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There has been a global surge in adolescents' use of electronic nicotine delivery systems (vaping), cannabis (vaped and edible), and prescription opioids, collectively termed ECPO. The nature of ECPO use can make it difficult to detect due to few obvious immediate physical and behavioural signs, as well as subtle long-term effects that allow adolescents to transition from initial exploration into hazardous ECPO use without easy detection by care providers. Here, we address the nature of the presentation of ECPO use in adolescents (roughly age 13-18 years), including challenges in detecting use and related complications, which affect screening, prevention, and intervention. We begin by reviewing empirical data on these difficult to detect effects in adolescents, including acute effects at cellular and neural levels and long-term neurocognitive and developmental changes that precede outwardly detectable physical signs. We then provide concrete approaches for providers to screen for ECPO use in adolescents even in the absence of overt physical and behavioural symptoms. Finally, we conclude with direct practice recommendations for prevention and intervention.

OBJECTIVE: This study evaluated the association between children’s daily negative affect (NA) trajectories and unhealthy food consumption during weekends using Ecological Momentary Assessment (EMA). DESIGN: Children answered mobile phone based EMA surveys seven times a day for two weekend days per wave, with each survey assessing current NA and past two-hour consumption of fried foods (chips or fries), sweets (pastries or sweets), and sugary beverages (drank soda or energy drinks). SETTING: Los Angeles, California PARTICIPANTS: The sample consisted of 195 children (51% female; mean age=9.65years, SD=0.93) from the Mothers and Their Children’s Health (MATCH) cohort study. MAIN OUTCOMES MEASURES: NA trajectory (Independent Variable), unhealthy food consumption (Dependent Variable) ANALYSIS: Latent growth mixture modeling (LGMM) classified NA trajectories across days and examined their association with unhealthy food consumption. RESULTS: The LGMM identified three classes of daily NA trajectories: (1) Stable low, (2) Inverse U-shaped, and (3) U-Shaped. Fried food consumption was higher on days with Inverse U-Shaped and U-Shaped NA trajectories compared to days with stable low NA. CONCLUSIONS AND IMPLICATIONS: By better understanding day-to-day variability in children’s affect and eating, we can individually tailor obesity interventions to account for the emotional contexts in which unhealthy eating occurs.

Prescription opioid misuse (POM) is often implicated in heroin initiation, despite evidence that POM does not predict heroin initiation any better than other drug use. Additionally, prescription misuse and illicit use behaviors tend to respectively "cluster" together. This study aimed to test a series of theory-driven factor models to explore how POM and heroin use are situated within the broader constellation of drug use that typically occurs alongside opioid (mis)use.36,309 individuals from NESARC-III (56.31% female; mean age=45.63 [SD=17.53]) reported their lifetime (mis)use of prescription opioids, prescription stimulants, prescription sedatives, heroin, cannabis, cocaine/crack, illicit stimulants (e.g., methamphetamine), club drugs, hallucinogens, and inhalants, and were administered a DSM-5 substance use disorder (SUD) assessment. Bifactor, correlated factors, and one-factor confirmatory factor models were fit using all drug use/SUD variables and subsequently compared.POM was most strongly correlated with prescription sedative misuse; heroin use was most strongly correlated with cocaine/crack use. All factor models fit the data well. Highly correlated factors and patterns of factor loadings suggested that POM and heroin use were most parsimoniously captured within a general factor alongside all other forms of drug use. This was also the case for SUD. Additional analyses testing an alternate factor structure provided further support for unidimensionality.POM and heroin use, as well as prescription- and heroin-based SUDs, were neither separable nor distinctly associated. Future research should account for other drug use more comprehensively rather than isolating POM as a primary risk factor in heroin use and use disorder.

