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Objective: Examine if concerns for police brutality, societal discrimination, and school shootings relate to subsequent cigarette and cannabis use among Hispanic and non-Hispanic White (NHW) youth. Hispanic youth may be particularly vulnerable to such concern., Methods: Data are from the University of Southern California's Happiness and Health Survey, a prospective cohort study, which followed Hispanic (N = 1007) and NHW (N = 251) students from ten inner-city and suburban high schools in Los Angeles County, starting from 2013 until 2019. Participants reported concern, worry, and stress levels regarding police brutality, societal discrimination, and school shootings. Four categories were created to indicate levels of each concern variable over time (consistently low, decreased, increased, and consistently high). Associations with past-30-day cannabis, blunt, THC-oil, and cigarette use in 2019 were assessed. Separate models for each racial/ethnic category were used., Results: Among Hispanic participants, reporting consistently high concern about police brutality (vs. consistently low concern) was associated with higher odds to subsequently smoke cannabis (aOR = 1.69, 95% CI = 1.18-2.40), smoke blunts (aOR = 1.63, 95% CI = 1.11-2.39), and vape THC-oil (aOR = 1.67, 95% CI = 1.14-2.44). Hispanic participants who reported consistently high concern for societal discrimination also had higher odds (vs. consistently low concern) to subsequently smoke blunts (aOR = 1.54, 95% CI = 1.04-2.29) and vape THC-oil (aOR = 1.65, 95% CI = 1.12-2.43). Among NHW participants, increasing concern over school shootings (vs. consistently low concern) was associated with higher odds to subsequently smoke cannabis (aOR = 2.98, 95% CI = 1.08-7.70)., Conclusions: Concerns for police brutality, societal discrimination, and school shootings were associated with cannabis use especially among Hispanic participants. Providing Hispanic youth with healthy coping strategies may reduce cannabis use., Competing Interests: Declarations Ethics Approval The current study was approved by the institutional review board of the University of Southern California, which follows Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for cross-sectional studies in addition to the American Association for Public Opinion Research (AAPOR) reporting guidelines for surveys. Consent to Participate Informed consent was obtained from all individual participants included in the study. Competing Interests The authors declare no competing interests. Public Health Significance Statement This study indicates that concerns over police brutality and social injustice are increasing marijuana smoking, blunt smoking, and THC-oil vaping among Hispanic adolescents., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: To examine associations of concern, worry, and stress about discrimination, shootings/violence, and police brutality and exclusive and dual tobacco and cannabis use among young adults., Methods: A prospective, racially/ethnically diverse cohort of young adults (n = 1960) living in Los Angeles, California completed a baseline survey in 2020 (age range: 19-23) and a follow-up survey in 2021. Exploratory factor analysis (EFA) was employed on nine variables assessing levels of concern, worry, and stress about societal discrimination, societal shootings/violence, and community police brutality at baseline. Past 30-day tobacco and cannabis use at follow-up was categorized as current exclusive tobacco, exclusive cannabis, and dual tobacco and cannabis (vs never/former) use based on eleven use variables. Multinomial logistic regressions estimated adjusted associations between each factor score (translated to standard deviation units) with exclusive and dual tobacco and cannabis use., Results: The EFA produced four factor scores representing concern/worry/stress (i.e., distress) about community police brutality (F1), distress about societal shootings/violence (F2), and distress about societal discrimination (F3), as well as generalized stress about police brutality, shootings/violence, and discrimination (F4). F1, F2, and F3 were associated with subsequent exclusive current cannabis use, with F1 having the strongest association (OR: 1.35, 95% CI: 1.18-1.55), while only F1 (OR: 1.51, 95% CI: 1.27-1.78) was associated with dual tobacco and cannabis use. None of the factors were associated with exclusive tobacco use., Conclusions: Young adult concern, worry, and/or stress about social problems may increase risk of cannabis use with or without concurrent tobacco use 6-12 months later., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: The prevalence of internalizing problems among US adolescents has risen in the past decade. The extent to which concerns about school violence or shootings are associated with risk of internalizing problems is unknown., Objective: To examine the prospective association of concern, worry, and stress related to school violence or shootings with internalizing problems and to examine sex and racial and ethnic differences in the magnitude of the associations., Design, Setting, and Participants: This longitudinal cohort study involved 3 surveys administered 6 months apart (fall of grade 11 [prebaseline]; spring of grade 11 [baseline]; and fall of grade 12 [follow-up]) from 2015 to 2016. Participants included 2263 students from 10 high schools in Los Angeles, California. Analyses were performed from April 29, 2020, to April 8, 2021., Exposures: Baseline self-reported level of concern, worry, and stress about shootings or violence at the student's school or other schools, each rated on 5-point scales (ranging from not at all [0] to extremely [4]) with a mean score calculated as a 3-item composite index rescaled into z-score standard deviation units., Main Outcomes and Measures: Surpassing clinically significant or borderline significant thresholds for major depressive disorder, generalized anxiety disorder, or panic disorder based on symptom ratings on the Revised Children's Anxiety and Depression Scale at 6-month follow-up., Results: Of the 2263 students included in the analyses (1250 [55.2%] girls; mean [SD] age, 16.5 [0.4] years), appreciable proportions reported being very or extremely concerned (850 0f 2226 [38.2%]), worried (703 of 2209 [31.8%]), or stressed (332 of 2183 [15.2%]) about shootings or violence at their school or other schools. After adjusting for prebaseline covariates, concerns about school violence or shootings were associated with clinically significant generalized anxiety symptoms (odds ratio [OR], 1.31; 95% CI, 1.15-1.50) and panic symptoms (OR, 1.18; 95% CI, 1.05-1.32), but not depressive symptoms (OR, 1.13; 95% CI, 0.99-1.30) at the 6-month follow-up. There was a significant association between concern with school violence or shootings and depressive symptoms for Black youth (OR, 3.15; 95% CI, 1.38-7.19) and non-Hispanic/Latinx White youth (OR, 1.62 [95% CI, 1.25-2.09]) but not for youth of other races and ethnicities (OR for Asian, 1.26 [95% CI, 0.86-1.85]; OR for Hispanic/Latinx, 0.94 [95% CI, 0.76-1.16]; OR for other, 0.93 [95% CI, 0.54-1.61]). Sex did not moderate these associations., Conclusions and Relevance: The findings of this study suggest that concern, worry, and stress related to school violence or shootings may be risk factors for internalizing problems among adolescents, with variation in the strength of the association by race/ethnicity.

