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Introduction: The purpose of this longitudinal study was to identify distinct trajectories of cigarette smoking from sixth to twelfth grade and to characterize these trajectories by use of other drugs and high school dropout.Methods: The diverse sample for this analysis consisted of a cohort of 611 students from Northeast Georgia who participated in the Healthy Teens Longitudinal Study (2003-2009). Students completed seven yearly assessments from sixth through twelfth grade. We used semi-parametric, group-based modeling to identify groups of students whose smoking behavior followed a similar progression over time.Results: Current smoking (past 30 day) increased from 6.9% among sixth graders to 28.8% among twelfth graders. Four developmental trajectories of cigarette smoking were identified: Abstainers/Sporadic Users (71.5% of the sample), Late Starters (11.3%), Experimenters (9.0%), and Continuous Users (8.2%). The Abstainer/Sporadic User trajectory was composed of two distinct groups: those who never reported any tobacco use (True Abstainers) and those who reported sporadic, low-level use (Sporadic Users). The True Abstainers reported significantly less use of alcohol and other drugs and lower dropout rates than students in all other trajectories, and Sporadic Users had worse outcomes than True Abstainers. Experimenters and Continuous Users reported the highest drug use. Over one-third of Late Starters (35.8%) and almost half of Continuous Users (44.4%) dropped out of high school.Conclusions: Cigarette smoking was associated with behavioral and academic problems. Results support early and continuous interventions to reduce use of tobacco and other drugs and prevent high school dropout. [ABSTRACT FROM AUTHOR]

Background: The negative health effects of cigarette smoking and HIV infection are synergistic. Objective: To compare the prevalence of current cigarette smoking and smoking cessation between adults with HIV receiving medical care and adults in the general population. Design: Nationally representative cross-sectional surveys. Setting: United States. Patients: 4217 adults with HIV who participated in the Medical Monitoring Project and 27 731 U.S. adults who participated in the National Health Interview Survey in 2009. Measurements: The main exposure was cigarette smoking. The outcome measures were weighted prevalence of cigarette smoking and quit ratio (ratio of former smokers to the sum of former and current smokers). Results: Of the estimated 419 945 adults with HIV receiving medical care, 42.4% (95% CI, 39.7% to 45.1%) were current cigarette smokers, 20.3% (CI, 18.6% to 22.1%) were former smokers, and 37.3% (CI, 34.9% to 39.6%) had never smoked. Compared with the U.S. adult population, in which an estimated 20.6% of adults smoked cigarettes in 2009, adults with HIV were nearly twice as likely to smoke (adjusted prevalence difference, 17.0 percentage points [CI, 14.0 to 20.1 percentage points]) but were less likely to quit smoking (quit ratio, 32.4% vs. 51.7%). Among adults with HIV, factors independently associated with greater smoking prevalence were older age, non-Hispanic white or non-Hispanic black race, lower educational level, poverty, homelessness, incarceration, substance use, binge alcohol use, depression, and not achieving a suppressed HIV viral load. Limitation: Cross-sectional design with some generalizability limitations. Conclusion: Adults with HIV were more likely to smoke and less likely to quit smoking than the general adult population. Tobacco screening and cessation strategies are important considerations as part of routine HIV care. Primary Funding Source: Centers for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]

Objectives: The Opioid Use crisis continues to be an epidemic with multiple known influencing and interacting factors. With the need for suitable opioid use interventions, we present a conceptual design of an m-health intervention that addresses the various known interacting factors of opioid use and corresponding evidence-based practices. The visualization of the opioid use complexities is presented as the "Opioid Cube".Methods: Following Stage 0 to Stage IA of the NIH Stage Model, we used guidelines and extant health intervention literature on opioid apps to inform the Opioid Intervention (O-INT) design. We present our design using system architecture, algorithms, and user interfaces to integrate multiple functions including decision support. We evaluate the proposed O-INT using analytical modeling.Results: The conceptual design of O-INT supports the concept of collaborative care, by providing connections between the patient, healthcare professionals, and their family members. The evaluation of O-INT shows a preference for specific functions, such as overdose detection and potential for high system reliability with minimal side effects. The Opioid Cube provides a visualization of various opioid use states and their influencing and interacting factors.Conclusions: O-INT is a promising design with a holistic approach to manage opioid use and prevent and treat misuse. With several needed functionalities, O-INT design serves as a decision support system for patients, healthcare professionals, researchers, and policy makers. Together, O-INT and the Opioid Cube may serve as a foundation for development and adoption of highly effective m-health interventions for opioid use. [ABSTRACT FROM AUTHOR]

