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Competing Interests: Declaration of Competing Interest None declared.

There is a paucity of literature examining how preferences differ amongst various demographic groups. This study aimed to assess how perceptions of the ideal breast differ between respondents stratified by self-identified demographic factors. A cohort of 25 patients from the senior surgeon's practice presenting for breast surgery was assembled. Pre-operative anteroposterior photographs of these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents' impressions of 'breast attractiveness'. Respondents were asked to rate breasts on a Likert scale. Survey responses were analysed for differences in breast aesthetic preferences by sex, gender, sexual orientation, and race. Males rated all breasts higher on the Likert scale for attractiveness than females (2.8 vs 2.5, p < 0.001). Despite this discrepancy, ratings amongst male and female respondents were highly correlated with one another (R = 0.940; p < 0.0001). Considering sexual orientation, individuals attracted to women provided significantly higher attractiveness ratings to all breasts compared to individuals attracted to men only (2.8 vs 2.5, p < 0.001). White or Caucasian individuals ascribed significantly higher breast attractiveness ratings than Asian individuals (2.7 vs 2.2, p < 0.001), but not Black or African American individuals (2.7 vs 2.4, p = 0.23). Despite these racial discrepancies in mean breast attractiveness, ratings amongst the three groups were highly correlated. In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by demographic factors. These findings merit further investigation to understand these trends and observations., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Acellular dermal matrices (ADMs) are commonly used in prepectoral breast reconstruction. However, ADM is associated with high cost and potentially infection and seroma. Comparative studies on prepectoral reconstruction with and without ADM are limited to small, single-institution series. The purpose of this study was to perform a meta-analysis of prepectoral reconstruction with and without ADM. A systematic literature review was performed to identify studies comparing prepectoral reconstruction with and without ADM using PubMed, EMBASE, and Cochrane databases. Pooled rates of patient demographics and outcomes were analyzed. Meta-analytic effect size estimates were calculated for reconstructive complications in studies comparing reconstruction with and without ADM. In total, 515 reconstructions from four studies were included. Most cases were nipple-sparing mastectomies and utilized tissue-expander reconstructions. Meta-analysis demonstrated no significant difference in the rate of complications between cohorts with and without ADM. Short-term complications included reconstructive failure (1.2% in ADM cohort and 2.8% in no-ADM), seroma (1.2% and 8.3%, respectively), hematoma (1.2% and 2.1%), infection (4.7% and 4.2%), and mastectomy flap ischemia and/or necrosis (2.4% and 5.2%). Long-term complications included rippling (3.3% in ADM and 5.1% in no-ADM cohorts) and capsular contracture (6.8% and 3.4%, respectively). This meta-analysis demonstrated no difference in the rate of complications between cases with and without ADM. However, the outcomes data from no-ADM reconstruction mostly reflect robust mastectomy flaps. Surgeon discretion as informed by specific clinical scenarios should guide decisions regarding the use of ADM in prepectoral breast reconstruction., Competing Interests: Declaration of Competing Interest None declared., (Published by Elsevier Ltd.)

Objective: To examine the effect of cost of living on general surgery resident salaries and identify factors associated with greater incomes and availability of housing stipends., Design: Retrospective cross-sectional analysis of Fellowship and Residency Electronic Interactive Database (FREIDA), institutional websites, and Doximity. Program characteristics were compared through Kruskal-Wallis tests, ANOVA, and χ 2 tests. Multivariable linear mixed modeling and multivariable logistic regression were utilized to determine factors associated with higher salary and availability of housing stipend, respectively., Setting: Three-hundred fifty-one general surgery residency programs in the United States., Participants: Three-hundred-seven general surgery residency programs with available salary data for the 2022 to 2023 academic year., Results: The average postgraduate year 1 resident annual salary was $59,906.00 (standard deviation [SD] ± $5051.97). After adjustment for the cost of living, the average annual income surplus was $22,428.42 (SD ± $4848.64). Cost of living and resident remuneration varied substantially across regions (p < 0.001). Annual income surplus was the highest for programs in the Northeast when compared to other regions (p < 0.001). Resident annual income increased by $510 (95% confidence interval [CI] $430-$590) for each $1000 increase in the cost of living and $150 (95% CI $80-$210) for each 10-rank increase in Doximity general surgery program reputation ranking. An increased cost of living was associated with a higher likelihood of housing stipend availability (odds ratio 1.17, 95% CI 1.07-1.28)., Conclusions: General surgery residents are inadequately compensated for the cost of living, indicating the potential for increased compensation to alleviate economic strain of surgical trainees. As financial stress can have implications for mental and physical well-being, further discussion of current resident salaries and benefits is warranted., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Hematomas are reported to be the most common immediate complication in patients undergoing gender-affirming mastectomy, with rates substantially higher than those associated with other types of breast surgery. This study sought to examine the breadth of current literature and provide evidence-based explanations regarding the development of hematomas in chest masculinizing surgery and technical considerations for reducing their incidence., Methods: A systematic review was conducted to identify all articles related to gender-affirming mastectomy published through September 2021. Literature search yielded 2,661 articles for screening, of which 20 met inclusion criteria. Themes from the selected articles were compiled to generate consensus statements qualified by associated level of evidence (LOE)., Results: The rate of hematoma following gender-affirming mastectomy is reported in the literature ranging from 0% to 31.2%. The use of more limited, nipple-sparing incisions is associated with a higher hematoma rate than mastectomy with free nipple grafting (Level III). There is no conclusive evidence indicating any relationship between the use of masculinizing hormones and the incidence of hematoma (Level IV). Factors such as body mass index (Level III) and breast size (Level III) were not found to influence hematoma risk, though nicotine use (Level IV) was significantly associated with the incidence of hematoma., Conclusions: Hematoma is a known complication following gender-affirming mastectomy. The use of limited incision approaches has the strongest association with an increased risk of hematoma. There is no evidence indicating an association between hormone use (i.e., testosterone) and hematoma incidence. Future studies are needed to better define factors, interventions, and protocols to reduce the rate of hematoma., Level of Evidence: III., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: This randomized controlled trial examined whether an interactive, risk-focused educational program was associated with higher risk perceptions and decreased prescription opioid use/misuse among emerging adults., Methods: 