Background: Adolescent nonmedical prescription opioid use is associated with overdose and other adverse outcomes, but its risk factors are poorly understood., Methods: Data were drawn from a prospective cohort study of Los Angeles, California, high school students. At baseline (mean age = 14.6 years), students completed self-report screening measures of problem alcohol, cannabis, and drug use and 6 mental health problems (major depression, generalized anxiety, panic disorder, social phobia, obsessive-compulsive disorder, and hypomania or mania). Past 6-month nonmedical prescription opioid use (yes or no) was assessed across 7 semiannual follow-ups., Results: Among baseline never users of nonmedical prescription opioids ( N = 3204), average past 6-month prevalence of new nonmedical prescription opioid use across the 42-month follow-up was 4.4% (range 3.5%-6.1%). In a multivariable model co-adjusting for 9 baseline behavioral problems and other factors, major depression, hypomania or mania, cannabis, alcohol, and other drug use problems were associated with increased odds of nonmedical prescription opioid use over follow-ups. Cumulative indices of behavioral health comorbidity showed successively greater odds of subsequent nonmedical prescription opioid use for students with 1 (odds ratio [OR]: 3.74; 95% confidence interval [CI]: 2.79-5.01), 2 (OR: 8.79; 95% CI: 5.95-12.99), or 3 (OR: 9.69; 95% CI: 5.63-16.68) vs 0 baseline substance use problems, and similar increases were associated with increasing number of mental health problems (1 [OR: 1.60; 95% CI: 1.03-2.88] to all 6 [OR: 3.98; 95% CI: 1.09-14.82] vs 0)., Conclusions: Behavioral health problems may be associated with increased risk of subsequent nonmedical prescription opioid use during mid to late adolescence, with successively greater risk for those with greater behavioral health comorbidity. In pediatric clinical practice or school-based prevention, behavioral health screeners may be useful for identifying youth at high risk for nonmedical prescription opioid use., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Tobacco and cannabis poly-substance and poly-product use is common in adolescents and young adults (AYAs), but few studies have examined developmental trajectories of poly-use. This study characterized the prevalence, patterns, and racial/ethnic and sex differences of developmental trajectories of use and poly-use of 8 different widely-marketed tobacco and cannabis products across adolescence and young adulthood. 3322 AYAs from Los Angeles, California completed 5 surveys from fall of 11th grade (2015) to 1-2 years post-high school (2018-2019). Self-reported past 30-day use of three tobacco (nicotine vaping, cigarette, hookah) and five cannabis (combustible, blunt, edible, vaping, dabbing) products were analyzed using parallel growth mixture modeling to identify tobacco and cannabis use and poly-use trajectories; racial/ethnic and sex differences were evaluated as correlates of trajectory membership. Five trajectories were identified: Non-Users (58.6%); Young Adult-Onset Poly-Substance/Poly-Product Users (15.8%); Decreasing Moderate Poly-Substance/Poly-Product Users (9.8%); Increasing Predominant Cannabis Poly-Product Users (8.3%); and Chronic Poly-Substance/Poly-Product Users (7.3%). Within trajectories, developmental patterns of each tobacco and cannabis product were similar. Non-Hispanic White (vs. non-NH White) participants had higher odds of belonging to the Chronic Poly-Substance/Poly-Product Users (vs. Non-Users) trajectory (aOR = 2.24[1.37,3.67]); females (vs. males) had higher odds of belonging to the Young Adult-Onset Poly-Substance/Poly-Product Users (vs. Non-Users) trajectory (aOR = 1.30[1.02-1.66]). Tobacco and cannabis poly-substance use patterns, including use of various products, appear to be a common developmental trajectory during some point in adolescence and young adulthood. The interplay of tobacco and cannabis poly-substance/poly-product use merit attention in prevention and regulatory policies to protect AYA health., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: The rapidly evolving landscape of vaping devices has complicated analyses of use patterns among youth and young adults. The current study describes the prevalence of use, substances vaped, and purchasing behaviors across five different vaping device categories., Aims and Methods: Participants (n = 2505; mean age = 19.2, SD = 0.46) from a cohort in the Los Angeles area completed web-based surveys from June 2018 to October 2019. For each of four device type categories depicted via digital images (any pod-style vape, cigalike, box-mod, vape pen) and for JUUL specifically, participants reported ever and past 30-day use, substance vaped (mostly nicotine, nicotine and tetrahydrocannabinol [THC], mostly THC, neither), ownership of device (yes/no), where they obtained that device (eg, purchased themselves, from a friend), and if purchased, purchase location (eg, vape shop, online)., Results: Overall, 44.9% reported ever use, and 26.2% reported past 30-day use of at least one of the devices. The prevalence of past 30-day use was highest for pod-style vapes (any pod = 17.0%; JUUL = 15.1%). Among respondents who reported ever owning any