Introduction: An increasing number of U.S. states and communities have implemented smoke-free policies prohibiting smoking in all indoor workplaces and public areas. Public attitudes toward smoke-free environments are an evidenced-based, key indicator for the successful implementation and enforcement of smoke-free policies. Methods: Data were obtained from the 2009–2010 National Adult Tobacco Survey, a landline and cell phone survey of adults aged ≥18 years old residing in the 50U.S. states and the District of Columbia. The overall proportion of respondents who reported that smoking should “never be allowed” in workplaces, restaurants, and bars/casinos/clubs was calculated, both nationally and by state. National estimates were also calculated by sex, age, race/ethnicity, education, annual household income, sexual orientation, and smoking status. Results: Nationally, 81.6% of U.S. adults think workplaces should be smoke-free (state range: 68.6% [Kentucky] to 89.1% [California]); 74.9% think restaurants should be smoke-free (state range: 59.5% [Missouri] to 84.6% [California]); 50.0% think bars/casinos/clubs should be smoke-free (state range: 32.3% [Nevada] to 61.3% [Maine]); and 47.5% think workplaces, restaurants, and bars/casinos/clubs should be smoke-free (state range: 30.3% [Nevada] to 58.8% [Maine]). Regardless of venue type, women, older individuals, non-Hispanic Asians, individuals with higher education and income, and nonsmokers were the most likely to think these environments should be smoke-free. Conclusions: A majority of U.S. adults think workplaces and restaurants should be smoke-free, while half think bars, casinos, and clubs should be smoke-free. Continued efforts are needed to educate the public about the dangers of secondhand smoke and the benefits of smoke-free indoor environments. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking remains the leading cause of preventable morbidity and mortality in the United States. Despite overall declines in cigarette smoking, a high prevalence of smoking persists among certain subpopulations, including persons with mental illness. Methods: Combined data from the 2009-2011 National Survey on Drug Use and Health (NSDUH) were used to calculate national and state estimates of cigarette smoking among adults aged =18 years who had any mental illness (AMI), defined as having a mental, behavioral, or emotional disorder, excluding developmental and substance use disorders, in the past 12 months. Results: During 2009-2011, an annual average of 19.9% of adults aged =18 years had AMI; among these persons, 36.1% were current smokers, compared with 21.4 % among adults with no mental illness. Smoking prevalence among those with AMI was highest among men, adults aged <45 years, and those living below the poverty level; smoking prevalence was lowest among college graduates. During 2009-2011, adults with AMI smoked 30.9% of all cigarettes smoked by adults. By U.S. region, smoking prevalence among those with AMI was lowest in the West (31.5%) and Northeast (34.7%) and highest in the Midwest (39.1%) and South (37.8%), with state prevalence ranging from 18.2% (Utah) to 48.7% (West Virginia). Conclusions: The prevalence of cigarette smoking is high among adults with AMI, especially for younger adults, those with low levels of education, and those living below the poverty level; the prevalence varies by U.S. region. Implications for Public Health Practice: Increased awareness about the high prevalence of cigarette smoking among persons with mental illness is needed to enhance efforts to reduce smoking in this population. Proven population-based prevention strategies should be extended to persons with mental illness, including implementing tobacco-free campus policies in mental health facilities. Primary care and mental health-care providers should routinely screen patients for tobacco use and offer evidence-based cessation treatments. Given that persons with mental illness are at risk for multiple adverse behavioral and health outcomes, tobacco cessation will have substantial benefits, including a reduction in excess morbidity and mortality attributed to tobacco use. [ABSTRACT FROM AUTHOR]

Objective: To examine the mediating role of psychological distress on the relationship between adverse childhood experiences and adult alcohol problems by gender. Methods: Linear and logistic regression analyses were conducted on 7279 Kaiser- Permanente members, aged >18 years. Results: Psychological distress mediated significant proportions of alcohol problems associated with childhood emotional abuse and neglect, physical abuse and neglect, mental illness in the household, parental separation or divorce, sexual abuse, and household drug use among women and mental illness in the household, emotional neglect, physical abuse, household drug use, and sexual abuse among men. Conclusion: It may be important to identify early childhood trauma and adult psychological distress in programs that focus on reducing alcohol abuse. [ABSTRACT FROM AUTHOR]