503 participants aged 15-24 years scheduled for ambulatory surgery were randomized to routine prescription education with or without our Scenario-Tailored Opioid Messaging Program (STOMP) provided prior to receipt of a prescribed opioid. Surveys were completed preoperatively, and at days 7&14, months 1&3 postoperatively. Outcomes included analgesic risk perceptions, opioid use, and misuse intentions/behavior., Results: Compared to Controls, STOMP was associated with stable but higher risk perceptions on day 14 (β = 1.76 [95% CI 0.53, 2.99], p = .005) and month 3 (β = 2.13 [95% CI 0.86, 3.40], p = .001). There was no effect of STOMP or analgesic misuse risk perceptions on days of opioid use or subsequent misuse intentions/behavior. The degree to which participants valued pain relief over analgesic risk (trade-off preference) was, however, associated with prolonged postoperative opioid use and later misuse., Conclusion: Education emphasizing the risks of opioids was insufficient in reducing opioid use and misuse in youth who were prescribed these analgesics for acute pain relief., Practice Implications: Education may need to better address analgesic expectations to shorten opioid use and mitigate misuse., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: The coronavirus disease-19 (COVID-19) pandemic dramatically changed the delivery of breast cancer care. The objective of this study was to quantify the effect of the pandemic on breast cancer screening, treatment, and reconstruction at a single institution in New York City., Methods: A retrospective chart review was conducted to determine the number of mammograms, lumpectomies, mastectomies, and breast reconstruction operations performed between January 1, 2019 and June 30, 2021. Outcomes analyzed included changes in mammography, oncologic surgery, and breast reconstruction surgery volume before, during and after the start of the pandemic., Results: Mammography volume declined by 11% in March-May of 2020. Oncologic breast surgeries and reconstructive surgeries similarly declined by 6.8% and 11%, respectively, in 2020 compared with 2019, reaching their lowest levels in April 2020. The volume of all procedures increased during the summer of 2020. Mammography volumes in June and July 2020 were found to be at pre-COVID levels, and in October-December 2020 were 15% higher than in 2019. Oncologic breast surgeries saw a similar rebound in May 2020, with 24.6% more cases performed compared with May 2019. Breast reconstruction volumes increased, though changes in the types of reconstruction were noted. Oncoplastic closures were more common during the pandemic, while two-stage implant reconstruction and immediate autologous reconstruction decreased by 27% and 43%, respectively. All procedures are on track to increase in volume in 2021 compared to that in 2020., Conclusion: The COVID-19 pandemic reduced the volume of breast cancer surveillance, surgical treatment, and reconstruction procedures. While it is reassuring that volumes have rebounded in 2021, efforts must be made to emphasize screening and treatment procedures in the face of subsequent surges, such as that recently attributable to the Delta and Omicron variants., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses., Design: Cross-sectional survey., Setting: Four hospitals in the Midwestern United States., Participants: Registered nurses who worked in perinatal units (N = 440)., Methods: We collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal-newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach's alpha. We tested for differences between units using analysis of variance and Tukey's post hoc honest significant difference test of pairwise differences., Results: The final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88-.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant., Conclusions: The Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aims to define the impact of the novel Coronavirus Disease 2019 (COVID-19) pandemic on the volume of common plastic and reconstructive procedures in the United States., Methods: TrinetX is a national, federated database that was utilized in surveying plastic and reconstructive procedural volumes among 53 Healthcare organizations (HCO) between March 2018 and May 2021. This timeframe was divided into pre-pandemic (March 2018 to February 2020) and pandemic periods (March 2020 to May 2021). Each period was then sub-divided into four seasons of the year and the mean monthly procedural volume per HCO was compared. A student's t-tests comparing pre-pandemic and pandemic seasonal mean procedural volumes were used for statistical analysis., Results: A total of 366,032 patient encounters among 53 HCO were included. The average seasonal volume per HCO of all procedures reduced from 872.11 procedures during pre-pandemic seasons to 827.36 during pandemic seasons. Spring 2020 vol declined for most procedures as 15 of 24 (63%) assessed procedure categories experienced statistically significant decreases. Spring 2021 experienced rebounds with 15 of 24 (63%) assessed procedures showing statistically significant increases., Conclusion: During the pandemic period, the average procedural volume per HCO of 14 procedure categories was significantly less than the pre-pandemic average procedural volume. Overall, an inverse relationship was observed between novel COVID-19 cases and plastic and reconstructive surgery procedure volumes in the United States., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Rankings of residency programs are highly influential and utilized by residency applicants. Existing ranking resources often use opaque criteria that may include bias or do not accurately represent the academic achievement of current faculty. This study aims to create an updated general surgery residency ranking list based on the academic achievements of their respective surgery department faculty members., Design: One hundred and six general surgery residency programs were selected from the American Medical Association Residency & Fellowship Programs Database. The names of faculty members affiliated with the departments of surgery were manually obtained. Lifetime and five-year h-indexes, a sum of grant awards from the National Institute of Health and Veterans Affairs, and a tally of journal editorial board positions were collected for the faculty. Metrics were compared among surgical departments, and the corresponding residency programs were ranked accordingly., Setting: The study evaluated university-based general surgery residency programs in the United States from 2017 to 2019 via assessing their respective institutions' departments of surgery., Participants: A total of 7568 faculty members were evaluated. Faculty were required to be full-time, clinical surgeons to meet inclusion criteria., Results: Based on a composite of all measured criteria, the top overall surgery department was at the University of Michigan. Massachusetts General Hospital had the highest lifetime and five-year h-indexes. Brigham and Women's Hospital had the most National Institute of Health funding, and the University of Pittsburgh Medical Center had the most Veterans Affairs funding. Washington University in St. Louis/Barnes Jewish Hospital had the most editorial board positions in their department., Conclusions: The academic success of departments of surgery was evaluated to develop a ranking list of general surgery residency programs. Through utilizing standardized methods and several measures of academic achievement, this comprehensive general surgery residency classification system will allow residency applicants to make more informed decisions., (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Sexual minority women are consistently at increased risk for tobacco use compared to heterosexual