol-related consequences, and significant negative direct effects between male sex and harmonious passion and binge drinking. There was also a positive direct effect between binge drinking and alcohol-related consequences. Male sex and obsessive passion were both indirectly related to alcohol-related consequences via binge drinking. Type of passion and male sex differentiates risky drinkers who binge drink and who experienced alcohol-related consequences. Future research should examine whether targeting obsessive passion reduces binge drinking and negative outcomes.