Objectives. We estimated smoking prevalence, frequency, intensity, and cessation attempts among US adults with selected diagnosed lifetime mental illnesses. Methods. We used data from the 2007 National Health Interview Survey on 23393 noninstitutionalized US adults to obtain age-adjusted estimates of smoking prevalence, frequency, intensity, and cessation attempts for adults screened as having serious psychological distress and persons self-reporting bipolar disorder, schizophrenia, attention deficit disorder or hyperactivity, dementia, or phobias or fears. Results. The age-adjusted smoking prevalence of adults with mental illness or serious psychological distress ranged from 34.3% (phobias or fears) to 59.1% (schizophrenia) compared with 18.3% of adults with no such illness. Smoking prevalence increased with the number of comorbid mental illnesses. Cessation attempts among persons with diagnosed mental illness or serious psychological distress were comparable to attempts among adults without mental illnesses or distress; however, lower quit ratios were observed among adults with these diagnoses, indicating lower success in quitting. Conclusions. The prevalence of current smoking was higher among persons with mental illnesses than among adults without mental illnesses. Our findings stress the need for prevention and cessation efforts targeting adults with mental illnesses. [ABSTRACT FROM AUTHOR]

The article presents a review of research on the association between adverse childhood events, such as emotional, physical and sexual abuse, neglect and childhood household dysfunction, and affective and anxiety disorders, personality disorders and substance abuse. The results of the Adverse Childhood Experiences (ACE) Study are analyzed. The author also seeks to highlight the ways in which risk factors for psychiatric conditions are often nonspecific for negative mental health outcomes.

Objective: To examine the relationship of adverse childhood experiences (ACEs), including abuse, neglect, and forms of household dysfunction, to the risk of liver disease by assessing the role of risk behaviors, such as substance abuse and high-risk sexual activity, as mediators of the ACEs–liver disease relationship. Methods: Retrospective cohort study data were collected from 17 337 adult health plan members through a survey. Logistic regression adjusted for age, sex, race, and education was used to estimate the strength of the ACEs–liver disease relationship and the impact of the mediators in this relationship. Results: Each of 10 ACEs increased the risk of liver disease 1.2 to 1.6 times (P<.001). The number of ACEs (ACE score) had a graded relationship to liver disease (P<.001). Compared with persons with no ACEs, the adjusted odds ratio of ever having liver disease among persons with 6 or more ACEs was 2.6 (P<.001). The ACE score also had a strong graded relationship to risk behaviors for liver disease. The strength of the ACEs–liver disease association was reduced 38% to 50% by adjustment for these risk behaviors, suggesting they are mediators of this relationship. Conclusions: The ACE score showed a graded relationship to the risk of liver disease that appears to be mediated substantially by behaviors that increase the risk of viral and alcohol-induced liver disease. Understanding the effect of ACEs on the risk of liver disease and development of these behaviors provides insight into causal pathways, which may prove useful in the prevention of liver disease. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA). To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA. Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18–24 years. Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated. ACEs prevalence ranged from 7.8 % (emotional violence) to 55.0 % (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes. ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population. [ABSTRACT FROM AUTHOR]

Objective: Childhood abuse and other adverse childhood experiences (ACEs) have historically been studied individually, and relatively little is known about the co-occurrence of these events. The purpose of this study is to examine the degree to which ACEs co-occur as well as the nature of their co-occurrence. Method: We used data from 8,629 adult members of a health plan who completed a survey about 10 ACEs which included: childhood abuse (emotional, physical, and sexual), neglect (emotional and physical), witnessing domestic violence, parental marital discord, and living with substance abusing, mentally ill, or criminal household members. The bivariate relationship between each of these 10 ACEs was assessed, and multivariate linear regression models were used to describe the interrelatedness of ACEs after adjusting for demographic factors. Results: Two-thirds of participants reported at least one ACE; 81%-98% of respondents who had experienced one ACE reported at least one additional ACE (median: 87%). The presence of one ACE significantly increased the prevalence of having additional ACEs, elevating the adjusted odds by 2 to 17.7 times (median: 2.8). The observed number of respondents with high ACE scores was notably higher than the expected number under the assumption of independence of ACEs (p < .0001), confirming the statistical interrelatedness of ACEs. Conclusions: The study provides strong evidence that ACEs are interrelated rather than occurring independently. Therefore, collecting information about exposure to other ACEs is advisable for studies that focus on the consequences of a specific ACE. Assessment of multiple ACEs allows for the potential assessment of a graded relationship between these childhood exposures and health and social outcomes. [ABSTRACT FROM AUTHOR]