women. Neither biomarkers of nicotine exposure nor biomarkers of tobacco toxicant exposure have been examined by sexual identity., Methods: This study used interview and biomarker data from women in the biomarker core sample of Wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013-2014; n = 4930). We examined associations of sexual identity with nicotine exposure (measured with urinary cotinine and TNE-2) and with tobacco-specific nitrosamines (measured with urinary NNAL). Multivariable regression modeling was used to examine these associations among the full biomarker core sample, among past 30-day tobacco users, and among exclusive established cigarette users before and after controlling for tobacco use quantity and intensity., Results: In the full biomarker sample of women, prior to adjusting for tobacco use quantity and intensity, bisexual women had significantly higher cotinine, TNE-2, and NNAL levels compared to heterosexual women. Among exclusive established cigarette users, gay/lesbian women had significantly higher NNAL compared to heterosexual women prior to adjusting for tobacco quantity and intensity. No differences by sexual identity were found after adjusting for tobacco use quantity and intensity., Conclusions: This is the first study to demonstrate differences in biological markers of tobacco exposure by sexual identity among women in the U.S. This has important public health implications as greater exposure to both nicotine and to tobacco-specific nitrosamines are strongly linked to cancer risk., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to explore the association between respiratory symptoms among U.S. adolescents who were current (past 30-day) users of cigarettes, e-cigarettes, and/or cannabis, as well as lifetime users of cannabis with electronic nicotine delivery systems (ENDS)., Methods: Wave 4 from a national probability sample (N = 14,798) of adolescents (12-17 years) using Population Assessment of Tobacco and Health Study data was used for this study. Retention rate was 88.4%., Results: The odds of indicating "wheezing or whistling" in the chest were roughly two times higher among those who had used cannabis in ENDS (adjusted odds ratio 1.81, 95% confidence interval 1.47-2.22); neither e-cigarettes nor cigarettes had a significant association with all five respiratory symptoms in the fully adjusted models., Conclusions: This study provides preliminary evidence that adolescents' cannabis use with ENDS may have negative health consequences. Lifetime cannabis use with ENDS was substantially associated with higher odds of respiratory symptoms., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to determine the developmental course of marijuana use among adolescents based on their history of cigarette and e-cigarette use among a national U.S. sample of adolescents who were followed over a four year time-period., Methods: The data for this study used four waves of the Population Assessment of Tobacco and Health (PATH) Study provided by a panel of 12 to 17-year-olds at Wave 1 (n = 11,059) who completed each of the four annual waves of the adolescent/adult survey. We examined recent use (i.e., past 30-day) of e-cigarettes, cigarettes, and marijuana use at each of the four waves., Results: Respondents who had a history of non-concurrent dual use (AOR = 1.67, 95 % CI = 1.24, 2.24) and a history of concurrent dual use (AOR = 1.67, 95 % CI = 1.40, 1.99) had greater odds of past 30-day marijuana use when compared to respondents who had a history of past 30-day e-cigarette use only. Interaction effect models found that e-cigarette only users were at lower risk for past 30-day marijuana use at Wave 1, however, the risk of past 30-day marijuana use increased at a faster rate across the four waves for e-cigarette only users when compared to their peers who used cigarettes or a combination of cigarettes and e-cigarettes., Conclusion: While concurrent and non-concurrent dual use was strongly associated with marijuana use over the study period, marijuana use increased at a faster rate across the four-year span of the study among e-cigarette only users., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Alcohol misuse remains a leading preventable risk factor for morbidity and mortality in the United States. Evidence suggests that alcohol misuse is more prevalent among transgender populations. This study examined the association between transphobic discrimination and alcohol use/misuse among a large sample of transgender people., Methods: Using the 2015 U.S. Transgender Survey (N = 27,715), logistic regression models were conducted to estimate the adjusted odds ratios (AOR) and 95 % confidence intervals (CI) of current alcohol use, past-month binge drinking (≥1 occasion of consuming ≥5 alcoholic beverages within the past month), and past-month frequent binge drinking (≥5 occasions of binge drinking within the past month) among transgender people., Results: Of the respondents, 60.4 % reported current alcohol use, 24.3 % reported past-month binge drinking, and 8.5 % reported past-month frequent binge drinking. The majority (70.1 %) had experienced some form of past-year transphobic discrimination. Experiencing 3+ forms of transphobic discrimination was significantly associated with past-month binge drinking (AOR = 1.49, 95 % CI = 1.37-1.62) and past-month frequent binge drinking (AOR = 1.57, 95 % CI = 1.37-1.79) than individuals who did not experience transphobic discrimination. Persons who cross-dress showed higher odds of current alcohol use (AOR = 1.52, 95 % CI = 1.32-1.74), past-month binge drinking (AOR = 2.51, 95 % CI = 2.21-2.85), and past-month frequent binge drinking (AOR = 4.13, 95 % CI = 3.45-4.94) than transgender women. Discrimination within public spaces and housing domains had the most robust associations with alcohol misuse., Conclusions: Experiencing transphobic discrimination increased the odds of alcohol misuse among transgender people. Stakeholders and providers should be cognizant of the multifaceted nature of transphobic discrimination as unique social stressors that many transgender persons experience., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: The aim of this study was to examine the school-level prevalence and predictors of e-cigarette use among U.S. adolescents., Methods: The Monitoring the Future study is an annual national cross-sectional study of secondary (middle and high) school students. This study uses 2015 and 2016 survey data from 8th, 10th, and 12th grade students (n = 38,926) attending 580 U.S. public and private secondary schools. E-cigarette use, binge drinking, cigarette smoking, marijuana use, and nonmedical prescription drug use were measured at the individual level. School-level characteristics were measured with both aggregated student-level measures (e.g., school-level e-cigarette use, school-level racial composition) and school characteristics (e.g., public vs. private, urban vs. rural)., Results: The prevalence of past-month e-cigarette use varied considerably across 580 U.S. middle and high schools, ranging from 0% to 60% at individual schools (mean = 10.2%, standard deviation = 8.9%). Multivariable regression analyses indicated that past-month e-cigarette use was significantly higher at schools with a higher proportion of White students, schools that were located in the U.S. Southern and Western regions, and schools with higher prevalence of past-month cigarette smoking, after controlling for relevant individual- and school-level covariates., Conclusions: E-cigarette use varies considerably across schools, and this study suggests that school context plays an important role in e-cigarette use. Cigarette smoking and e-cigarette use at the school level are closely linked and are important risk factors for individual-level e-cigarette use. The wide