device (n = 643 [25.7%]), 59.9% reported purchasing the device themselves, despite not being of legal purchasing age (15.4% of total sample); across all device types, products were most often purchased in vape shops or online., Conclusions: Across all devices, the prevalence of self-purchase of vaping devices among underage young adults in the Los Angeles area was high, and most were purchased from a vape shop or online. Tobacco control policies to prevent underage purchase of tobacco products-particularly among never smokers-are needed., Implications: A high proportion of underage young adults reported owning their own vaping device and having purchased it themselves from a vape shop or online. Stronger tobacco control policies and better enforcement efforts are needed to successfully prevent underage purchase of tobacco products., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Evidence on prospective bidirectional associations between e-cigarette and alcohol use among adolescents can inform prevention and policy but is largely absent from the literature., Methods: Data were drawn from a prospective cohort of students attending 10 Los Angeles high schools (N = 3396; baseline mean age = 14.1, SD = 0.4). Students completed surveys every 6-months from 2013 to 2017; 8 total waves. Analyses were restricted to (a) individuals who were never users of alcohol (N = 2394) or (b) individuals who were never users of e-cigarettes (N = 2704) at baseline. Repeated-measures, generalized linear mixed models were used to estimate the adjusted odds of past 6-month alcohol and e-cigarette initiation, in separate models., Results: Among alcohol never-users at baseline, 15.7 % (N = 375) initiated alcohol use over the study period. Compared to never-users of e-cigarettes, those who reported use of e-cigarettes had 3.5 times the odds of subsequently initiating alcohol use in the following wave (OR = 3.54; 95 % CI: 2.81, 4.47). Stronger associations were observed for males (OR = 4.94; 95 % CI: 3.78, 6.45) than for females (OR = 3.21; 95 % CI: 2.33, 4.41; p interaction  = 0.04). Among e-cigarette never-users at baseline, 26.3 % (N = 709) initiated e-cigarette use over the study period. Compared to never-users of alcohol, those who reported use of alcohol had 3.2 times the odds of subsequently initiating e-cigarette use in the following wave (OR = 3.23; 95 % CI: 2.68, 3.89). This association did not differ by gender., Conclusions: E-cigarette and alcohol use can be markers to identify youth at risk for future alcohol and e-cigarette use, respectively. Research examining mechanisms underlying these associations is needed to infer causality., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Aims: To identify prototypical developmental patterns of tobacco product and cannabis use and co-use initiation during adolescence, and determine risk factors for and consequences of these initiation patterns., Design: Prospective repeated-measures cohort with eight semi-annual assessments during high school. Multiple-event process survival mixture modeling identified latent initiation classes with distinct patterns of variation in timing of use initiation of tobacco products and cannabis. We then estimated: (1) associations of baseline risk factors with membership in initiation classes and (2) differences between initiation classes in frequency of cannabis and tobacco product use at the final assessment., Setting: Ten high schools in the Los Angeles, CA, USA metropolitan area, 2013-17., Participants: Students [1031 (45.4%) males; mean (standard deviation) age at baseline = 14.6 (0.39) years] who had never used any tobacco products or cannabis at baseline 9th grade assessment (n = 2272)., Measurements: Self-report measures of electronic cigarette (e-cigarette), combustible cigarette, hookah, cigar/cigarillos and cannabis use were collected at each assessment., Findings: Four distinct tobacco and cannabis use initiation classes were identified: (1) early and high-risk cannabis and polytobacco initiators (n = 116; 5.1%); (2) early cannabis and polytobacco initiators (n = 172; 7.6%); (3) late cannabis and e-cigarette initiators (n = 431; 19.0%); and (4) abstainers (n = 1553; 68.4%). At baseline, older age for the early and high-risk cannabis and polytobacco initiators [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.10, 1.35, P < 0.001], peer cannabis use (OR = 1.60, 95% CI = 1.23, 2.08, P < 0.001) and delinquent behavior (OR = 1.30, 95% CI = 1.08, 1.55, P = 0.004) were associated with membership in the three initiation classes (versus abstainers). Membership in the early and high-risk cannabis and polytobacco initiators class (versus three other classes) was significantly associated with increased past 30-day frequency and daily intensity of use at the final assessment (P-values < 0.001)., Conclusions: Older age, peer cannabis use and delinquent behavior appear to be risk factors for the initiation of tobacco/cannabis product use among high school students in the Los Angeles metropolitan region. Early and higher-risk polyproduct use initiation appears to be associated with greater escalation of past 30-day and daily tobacco and cannabis use at the end of the high school., (© 2020 Society for the Study of Addiction.)