Smoking-related weight control expectancies are a motivational factor for maintaining cigarette use, particularly among women. Yet, less research has investigated the physiological and behavioral daily life weight-related experiences of women with smoking-related weight control expectancies. Increased research could contribute to understanding of maintenance factors for this group of smokers as well as unique intervention targets. Female smokers completed a baseline survey of smoking-related weight control expectancies and 35-days of ecological momentary assessment of physiological (i.e., smoking-related reduction in hunger, end-of-day perceived weight gain and bloating) and behavioral (i.e., daily exercise and sitting) weight-related experiences. Higher smoking-related weight control expectancies were associated with perceived smoking-related reductions in hunger and end-of-day perceived weight gain. Smoking-related weight control expectancies did not significantly associate with end-of-day bloating, daily exercise, or sitting. Given these findings, smoking-related weight control expectancies may maintain smoking in order to reduce hunger and to cope with perceived fluctuations in weight in daily life. It is critical for smoking cessation programs to assess smoking-related weight control expectancies and implement targeted treatments for these women.

Objectives Higher levels of positive affect and feelings of energy are associated with greater physical activity (PA) and lower sedentary time (ST). However, whether fluctuations in these feelings contribute to the regulation of these behaviors is unclear. This study examined the extent to which subject-level variability (i.e., degree of intraindividual variability) in positive affect and feeling energetic predicted participants’ overall levels of PA and ST. Design This analysis combined data from four ecological momentary assessment (EMA) studies (agerange: 8–73 years) with ambulatory monitoring via waist-worn accelerometry (N = 661). Methods Positive affect and energy were assessed through EMA several times per day across 4–7 days. Accelerometer data was used to create the following behavioral outcomes: (1) meeting MVPA guidelines (children: 60 minutes/day, adults: 30 minutes/day) and (2) minutes of ST per hour of accelerometer wear. A two-stage analytic approach was used to test the study aim. In the first stage, mixed-effects location scale modeling decomposed mean levels and variability in positive affect and energy. In the second stage, a linear or logistic regression (depending on whether the outcome was continuous or dichotomous, respectively) was tested to investigate associations between subject-level mean and variability in EMA ratings and the behavioral outcome. Results Greater subject-level variability but not subject-level mean of feeling energetic was associated with lower odds of meeting MVPA guidelines (β = −0.43, p Conclusions Fluctuations in physical feeling states may deplete self-regulatory resources involved in planning and implementing PA behavior. Alternatively, being more physically active may stabilize one's perceived energy levels.

INTRODUCTION: Pregnant women’s daily time-activity and mobility patterns determine their environmental exposures and subsequently related health effects. Most studies ignore these and assess pregnancy exposures using static residential measures. METHODS: We conducted 4-day continuous geo-location monitoring in 62 pregnant Hispanic women, during pregnancy and early post-partum then derived trips by mode and stays, classified by context (indoor/outdoor, type). Generalized mixed-effect models were used to examine whether these patterns changed over time. RESULTS: Women spent on average 17.3 h/day at home. Commercial and service locations were the most popular non-home destinations, while parks and open spaces were seldom visited. Women made 3.5 daily (63.7 min/day and approximately 25% were pedestrian-based). Women were less likely to visit commercial and services locations and make vehicle-based trips postpartum compared to the 3(rd) trimester. CONCLUSION: Our findings suggest time-activity patterns vary across pregnancy and postpartum, thus assessing exposures at stationary locations might introduce measurement error.

Schools are a recommended place for childhood obesity prevention. Local Wellness Policies (LWPs) establish guidelines for schools to provide opportunities for students to access nutritious foods and be physically active. Little is known about the impact of LWPs, when implemented, on students' behavior and body mass index (BMI). The Wellness Champions for Change trial assesses the student-level impact of providing theory-based training and technical assistance to help schools implement LWPs. This 3-arm, cluster randomized controlled trial will take place in 30 low- or middle-income schools (15 elementary and 15 middle) in five Maryland school districts. Ten schools will receive both Wellness Champions for Change (WCC), which involves training teacher-led wellness teams, and Wellness Champions for Change-Student (WCC-S), which engages students as wellness team members. Ten schools will receive WCC only, and ten control schools will receive a delayed intervention. The RE-AIM framework will guide evaluation. Student Effectiveness measures will include BMI z-scores, self-reported diet patterns, and objectively-measured physical activity. The sample size (1080 students across 30 schools, followed for 2.5 years) will enable power (>0.8) to detect BMI z-score differences. A three-level linear mixed model that accounts for clustering will be used to assess Effectiveness. A mixed methods approach will assess school- and district-level Reach, Adoption, and Implementation. If effective, this approach will represent a sustainable, multi-level, school-based strategy to prevent childhood obesity. The evaluation framework will allow for the description of factors necessary to broadly disseminate this approach for obesity prevention on a large scale.