variation in prevalence of e-cigarette use highlights the need for schools to work with professionals to obtain school-level assessment rather than relying solely on state or national results to guide prevention efforts., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The primary objectives were to (1) examine the initiation patterns of e-cigarette and cigarette smoking, (2) compare recent trends in initiation patterns for 2015, 2016, and 2017, (3) examine sociodemographic differences in initiation patterns over time and, (4) examine how initiation patterns are associated with cigarette-related perceptions, behaviors, and intentions., Methods: Data were collected via self-administered questionnaires from 2015 to 2017 nationally representative samples of eighth-grade (modal ages 13-14 years) and 10th-grade (modal ages 15-16 years) students (N = 36,506) attending U.S. secondary public and private schools., Results: Among lifetime e-cigarette or cigarette users (n = 9,858), initiating e-cigarettes only was the most common (47.45%). This was followed by cigarette before e-cigarette initiation (18.50%), which decreased in prevalence from 2015 to 2017. E-cigarette before cigarette initiation was the smallest group (6.89%) but increased from 2015 to 2017. E-cigarette before cigarette users were more likely to perceive cigarette use as risky (adjusted odds ratios [aOR]: 1.40; 95% CI: 1.11-1.77) but also more likely to currently smoke cigarettes (aOR:1.30; 95% CI: 1.03-1.63) compared with those who initiated cigarettes before e-cigarettes. Both cigarette only initiators (aOR: .52; 95% CI: .33-.80) and e-cigarette only initiators (aOR: .22; 95% CI: .07-.16) were less likely to report future intentions to smoke compared with those who initiated cigarettes before e-cigarettes., Conclusions: Initiation patterns related to e-cigarette and cigarette use among U.S. youth appears to be changing rapidly. Furthermore, patterns of initiation should be considered in future research as cigarette-related risk among different e-cigarette and cigarette use initiation patterns is heterogeneous., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The objective of this study was to examine the combinations of e-cigarette use, cigarette use, and other tobacco use over time and the relationship these longitudinal use patterns have with symptoms of tobacco use disorder (TUD) and substance use disorders (SUDs) among a sample of adolescents., Methods: Data from U.S. adolescents (aged 12-17 years) who were surveyed for the Population Assessment of Tobacco and Health Study at baseline, first follow-up, and second follow-up (2013-2014, 2014-2015, and 2015-2016; n = 7,595) was used to analyze symptoms of TUD and SUDs based on longitudinal combinations of tobacco/nicotine use., Results: The most common combination of tobacco/nicotine use across the three waves was "no use of any tobacco/nicotine products" at baseline and first follow-up to "e-cigarette use only" at the second follow-up. Multivariable analyses found that past 30-day cigarette use and other tobacco use at the most recent follow-up was associated with an increase in both current TUD and SUD symptoms, whereas past 30-day e-cigarette use at the most recent follow-up was modestly associated with an increase in current SUD symptoms., Conclusions: Individuals who transitioned to e-cigarette use were at relatively low risk for increased TUD and SUD symptoms. However, individuals who transitioned or continually used cigarettes were typically at greater risk for indicating more TUD and SUD symptoms. Given the low risk of e-cigarette only users to indicate TUD and SUD symptoms, prevention efforts need to be made to target these youth before they transition to cigarettes and other types of tobacco use., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine if low molecular weight synthetic colloid fluids administered to dogs interfere with refractometric estimates of total plasma protein (TPPr) and urine osmolality (UOsm)., Study Design: Experimental study., Animals: Eighteen healthy Greyhound dogs., Methods: Anaesthetized Greyhounds subjected to haemorrhage for 60 minutes were given 80 mL kg -1 of Plasma-Lyte 148 (CRYST), or 20 mL kg -1 of hydroxyethyl starch 130/0.4 (HES) or succinylated gelatine (GELO) (n = 6 per group) intravenously over 20 minutes. Refractometric (TPPr) and biuret total plasma protein (TPPb) were measured before haemorrhage (Baseline), at end of shock (Shock), immediately (T20), then 40 minutes (T60), 100 minutes (T120) and 160 minutes (T180) after fluid administration. Urine specific gravity (USG) and UOsm were measured at all time points except T20. Estimated UOsm (eUOsm) was calculated from USG. Bias and limits of agreement (LOA) for TPPr versus TPPb, and eUOsm versus UOsm were calculated at each time point., Results: For dogs given CRYST and GELO, median TPPr and TPPb decreased in parallel, with a small consistent TPP bias (CRYST range of bias, 0.38-0.67 g dL -1 ; GELO range of bias, 0.42-0.58 g dL -1 ). Dogs given HES showed divergence between median TPPr and TPPb after T20, with a peak bias at T20 of 1.62 g dL -1 (LOA 1.29-1.95). Dogs given HES and GELO had markedly increased USG [HES peak median USG at T180 of 1.119 (Q1-Q3 1.103-1.122); GELO peak median USG at T120 of 1.114 (Q1-Q3 1.082-1.119)], with large increases in bias between eUOsm and UOsm [HES peak bias at T60 of 2995 mOsm kg -1 (LOA 2032-3958 mOsm kg -1 ); GELO peak bias at T120 of 2465 mOsm kg -1 (LOA 940-3990 mOsm kg -1 )]., Conclusions and Clinical Relevance: Administration of HES and GELO to dogs with haemorrhagic shock interferes with refractometric measurements for at least 3 hours after administration., (Copyright © 2019 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objective: To examine whether sources of nonmedical use of prescription drugs (NMUPD) involving anxiolytics, opioids, and stimulants were associated with sociodemographic characteristics, NMUPD characteristics (eg, frequency), and other substance use., Method: Nationally representative samples of US high school seniors (N = 18,549) were surveyed by self-administered questionnaires (2009-2016). Design-based latent class analysis and Rao-Scott χ 2 tests were used to test associations among sociodemographic characteristics, NMUPD characteristics, other substance use behaviors (eg, binge drinking, cigarette smoking, marijuana use), and NMUPD sources., Results: Approximately 11.0% of high school seniors reported past-year NMUPD (n = 1,917). A substantial proportion of nonmedical users obtained the prescription drugs from multiple sources (44.2%). Latent class analysis identified 5 subgroups of NMUPD sources (friend/relative sources, friend/purchased sources, own leftover prescription, multiple sources, and other sources). Nonmedical users who obtained prescription drugs from friend/purchased sources were more likely to be adolescent boys, whereas those who used their own leftover prescriptions were more likely to be adolescent girls. Nonmedical users who obtained prescription drugs from multiple sources were more involved in substance use. In contrast, adolescent nonmedical users who used their own leftover prescriptions were less involved in substance use., Conclusion: Growing evidence indicates that different NMUPD sources are associated with different substance use behaviors. All NMUPD sources should be discouraged, because they place individuals, families, and communities at risk. Patients and their families should receive education on how to manage and properly dispose of controlled medications to avoid diversion into the community. Prescribers are encouraged to check prescription monitoring programs and screen adolescents for substance use/misuse when prescribing controlled medications., (Copyright © 2019. Published by Elsevier Inc.)