Although the construct of impulsivity has generally been found to be associated with obesity and health behaviors in adults, research among adolescents is more limited and studies have yet to elucidate which facets of impulsivity may be most salient with regard to different eating and physical activity behaviors. Therefore, the present cross-sectional study assessed facets of impulsivity, measured by the UPPS-P questionnaire, in relation to health behaviors among adolescents. A sample of 2797 high school students from Los Angeles, California completed self-report measures during the ninth grade. The UPPS-P subscales (i.e., (lack of) premeditation, sensation seeking, (lack of) perseverance, negative urgency, positive urgency) were examined as predictors of unhealthy diet quality (i.e., frequency of consumption of high-fat foods and sweet food and drinks, measured by the National Cancer Institute (NCI) Quick Food Scan) and frequency of vigorous physical activity (measured by the Youth Risk Behavior Surveillance System). Greater sensation seeking, positive urgency, and negative urgency was associated with greater unhealthy diet quality ( p s < 0.001). Greater negative urgency and lack of perseverance was associated with less frequent vigorous physical activity, whereas greater sensation seeking, lack of premeditation, and positive urgency was associated with more frequent vigorous physical activity ( p s < 0.05). While negative urgency (i.e., impulsivity in the context of negative emotions) was consistently associated with poor health behaviors, other facets of impulsivity may potentiate vigorous physical activity in youth. Together these findings underscore the importance of considering the multidimensional nature of impulsivity in relation to adolescents' health behaviors and highlight areas for future longitudinal research.

Background: Flavors in tobacco products may be salient drivers of tobacco product use among people with overweight or obesity. Yet, whether perceived appeal of e-cigarettes with different flavors varies as a function of weight status is unknown. Purpose: To conduct secondary data analyses of a laboratory experiment to examine whether weight moderates differences in perceived appeal of fruit, menthol, and tobacco flavored e-cigarettes in young adults who vape. Methods: Using a within-subjects experimental design, young adults in Los Angeles, CA, USA. (Mage = 25.36 ± 4.42 Range: 18-35) with normal weight (n = 48) or overweight/obesity (n = 51) were administered standardized doses of e-cigarette solutions varying in flavor (fruit, menthol, tobacco). Following each administration, participants rated the appeal of the solution (range: 0-100). Results: The extent to which menthol (vs. tobacco)-flavored e-cigarettes were rated more appealing was amplified among participants with overweight or obesity versus normal weight participants (flavor × weight interaction Estimate = 7.54, p = .01 95% CI = [2.30, 12.80]). There were no differences in the effects of fruit (vs. tobacco) flavored e-cigarettes on appeal as a function of weight status. Conclusions: Menthol flavors in e-cigarettes may be disproportionately appealing to young adults with overweight and obesity., Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1899229.

Hedonic hunger (i.e., extreme responsiveness to food) has been associated with obesity and poor diet, but findings in the existing literature have primarily been cross-sectional. The current study examined hedonic hunger as a prospective predictor of the longitudinal trajectory of unhealthy food and drink intake across adolescence. Ninth grade students from Los Angeles area high schools (analyzed sample N = 3268) completed paper-and-pencil surveys across four annual waves; hedonic hunger was assessed at Wave 1, and unhealthy food and drink intake was assessed at Waves 1-4. Multilevel models showed a significant main effect of hedonic hunger and interactions between hedonic hunger and the linear and quadratic components of time. The association between hedonic hunger and unhealthy food and drink intake was strongest at Wave 1 and weakened over time, yet those with higher hedonic hunger reported greater unhealthy food and drink intake across the four years. Efforts to prevent and intervene upon hedonic hunger and its association with unhealthy food and drink intake during childhood and adolescence are warranted.