Purpose Although evidence suggests that anhedonia—a reduced ability to experience pleasure in response to rewarding stimuli—may predict weight gain during adolescence, it remains unclear whether changes in anhedonia during adolescence are associated with changes in body mass index (BMI). This study examines longitudinal associations between changes in anhedonia and developmental trajectories of BMI during adolescence. Methods Self-report measures of anhedonia and BMI were collected at five semiannual assessments among students from 10 high schools in Los Angeles, CA, area (N = 3,396) followed up from the 9th grade to the 11th grade. Four BMI trajectories were identified using growth mixture modeling: (1) stable normative weight ; (2) overweight to normative weight (i.e., decreasing BMI); (3) overweight to chronically obese (increasing BMI); and (4) normative weight to overweight (increasing BMI). Latent growth curve modeling estimated baseline level and changes in anhedonia. A multinomial logistic regression model tested associations of baseline level and slope of anhedonia with the four BMI trajectory groups. Results Compared with the stable normative BMI trajectory group, each 1-unit standard deviation increase in anhedonia slope increased the odds of membership in the overweight to chronically obese group (odds ratio [OR] [95% confidence interval {CI}] = 1.29 [1.09–1.49], p normative weight to overweight group (OR [95% CI] = 1.28 [1.04–1.53], p = .006), and decreased the odds of membership in the overweight to normative weight group (OR [95% CI] = .78 [.57–.95], p = .01). Conclusions Across a 2-year period of high school, the rate of change in anhedonia is associated with certain BMI trajectories linked with poorer metabolic health. Increasing anhedonia may be an important risk factor to consider in adolescent obesity prevention.

To examine the associations between high-fat/high-sugar foods (HFHS) and fruit and vegetable (FV) consumption and affective states in women.The researchers used electronic ecological momentary assessment to capture HFHS and FV consumption in the past 2 hours (predictor) and current affective states (outcome) across 1 week among 202 women. Multilevel linear regression was conducted. Weight status was tested as a moderator.Consumption of FV in the past 2 hours was positively associated with feeling happy (P .05). Women who consumed more HFHS or fewer FV than others in the study reported higher average sadness (both P .05). Overweight or obese women who reported more frequent HFHS consumption than others had higher average stress than normal weight women (P .05).The association between HFHS consumption and stress might be stronger in overweight or obese than normal weight women. Future studies could further enhance the electronic ecological momentary assessment method to explore other time-varying moderators and mediators of food consumption and affect.

Research is inconclusive about whether physical activity (PA) should be performed every day or performed less frequently but in longer bouts to obtain mental health benefits. The current study examined the extent to which day-to-day variability in PA is associated with adults' mental health, and if this association differed by Body Mass Index (BMI). Adults (N = 116) completed three waves of data collection (each lasting 4 days) during which participants completed a questionnaire assessing mental health (life satisfaction, depressive symptoms, perceived stress), wore a waist accelerometer, and had height and weight measured. This study employed a novel two-stage data analysis approach using the standalone program MIXWILD. The first-stage model partitioned mean level as well as between-subject and within-subject variances in daily PA by estimating a random location (subject-level mean) and a random scale (subject-level variability) for daily PA. In the second-stage, these random subject effects for daily PA along with their interactions with BMI were used as predictors for subject-level mental health outcomes. Associations between subject-level variability in daily PA and mental health outcomes significantly differed depending on adults’ BMI (life satisfaction: β = −0.05, p