Objective: To compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities., Methods: Secondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685)., Results: Rates of eligibility for low-dose helical computed tomography (LDCT) were roughly twice as high among sexual minorities than among heterosexuals (21.1% vs. 11.7%). The odds of gay men and lesbian women indicating eligibility for LDCT screening were four to five times higher when compared to their heterosexual peers. No statistically significant differences were found between sexual minorities and heterosexuals with respect to having a CT scan for lung cancer in the past year., Conclusions: There are potential sexual-identity-related disparities in the utilization of lung cancer screening among eligible smokers. Interventions are needed to increase awareness and uptake of lung cancer screening in order to detect and manage this common form of cancer in the U.S., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: This longitudinal study assesses characteristics associated with adolescents' nonmedical use of prescription opioids (NMUPO) including: frequency, co-ingestion, motives, specific opioid type; sequence of initiation of medical use of prescription opioids and NMUPO in relationship to subsequent substance use disorder (SUD) symptoms., Methods: Twenty-one independent national cohorts of U.S. high school seniors (n = 8,373) were surveyed and followed 17 years from adolescence to age 35., Results: The majority of adolescents who engaged in NMUPO reported occasional/frequent NMUPO, non-pain relief motives for NMUPO, simultaneous co-ingestion involving NMUPO and other drugs, opioid analgesics with high misuse potential, and multiple types of opioid analgesics. Adolescents who reported NMUPO for pain relief, NMUPO involving opioid analgesics with high misuse potential, or multiple prescription opioids had significantly greater odds of SUD symptoms at age 35, relative to those who had no history of NMUPO during adolescence. In addition, medical use of prescription opioids after initiating NMUPO (or NMUPO only) during adolescence was associated with significantly greater odds of subsequent SUD symptoms at age 35 relative to those who reported the medical use of prescription opioids only or had no medical use or NMUPO during adolescence., Conclusions: This is the first U.S. national prospective study to examine the relationships between adolescents' NMUPO characteristics and later SUD symptoms in early midlife. Several characteristics (frequency, co-ingestion, motives, opioid type, and medical/NMUPO initiation history) were identified that could be used to screen and detect high-risk youth for indicated interventions to reduce prescription opioid misuse and SUDs., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: One in five adolescents and emerging adults have reported prescription opioid misuse (POM), posing significant risks for opioid-related adverse outcomes. Devising prevention strategies requires a better understanding of the decisional factors underlying risky misuse behavior. This research examined the associations between past opioid use behavior, opioid risk knowledge and perceptions, and intentional POM decisions., Methods: Participants aged 15-23years completed surveys assessing past prescription opioid use and misuse, opioid risk knowledge, opioid risk perceptions, and pain relief preferences (i.e., analgesic benefit vs. risk aversion preference). The outcome, Willingness to Misuse (i.e., intentional decisions to use a prescription opioid in a non-compliant manner) was measured using hypothetical pain decision scenarios., Results: Surveys were completed by 972 adolescents and young adults. In total, 44% had taken a prescription opioid and 32% of these reported past POM. Willingness to Misuse was significantly associated with lower opioid misuse risk perceptions (β = .75 [95% CI .66-.86]) and past opioid misuse (β = 1.81 [95% CI 1.13-2.91]) but not simple risk knowledge (β = .81 [95% CI .58-1.11]. The probability of future misuse was highest for those who reported past opioid misuse and had low risk perceptions (58.7% [95% CI 51.3-65.8]) and high pain relief preferences (53.4% [95% CI 45.3%-61.3%])., Conclusions: Findings suggest that simple knowledge of prescription opioid risks is insufficient to curtail misuse among adolescents and emerging adults. Rather, it may be important to heighten opioid risk perceptions and strengthen opioid risk aversion values when prescribing opioid analgesics to better prevent future misuse in this high risk population., (Copyright © 2018. Published by Elsevier Inc.)