Importance: Rates of e-cigarette use (ie, nicotine vaping) and cannabis vaping continue to increase among youth and young adults. However, the association of nicotine and cannabis vaping with independent respiratory health outcomes has not been well studied., Objective: To investigate associations of nicotine and cannabis vaping with bronchitic symptoms, wheeze, and shortness of breath., Design, Setting, and Participants: Cross-sectional survey data on self-reported lifetime, 6-month, and 30-day vaping from 2553 young adults recruited from high schools in Southern California were collected from June 2018 to October 2019. Of these participants, 94% provided data for shortness of breath and wheeze, and 86% provided data for chronic bronchitis., Main Outcomes and Measures: Self-reported nicotine and cannabis vaping were measured on a Likert-type scale using the following responses: (1) never used, (2) lifetime but no past 6-month use, (3) past 6-month use but no use in the past 30 days, (4) use on 1 or 2 of the past 30 days, and (5) use on 3 or more of the past 30 days. Three respiratory health outcomes were assessed separately on the basis of self-reported symptoms: bronchitic symptoms in the previous 12 months (ie, daily cough for 3 months in a row, congestion or phlegm other than with a cold, and/or bronchitis), wheeze in the previous 12 months, and shortness of breath when hurrying on level ground or walking up a slight hill., Results: Of 2553 participants in the analytic sample (mean [SD] age, 19.3 [0.79] years; 1477 [57.9%] female individuals), 1095 of 2553 young adults (42.9%) reported vaping nicotine and 939 of 2553 (38.4%) reported vaping cannabis. Compared with those who never vaped cannabis, individuals who vaped cannabis in their lifetime but not in the past 60 months (204 of 2553 [8.4%]; adjusted odds ratio [aOR], 1.83 [95% CI, 1.08-3.10]), in the past 6 months but not in the last 30 days (490 of 2443 [20.1%]; aOR, 1.58 [95% CI, 1.02-2.46]), 1-2 days in the past 30 days (90 of 2443 [3.7%]; aOR, 2.83 [95% CI, 1.46-5.50]), and 3 or more days in the past 30 days (155 of 2443 [6.3%]; aOR, 2.14 [95% CI, 1.16-3.92]) had significantly higher odds of chronic bronchitic symptoms after adjusting for nicotine vaping, cigarette smoking, cannabis smoking, and sociodemographic characteristics. Cannabis vaping 3 or more times in the last 30 days was also associated with increased odds of wheeze (aOR, 2.27 [95% CI, 1.17-4.37]). Associations of cannabis vaping with shortness of breath and nicotine vaping with any respiratory health outcome were not statistically significant in fully adjusted models., Conclusions and Relevance: Findings of this cross-sectional study suggest that cannabis vaping is associated with increased risk of bronchitic symptoms and wheeze in young adults. Further research is needed to understand the temporality of the association and the mechanisms underlying the difference between nicotine and cannabis vaping in the risk of bronchitic symptoms and wheeze.

Background and Aims: The construct of susceptibility to substance use initiation (i.e. cognitive proclivity to future use) is critical for prevention efforts in adolescent populations. This study aimed to provide empirical evidence for the validity of the susceptibility construct for different cannabis products (i.e. combustible, edible or vaporized cannabis), and evaluate whether susceptibility measures are predictive of subsequent initiation., Design: Prospective cohort study including baseline data (Spring 2015) and four follow-up surveys administered every 6 months through Spring 2017., Setting: Ten schools in the Los Angeles, California metropolitan area., Participants: Adolescents [n = 2100; mean age = 16.1; standard deviation (SD) = 0.41; 54% female] who reported never having used any cannabis product at baseline., Measurements: We assessed five indices of a susceptibility to use cannabis composite index at baseline, adapted from a validated tobacco use index (intention to use, willingness, curiosity and positive/negative cannabis use outcome expectancies, with four response categories, definitely not [1] to definitely yes [4]), by cannabis product (combustible, edible or vaporized). A composite index was created for each product by averaging responses across the five susceptibility items. Subsequent initiation of use of each cannabis product was assessed at each follow-up wave., Findings: Factorial validity for unidimensionality for each five-item index (by product) was confirmed. The composite index for susceptibility to cannabis use was greatest for combustible (mean = 1.44; SD = 0.58), moderate for edible (mean = 1.37; SD = 0.53) and lowest for vaporized cannabis (mean = 1.30; SD = 0.44). The associations of each composite susceptibility index with subsequent initiation of that product and each of the other cannabis products over follow-up (i.e. cross-product associations) were statistically significant, with hazard ratios ranging from 2.30 to 2.80 across 24 months of follow-up (all Ps < 0.05)., Conclusions: A five-item susceptibility to cannabis use composite index (by product) appears to be useful for characterizing and predicting youth at risk for cannabis use initiation across a spectrum of cannabis products., (© 2020 Society for the Study of Addiction.)

Cannabis legalization and commercialization has resulted in novel alternative cannabis products on the market, including edible and vaporized cannabis, which may appeal to youth with psychiatric problems. Psychiatric comorbidity in adolescent use and poly-use (i.e., use of >2 products) of combustible, edible, and vaporized cannabis products has largely gone uninvestigated. This 2015 cross-sectional survey of Los Angeles, California area adolescents (Mage = 16.1, N = 3177) characterized associations of various psychiatric problems with use and poly-use of combustible, edible, and vaporized cannabis. Exposure variables included past 30-day non-cannabis substance use (alcohol, e-cigarettes, combustible cigarettes, and nonmedical prescription opioid and stimulant use; yes/no), and psychiatric problems including past-week depressive symptom frequency, past 6-month ADHD symptom and conduct problem frequency, anhedonia, and five dimensions of impulsivity (sensation seeking, perseverance, lack of premeditation, positive urgency, and negative urgency). Outcome variables included past 