Purpose: There is a need to obtain greater clarity regarding adolescents' e-cigarette use and the associations of use with a wider range of risk behaviors. This study examines the associations among past-month e-cigarette use only, traditional cigarette smoking only, dual use (i.e., concurrent e-cigarette use and cigarette smoking), school-related (i.e., truancy and poor academic performance) risk behaviors, and substance-related (i.e., alcohol use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) risk behaviors., Methods: Data were collected via self-administered questionnaires from a nationally representative sample of 8,696 high school seniors., Results: An estimated 9.9% of U.S. high school seniors reported past-month e-cigarette use only, 6.0% reported past-month cigarette smoking only, and 7.3% reported past-month dual use. School- and substance-related risk behaviors had strong associations with past-month e-cigarette use. Adolescents who only used e-cigarettes had significantly greater odds of all school- and substance-related risk behaviors relative to nonusers. Dual users had significantly greater odds of frequent/daily e-cigarette use as well as all school- and substance-related risk behaviors relative to those who only used e-cigarettes. Finally, adolescents who engaged in frequent/daily e-cigarette use had significantly greater odds of binge drinking, marijuana use, other illicit drug use and nonmedical prescription drug use, relative to experimental e-cigarette users., Conclusions: E-cigarette use is common among U.S. adolescents, and there are robust associations between e-cigarette use and school- and substance-related risk behaviors. There is evidence that e-cigarette use clusters with risk behaviors and appears to represent a problem behavior, especially dual use of e-cigarettes and traditional cigarettes., (Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Examine the past-year prevalence of nonmedical use of prescription opioids (NUPOs), heroin use, and the concurrent NUPO and heroin in a sample of 12th graders involved in 16 different sports., Methods: A secondary analysis of nationally representative data from nine cohorts (2006-2014) of the Monitoring the Future study (n = 21,557)., Results: No differences were found between 12th graders who participated in at least one competitive sport and nonparticipants with respect to past-year NUPO, heroin use, and concurrent NUPO and heroin use. Most of the 16 sports analyzed were not associated with the three drug use outcomes. However, 12th graders who participated in ice hockey had substantially greater odds of both past-year heroin use and concurrent NUPO and heroin, while those who participated in weightlifting (NUPO and heroin) and wrestling (NUPO) had slightly higher odds of using these drugs., Conclusions: The study provides critical information to inform physicians, parents, and school officials of the risks associated with participating in certain high contact sports, particularly ice hockey., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The age of onset (early vs. late) and context (medical vs. nonmedical) of exposure to stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have been identified as important factors in the addictive potential of these controlled medications. This study examines the role of medical and nonmedical contexts in the association between early exposure to stimulant medications and substance use and substance-related problems among adolescents., Methods: A Web-based survey was self-administered by Detroit-area secondary school students (N=4755) between the 2009-10 and 2012-13 school years. The sample consisted of 51% females, 62% Whites, 32% African-Americans, and 6% from other racial categories., Results: During the study period, an estimated 11.7% of respondents were ever diagnosed with ADHD. Approximately 6.7% (n=322) of respondents indicated lifetime medical use of prescription stimulants while 2.6% (n=124) indicated lifetime nonmedical use. The odds of substance use and substance-related problems were significantly lower among those who initiated earlier medical use of stimulant medications relative to later medical initiation. In contrast, the odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation., Conclusions: More than one in every ten adolescents in this epidemiologically-derived community-based sample was diagnosed with ADHD. This is the first investigation to demonstrate that context (medical vs. nonmedical) plays a critical role in the relationship between early exposure to stimulant medications and the subsequent risk of substance-related problems during adolescence within the same diverse youth sample., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To examine adolescents' annual use of medical marijuana and determine if legal medical marijuana users are at lower risk for frequent marijuana use and other substance use when compared to adolescents who use diverted medical marijuana or from an illicit source., Methods: Public access Monitoring the Future data were used for this secondary analysis. The total weighted sample size was 4394 12th graders., Results: Users of medical marijuana and diverted medical marijuana had notable odds of using daily, using prescription drugs, and using illicit drugs among other substance use behaviors. Medical marijuana users had much higher odds of using medical marijuana because of being "hooked" when compared to diverted medical users and illicit users., Conclusion: This study is the first to provide nationally representative data on three groups of adolescent marijuana users. Although most adolescents use illicit sources, more adolescents appear to be using diverted medical marijuana, than using medical marijuana legally., (Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the social contexts associated with the past-year substance use (multiple substances, alcohol, marijuana, and nonmedical use of prescription opioids, stimulants, and tranquilizers) among U.S. high school seniors., Methods: A secondary analysis of nationally representative survey data from 10 cohorts (2002-2011) of the Monitoring the Future study, including 24,809 high school seniors., Results: The social contexts associated with the past-year substance use varied considerably based on the substance used. The most prevalent location for alcohol, marijuana, and polydrug use was at a party, whereas nonmedical use of prescription stimulants, tranquilizers, and opioids was most likely to occur at home. Most types of substance use occurred in the presence of other people with the exception of nonmedical use of prescription stimulants, which was a more solitary behavior., Conclusions: These exploratory findings indicate that prevention efforts may need to account for differences in social contexts between types of substances used., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The objective of this longitudinal study was to assess the prevalence of medical use, medical misuse, and non-medical use of opioid medication among adolescents who participate in organized sports., Methods: Data for this study were taken from the Secondary Student Life Survey. A total of 1,540 adolescents participated in three waves of data collection occurring between the 2009-2010 and 2011-2012 school years, with 82% of the baseline sample completing all three waves., Results: Using generalized estimating equation models to analyze the longitudinal data, it was found that male adolescents who participated in organized sports during each wave of the Secondary Student Life Survey had higher odds of being prescribed an opioid medication (i.e., medical use) during the past year (adjusted odds ratio [AOR], 1.86; 95% confidence interval [CI], 1.23-2.82), higher odds of past-year medical misuse of opioid medication as a result of taking too much (AOR, 10.5; 95% CI, 2.42-45.5), and higher odds of past-year medical misuse of opioid medication to get high (AOR, 4.01; 95% CI, 1.13-14.2) compared with males who did not participate in organized sports during the study period. Among females, no association was found between participation in organized sports and medical use, medical misuse, and non-medical use of opioid medication., Conclusions: The results of this study indicate that adolescent males who participate in sports may have greater access to opioid medication, which puts them at greater risk to misuse these controlled substances., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The objective of this descriptive study was to determine adolescents' access to their own medications at home, specifically prescription pain, stimulant, antianxiety, and sedative medications., Methods: Semistructured interviews were conducted with a cohort of 501 adolescents from two southeastern Michigan school districts. Participants were asked what medications had been prescribed to them during the previous 6 months; if they had received prescription medications, they were asked in-depth questions about them, including how medications were stored and supervised at home., Results: The sample was comprised of adolescents in the 8th and 9th grades, and 50.9% were male. Participants were primarily white (72.9%, n = 365) or African-American (21.6%, n = 108). Slightly less than half of the adolescents (45.9%, n = 230) reported having been prescribed medications in the previous 6 months. Of this group, 14.3% (n = 33) had been prescribed pain medications, 9.6% (n = 22) stimulants, 1.7% (n = 4) antianxiety medications, and .9% (n = 2) sedatives. In total, 57 adolescents were prescribed medications in the pain, stimulant, antianxiety, or sedative categories (including controlled medications), and the majority (73.7%, n = 42) reported that they had unsupervised access to medications with abuse potential., Conclusions: The majority of adolescents who were prescribed medications in the pain, stimulant, antianxiety, or sedative categories during the previous 6 months had unsupervised access to them at home. It is critical that clinicians educate parents and patients about the importance of proper storage and disposal of medications, particularly those with abuse potential., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To (1) estimate the proportion of nonmedical users of prescription opioids (i.e., used prescription opioids in the past year without a doctor's orders) who used leftover medications from their own previous prescriptions; (2) assess substance use behaviors as a function of diversion source; and (3) identify the sources for these prescribed opioids., Methods: We analyzed data collected via self-administered questionnaires from nationally representative samples of high school seniors (modal age, 18 years) as a part of the Monitoring the Future (MTF) study. The sample consisted of four cohorts (senior years of 2007-2010, n = 8,888), including 647 high school seniors who reported past-year nonmedical use of prescription opioids, of whom 53% were estimated to be women., Results: An estimated 36.9% of past-year nonmedical users of prescription opioids obtained these opioid medications from their own previous prescriptions. Logistic regression analyses indicated that nonmedical users who used leftover medications from their previous prescriptions were primarily motivated to relieve physical pain, whereas nonmedical users who obtained medications from other sources had significantly higher odds of prescription opioid abuse and other substance use behaviors. Based on a subanalysis of nonmedical users who obtained prescription opioids from their previous prescriptions in 2010 (n = 51), approximately 27.1% obtained them from a dentist, 45.0% obtained them from an emergency room physician, and 38.3% obtained them from another physician., Conclusions: Leftover prescription opioids from previous prescriptions represent a major source of nonmedical use of prescription opioids among high school seniors. These findings indicate that enhanced vigilance is needed when prescribing and monitoring prescription opioids among adolescents, to reduce leftover medications and nonmedical use., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The objective of this study was to determine the past-year prevalence rates and behavioral correlates of co-ingestion of prescription opioids and other drugs among high school seniors in the United States., Methods: Nationally representative probability samples of high school seniors in the United States were surveyed as a part of the Monitoring the Future (MTF) study. Data were collected in schools via self-administered paper-and-pencil questionnaires during the spring of each cohort's senior year. The sample consisted of five cohorts (senior years of 2002-2006) made up of 12,441 high school seniors (modal age 18), of which 53% were women., Results: The estimated prevalence of any past-year co-ingestion of prescription opioids and other drugs for these cohorts was 4.4%, and 69.8% among nonmedical users of prescription opioids. The substances most commonly co-ingested with prescription opioids included marijuana (58.5%), alcohol (52.1%), cocaine (10.6%), tranquilizers (10.3%), and amphetamines (9.5%). Nonmedical users who co-ingested prescription opioids with other drugs were more likely to report intranasal administration, recreational motives, oxycodone use, and greater subjective high when using prescription opioids than nonmedical users who did not co-ingest prescription opioids and other drugs., Conclusions: Nearly 7 out of every 10 nonmedical users of prescription opioids reported co-ingestion of prescription opioids and other drugs in the past year. The findings indicate that the co-ingestion of prescription opioids and other drugs by high school seniors in the United States serves as a marker for substance abuse and represents a significant public health concern., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: The objective of this study was to estimate the lifetime prevalence of diversion (i.e., trading, selling, giving away or loaning) of four classes of controlled medications (pain, stimulant, anti-anxiety, and sleeping) among adolescents, and to identify demographic and behavioral characteristics of adolescents who divert their own controlled medications., Methods: A web-based survey was self-administered by 2744 secondary school students from two southeastern Michigan school districts in 2009-2010. The sample consisted of 51% females, 65% Whites, 29% African-Americans, 4% Asians, 1% Hispanics and 1% from other racial categories., Results: Thirty-three percent of the students had ever been prescribed at least one controlled pain, stimulant, anti-anxiety, or sleeping medication. Approximately 13.8% (n=117) of lifetime prescribed users of controlled medications (n=848) had ever traded, sold, given away or loaned their medications. Multiple logistic regression analyses indicated that being approached to divert medications, nonmedical use of prescription medications, externalizing behaviors, and being non-White were significantly associated with the diversion of controlled medications. Multiple logistic regression analysis indicated that the odds of substance use and abuse for lifetime prescribed users who diverted their controlled medications were significantly greater than prescribed users who never diverted., Conclusions: The findings indicate that approximately one in seven prescribed users had diverted their controlled medications in their lifetimes. Being approached to divert medications and substance use are more prevalent among adolescents who diverted their controlled medications. Careful assessments, diligent prescribing and monitoring of controlled medications, and continual patient education could be useful in reducing medication diversion., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Purpose: This study examines adolescent nonmedical use of prescription medications (NUPM) and its relationship to other problem behaviors., Methods: A secondary analysis was conducted with data gathered from 912 adolescents in 2007. Four mutually exclusive groups were created from the data. Adolescents who: 1) did not use controlled prescription medications (nonusers); 2) used their own controlled medications as prescribed (medical-users); 3) engaged in nonmedical use for self-treatment motivations (self-treaters), and 4) engaged in nonmedical use for sensation-seeking motivations (sensation-seekers). These four groups were compared on problem behaviors as well as depression and impulsivity., Results: Approximately 10.9% of the sample engaged in NUPM and 36.8% had a legal prescription for a controlled medication. Sensation-seekers were more likely to engage in most problem behaviors when compared with all other groups; impulsivity and depression was variable among groups., Conclusions: The findings suggest there are different subtypes of nonmedical users of prescription medications.

This study used three characteristics (i.e., motive, route of administration, and co-ingestion with alcohol) of nonmedical prescription drug misuse across four separate classes (i.e., pain, sedative/anxiety, sleeping, and stimulant medications) to examine subtypes and drug related problems. A Web survey was self-administered by a randomly selected sample of 3639 undergraduate students attending a large midwestern 4-year U.S. university. Self-treatment subtypes were characterized by motives consistent with the prescription drug's pharmaceutical main indication, oral only routes of administration, and no co-ingestion with alcohol. Recreational subtypes were characterized by recreational motives, oral or non-oral routes, and co-ingestion. Mixed subtypes consisted of other combinations of motives, routes, and co-ingestion. Among those who reported nonmedical prescription drug misuse, approximately 13% were classified into the recreational subtype, while 39% were in the self-treatment subtype, and 48% were in the mixed subtype. There were significant differences in the subtypes in terms of gender, race and prescription drug class. Approximately 50% of those in subtypes other than self-treatment screened positive for drug abuse. The odds of substance use and abuse were generally lower among self-treatment subtypes than other subtypes. The findings indicate subtypes should be considered when examining nonmedical prescription drug misuse, especially for pain medication.