30-day use (yes/no) of combustible, edible, and vaporized cannabis, independently, and number of cannabis products used (single, dual-use, poly-use). Results showed that all forms of non-cannabis substance use (ORs range: 13.7-36.1) and all psychiatric symptoms and traits (ORs in SD units range: 1.1-2.1) were positively associated with combustible, edible, and vaporized cannabis product use. The magnitude of comorbidity did not significantly differ by cannabis product type used in most cases. Psychiatric comorbidity was typically stronger in poly-product than single-product cannabis use and greater for externalizing-type than internalizing-type psychiatric problems. Practitioners, policy makers, and scientists should be aware that pervasive psychiatric comorbidity may be observed across the spectrum of cannabis product use among adolescents, particularly poly-product users., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To develop and validate a shortened form of the Children's Power of Food Scale (C-PFS), which measures anticipated reward from consuming highly palatable foods (i.e., hedonic hunger). Presently, two gaps exist with the C-PFS: the need for a shorter tighter measure, and evidence to support similar item function across populations., Method: Ninth grade students (N = 3277; 14.1 ± 0.4 years; 53.5% Female; 47% Hispanic) from 10 Los Angeles high schools completed the C-PFS and other surveys in class. Factor analysis, graded response modeling, and differential item functioning explored the structure of the 15 C-PFS items and identified a reduced set that parsimoniously taps hedonic hunger across the latent continuum and exhibits item-level invariance across sex, race/ethnicity, and weight status. Construct validity was examined via associations of self-reported dietary intake, impulsivity, and body mass index (BMI) to C-PFS scores., Results: Factor analytic models supported a single, primary dimension of hedonic hunger that accounted for 61% of the variance across all 15-items (α = 0.94). Adequate severity, discriminatory ability, and non-overlapping item-difficulty were observed for 11-items, of which 9-items were found to have item-level invariance across demographic and weight status groupings. Poor performing items were removed to create a 9-item scale (C-PFS-9; α = 0.93). Construct validity was demonstrated as higher C-PFS-9 scores were significantly related to greater sweet (β = 0.32, [95%CI = 0.23, 0.41], p < .001) and fatty food intake (β = 0.34, [95%CI = 0.26, 0.43], p < .001) and impulsivity resulting from positive (β = 0.11, [95%CI = 0.02, 0.21], p < .05) and negative mood (β = 0.36, [95%CI = 0.28, 0.45], p < .001). Females, relative to males, reported higher C-PFS-9 scores (β = 0.10, [95%CI = 0.02, 0.17], p < .05) and associations with BMI were mixed., Conclusion: The C-PFS-9 possesses excellent psychometric properties and retains the original construct coverage of hedonic hunger without a marked decrease in information obtained., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Importance: Understanding the prevalence and symptoms of electronic cigarette (e-cigarette) dependence and its association with future e-cigarette use among youth may help to guide pediatric clinical services and health policy., Objectives: To examine the cross-sectional prevalence and symptom presentation of e-cigarette dependence and to determine whether e-cigarette dependence is associated with subsequent e-cigarette use patterns 6 months later among youth with baseline past-year e-cigarette use., Design, Setting, and Participants: This prospective cohort study used baseline and 6-month follow-up surveys among students in the 12th grade during the 2016 to 2017 school year who reported any past-year e-cigarette use. Surveys were conducted on site in 10 high schools in Los Angeles, California. Data were analyzed from March 2019 to December 2019., Main Outcomes and Measures: Self-reported checklist of 10 tobacco product dependence symptoms reflecting loss of control over use, craving or urge, or withdrawal symptoms while abstinent, completed at baseline and administered separately for e-cigarettes and combustible cigarettes. Reporting 1 or more symptoms indicated a positive screen for dependence. Vaping continuation, defined as any past 6-month vaping, and past 30-day nicotine vaping days (range, 0-30), sessions per vaping day (range, 0-20), and puffs per session (range, 0-20) at 6-month follow-up were assessed., Results: Among 3168 twelfth-grade students who completed the baseline survey, 444 youths (mean [SD] age, 17.48 [0.39] years; 217 [48.9%] female) reported past-year e-cigarette use. Among these, 52 youths (11.7%) reported at least 1 e-cigarette dependence symptom. Among youth who reported past-year dual e-cigarette and combustible cigarette use, combustible cigarette dependence, reported by 43 youths (29.7%), was more prevalent than e-cigarette dependence, which was reported by 24 youths (16.4%). The most common symptoms, craving, urge, and need to use, and least common symptoms, abstinence-related concentration and emotional problems, were similar in both combustible and e-cigarette dependence. The prevalence of e-cigarette dependence was higher among youth who reported vaping in the past month than among those who did not (41 youths [17.6%] vs 11 youths [5.2%]; P < .001) and among youth who used e-cigarettes with nicotine than among those who used e-cigarettes without nicotine (42 youths [15.2%] vs 10 youths [6.0%]; P = .004). After adjusting for baseline vaping and e-cigarette dependence risk propensity scores, baseline e-cigarette dependence symptom status was associated with vaping continuation (adjusted odds ratio, 2.30 [95% CI, 1.07-4.94]; P = .02) and past 30-day number of nicotine vaping days (adjusted rate ratio, 2.17 [95% CI, 1.44-3.28]; P < .001), vaping sessions per day (adjusted rate ratio, 2.41 [95% CI, 1.52-3.83]; P < .001), and puffs per session (adjusted rate ratio, 1.70 [95% CI, 1.09-2.66]; P = .02) at 6-month follow-up., Conclusions and Relevance: These findings suggest that e-cigarette dependence may be an expression of tobacco use disorder associated with future use persistence and escalation among youth. Electronic cigarette dependence may be a behavioral health consequence of adolescent vaping that warrants consideration in pediatric patient care and public health policy.