Purpose: The main objective of this study was to assess the prevalence of medical and nonmedical use of four categories of prescription drugs (opioid, stimulant, sleeping, and sedative/anxiety medication) in a racially diverse sample of secondary public school students in the Detroit metropolitan area. A secondary objective was to examine the association between the use of four categories of prescription medications and illicit drug use and probable drug abuse., Methods: In 2005, a Web-based survey was self-administered by 1086 secondary school students in grades seven through 12., Results: The sample consisted of 54% female, 52% White, 45% African American, and 3% from other racial categories. Forty-eight percent of the sample reported no lifetime use of four categories of prescription drugs (nonusers), 31.5% reported medically prescribed use only (medical users), 17.5% reported both medical and nonmedical use (medical/nonmedical users) and 3.3% reported nonmedical use only (nonmedical users). Multivariate analyses indicated that medical/nonmedical users and nonmedical users were significantly more likely than nonusers to report illicit drug use and probable drug abuse. Medical users generally reported similar or increased odds of illicit drug use and probable drug abuse than non-users., Conclusions: These findings provide evidence that nonmedical use of prescription drugs represents a problem behavior among secondary school students.

This study examined the relationship between past-year drinking behaviors and nonmedical use of prescription drugs (NMUPD) in a nationally representative sample. Prevalence estimates in the United States were derived based on data collected from face-to-face interviews using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n=43,093 individuals aged 18 years and older). Nonmedical use of prescription opioids, stimulants, tranquilizers, and sedatives was more prevalent among individuals with alcohol use disorders (AUDs) than those without AUDs. The odds of reporting NMUPD were 18 times higher among alcohol dependent participants compared to past-year abstainers (OR=18.2, 95% CI=13.9-23.8). Although individuals with AUDs constituted less than 9% of the total sample, those with AUDs accounted for more than one in every three nonmedical users of prescription drugs. The past-year co-occurrence of AUDs and NMUPD was more prevalent among young adults 18-24 years of age than individuals 25 years and older. More than one in every four young adults aged 18-24 years who met the criteria for past-year DSM-IV alcohol dependence also reported past-year NMUPD. These findings suggest that the treatment for AUDs should include a thorough assessment of NMUPD, especially among young adults.

The purpose of this descriptive study was to examine the nonmedical use of prescription pain medications in a sample of public school students in the Detroit metropolitan area. The Web-based survey occurred during a two-week period in May 2003 and drew on a diverse population between the ages of 10 and 18 years. An 87% response rate was achieved, providing a final sample of 1017 students. Twenty-two percent of girls and 10% of boys reported lifetime nonmedical use of a pain medication (chi2 = 25.2, d.f. = 1, p < 0.001). Fifteen percent of girls and 7% of boys reported past year nonmedical use (chi2 = 12.7, d.f. = 1, p < 0.01). Compared to nonusers, nonmedical users of prescription pain medication were seven times more likely to smoke cigarettes, five times more likely to drink alcohol and smoke marijuana, almost four times more likely to binge drink, and eight times more likely to have used other illicit drugs. Of those reporting lifetime nonmedical use of prescription pain medication, 70% noted how they obtained the drugs; 34% reported getting the drugs from a family member, 17% from a friend and 14% from a dealer or theft.

This study identifies the prevalence, correlates, and sources associated with the illicit use of prescription pain medication among undergraduate college students. A cross-sectional, web-based survey was self-administered by a large random sample of 9,161 undergraduate students attending a large Midwestern university in the United States. Although undergraduate women were more likely to be prescribed pain medication, men were more likely to be approached to divert their prescription pain medication and report illicit use of prescription pain medication. Multivariate analyses indicated past year illicit use of prescription pain medication was higher among undergraduate students who were: previously prescribed pain medication, living in a house or apartment, and earning lower grade point averages. The majority of students obtained prescription pain medication for illicit use from peers and the second leading source was family members. There were several gender differences in the risk factors and sources of illicit use of prescription pain medication. Based on qualitative data, illicit use included recreational use for the purposes of intoxication and self-medication for pain episodes. Illicit users, who obtained prescription pain medication from peers, reported significantly higher rates of other substance use while those who obtained prescription medications from family members did not. These findings suggest that the illicit use of prescription pain medications may represent a problem among undergraduate students and effective prevention efforts are needed that account for gender differences.

The prevalence and correlates of illicit methylphenidate use were examined within a nationally representative U.S. sample of 8th, 10th, and 12th graders. The annual prevalence of illicit methylphenidate use was 4%. Race, grade level, geographical region, grade point average, and substance use were all significantly associated with illicit methylphenidate use.

During a school-based survey, middle and high school students (n = 1536) reported on their nonprescribed, lifetime use of asthma inhalers. Approximately 15% of 8th and 9th graders reported using nonprescribed asthma inhalers; the odds for this behavior were significantly higher for these students (2.25 and 2.30, respectively) and the nonprescribed use of asthma inhalers was significantly associated with higher rates of other drug use.

Purpose: To examine cigarette use and its relationship to daily life hassles in an urban sample of African-American adolescent girls., Methods: A sample of 105 African-American adolescent girls (mean age of 15.45 years) derived from a larger cross-sectional research project titled "Female Adolescent Substance Experience Study" funded by the National Institute of Drug Abuse comprised the sample. The sample was divided into adolescents who had ever smoked in their lifetime and adolescents who had never smoked before. Student's t-tests were conducted to determine whether there were differences between these groups on demographic characteristics and the number of daily life hassles. Pearson product moment correlations were also conducted to examine the association between age of smoking initiation and number of hassles., Results: Less than 50% of the teenagers had ever smoked cigarettes in their lifetime, and of those who had ever smoked, the average age of initiation was 12.55 years (SD = 2.63). Furthermore, girls who had ever smoked, in contrast to girls who had never smoked, had a significantly greater number of daily life hassles, in general, and within the school/academic and family/economic domains in particular. Age of smoking initiation was negatively related to the number of hassles, indicating that girls who started to smoke at a younger age reported more hassles., Conclusions: These findings are discussed in terms of developing an understanding of gender and ethnic-specific correlates of smoking that can be used to better delineate the developmental smoking trajectory of African-American girls.