Background: Data from controlled laboratory experiments in adults indicate that the subjective effects of cannabis vary by administration method (e.g., combustible, vaporized). Whether the subjective effects of cannabis experienced in the natural ecology and among adolescents differ by cannabis administration method is unknown. In this observational study, adolescents' retrospective reports of subjective effects after combustible, edible, and vaporized cannabis use were examined., Methods: Students from ten public schools in Los Angeles, CA, USA (M[SD] age = 16.1 [.43] years) who reported past 6-month use of combustible, edible, or vaporized cannabis (N = 584) were surveyed on subjective effects experienced after use (yes/no). They were provided with a 12 item self-report checklist of six positive (e.g., relaxed, energetic) and six negative (e.g., drowsy, lazy) subjective effects. For each method of administration, affirmative responses were summed in positive (range: 0-6) and negative (range: 0-6) effect composite scores., Results: Generalized estimating equations adjusted for demographics and recent cannabis use revealed a graded pattern of differences in positive subjective effects across products, with highest scores for combustible (M[SD] = 3.98[1.76]), followed by edible (M[SD] = 3.58 [2.04]) and vaporized (M[SD] = 3.11 [2.21]) cannabis (all pairwise cross-product contrasts p < .01). Mean negative effect score was highest for edible (M[SD] = 2.27 [1.95]), followed by combustible (M[SD] = 1.94 [1.66]), and vaporized (M[SD] = 1.34 [1.73]) cannabis, respectively (all pairwise contrasts p < .02)., Conclusion: Adolescents' reports of subjective effects varied across cannabis administration methods. Combustible cannabis' more desirable subjective effects profile might be indicative of higher abuse liability., (Copyright © 2019. Published by Elsevier B.V.)

Purpose: Adolescent involvement in cyberbullying is common and involves several roles (witness, perpetrator, or victim). Whether different cyberbullying roles are differentially associated with substance use is unknown. The present study examined the associations of adolescent cyberbullying involvement with use and polyuse of various substances., Methods: A longitudinal cohort of students in Los Angeles, California (N = 2,768) completed surveys at baseline (10th grade, 2014, mean age = 15.5 years) and 12-month follow-up (11th grade, 2015). Five mutually exclusive cyberbullying roles were identified at baseline-no involvement; witness only; witness and victim; witness and perpetrator; and witness, victim, and perpetrator. Past 6-month use of nine substances and poly-use of multiple substances were assessed at baseline and follow-up., Results: Most students (52.2%) were involved in >1 cyberbullying roles. Relative to no involvement, all cyberbullying roles, including witnessing only, were associated with increased odds of using most substances and polysubstance use at follow-up, after adjusting for sociodemographics and baseline substance use (odds ratios: 1.44 [95% confidence interval: 1.18-1.76] to 5.24 [2.73-10.05]). Relative to the witness-only role, students involved in all three roles were at greater odds of using several substances at follow-up (odds ratios: 1.47 [95% confidence interval: 1.05-2.05] to 2.96 [1.60-5.50])., Conclusions: Cyberbullying involvement, even witnessing, may be associated with future substance use in adolescence. All cyberbullying roles warrant consideration in understanding and preventing youth substance use., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives Mothers report higher levels of psychological stress than fathers. s. Psychological stress is posited to influence parenting practices that could increase children's obesity risk. However, previous studies have not investigated several aspects of maternal mental health and the moderating role of household structure on children's obesity risk. The objective was to investigate associations of maternal mental health with child obesity risk, and whether these associations differed by household structure (single-parent vs. dual parent/multigenerational). Methods Mothers and their 8-12 year old children (N = 175 dyads) completed baseline questionnaires on mothers' mental health and child anthropometrics. Separate logistic regressions assessed associations of standardized maternal mental health indicators with the odds of child overweight/obesity, controlling for child age, and women's BMI, age, education, employment status, and annual income. Household structure was investigated as a moderator of these relationships.Results There were no statistically significant relationships between maternal mental health characteristics and odds of child overweight/obesity. Among single mothers only, greater anxiety was associated with higher risk of child overweight/obesity [OR (95% CI) = 3.67 (1.27-10.62); p = 0.0163]; and greater life satisfaction was marginally associated with lower risk of child overweight/obesity [OR (95% CI) = 0.44 (0.19-1.01); p = 0.0522]. Mothers' life satisfaction may lower risk for their children's overweight/obesity, whereas higher anxiety may increase this risk, particularly among children living in single-mother households. Conclusions for Practice Future interventions could increase resources for single mothers to buffer the effects of stress and lower pediatric obesity risk.

Importance: Cannabis legalization and commercialization have introduced novel alternative cannabis products, including edible and vaporized cannabis that might appeal to youth and be associated with polyuse (ie, use of ≥2 different products)., Objective: To investigate the prevalence, patterns, and sociodemographic correlates of cannabis product use across combustible, edible, and vaporized administration methods, including polyuse of cannabis via multiple administration methods., Design, Setting, and Participants: This cross-sectional survey study included 10th-grade students from 10 Los Angeles, California, area high schools from January 2 through October 6, 2015. Students were recruited from respondents in the Happiness and Health Study, an ongoing prospective cohort study in the 10 high schools. Students not in school during administration of the pencil-and-paper survey completed abbreviated surveys by telephone, internet, or mail. Data were analyzed from July 17, 2017, through July 12, 2018., Exposures: Self-reported sex, race/ethnicity, and socioeconomic status (SES). Students with high SES had parents who attained college or a higher educational level and were ineligible for free or subsidized lunch; those with low SES had parents with lower educational attainment or were eligible for free or subsidized lunch., Main Outcomes and Measures: Self-report of ever use (yes or no) and past 30-day use (yes or no) status and frequency of use (days in past 30 days) of combustible, edible, and vaporized cannabis., Results: The sample included 3177 tenth-grade students (93.5% of study enrollees); among these students, 1715 (54.0%) were girls and the mean (SD) age was 16.1 (0.4) years. Among those with available demographic data, respondents were diverse in race/ethnicity (537 [17.2%] Asian; 149 [4.8%] black; 1510 [48.3%] Hispanic; 507 [16.2%] white; 207 [6.6%] multiethnic/multiracial; and 216 [6.9%] other) and included 1654 (60.1%) with a low SES. Prevalence of ever use was highest for combustible products (993 [31.3%]), followed by edible (676 [21.3%]) and vaporized (333 [10.5%]) products. A similar pattern was found for past 30-day use (426 [13.4%] for combustible, 249 [7.8%] for edible, and 156 [4.9%] for vaporized cannabis). Among participants who reported using cannabis in the past 30 days, mean frequency of use of combustible cannabis was higher by 2.65 days (95% CI, 1.40-3.91 days, P = .001) than the mean frequency of use for edible cannabis and 1.75 days higher (95% CI, 0.59-2.90 days, P = .003) than frequency of use for vaporized cannabis. Most cannabis users (665 [61.7%]) used multiple administration methods, and 260 (8.2%) used all 3 methods. Boys had higher prevalence of ever use for vaporized (170 [11.6%] vs 163 [9.5%]) but not combustible (459 [31.4%] vs 534 [31.1%]) or edible (303 [20.7%] vs 373 [21.7%]) cannabis. Respondents with low SES had higher prevalence of ever use for combustible (614 [37.1%] vs 242 [22.0%]) and edible (408 [24.7%] vs 166 [15.1%]) but not vaporized (186 [11.2%] vs 93 [8.5%]) cannabis., Conclusions and Relevance: Among 10th-grade students in Los Angeles, use of cannabis via alternative administration methods was of appreciable prevalence, predominately reported in conjunction with other cannabis products and unequally distributed across sociodemographic strata. Prevention programs and regulatory restrictions addressing the spectrum of cannabis products might benefit pediatric public health.

Although lower socioeconomic status has been linked to increased youth substance use, much less research has determined potential mechanisms explaining the association. The current longitudinal study tested whether alternative (i.e., pleasure gained from activities without any concurrent use of substances) and complementary (i.e., pleasure gained from activities in tandem with substance use) reinforcement mediate the link between lower socioeconomic status and youth substance use. Further, we tested whether alternative and complementary reinforcement and youth substance use gradually unfold over time and then intersect with one another in a cascading manner. Potential sex differences are also examined. Data were drawn from a longitudinal survey of substance use and mental health among high school students in Los Angeles. Data collection involved four semiannual assessment waves beginning in fall 2013 (N = 3395; M baseline age = 14.1; 47% Hispanic, 16.2% Asian, 16.1% multiethnic, 15.7% White, and 5% Black; 53.4% female). The results from a negative binomial path model suggested that lower parental socioeconomic status (i.e., lower parental education) was significantly related to an increased number of substances used by youth. The final path model revealed that the inverse association was statistically mediated by adolescents' diminished engagement in pleasurable substance-free activities (i.e., alternative reinforcers) and elevated engagement in pleasurable activities paired with substance use (i.e., complementary reinforcers). The direct effect of lower parental education on adolescent substance use was not statistically significant after accounting for the hypothesized mediating mechanisms. No sex differences were detected. Increasing access to and engagement in pleasant activities of high quality that do not need a reinforcement enhancer, such as substances, may be useful in interrupting the link between lower parental socioeconomic status and youth substance use.

Objective: To examine whether reduced substance-free enjoyable activity (i.e., 'alternative reinforcers') is a mediating mechanism linking lower socioeconomic status and adolescent substance use risk., Method: High school students in Los Angeles, CA (N = 2,553, 2013-2014, M age baseline = 14.1) were administered three semiannual surveys. Socioeconomic status was measured by highest parental education reported at Wave 1 (the beginning of 9th grade). Three elements of alternative reinforcement at Wave 2 (six-month follow-up) were assessed as mediators: ratings of frequency of engagement, level of enjoyment, and frequency × enjoyment product scores of substance-free typically pleasant activities (like participation in sports teams or school clubs). Study outcomes included prior six-month alcohol, marijuana, tobacco, and other substance use at Wave 3 (twelve-month follow-up). Logistic regression models adjusting for alternative reinforcers and substance use from the preceding wave as well as other co-factors were used to examine the association of Wave 1 parental education with Wave 3 substance use and mediation by Wave 2 alternative reinforcement., Results: Lower parental education at Wave 1 was associated with a greater likelihood of reporting alcohol (β = -0.122, 95% CI = -0.234, -0.009) and marijuana (β = -0.168, 95% CI = -0.302, -0.034) use at Wave 3. The inverse association between parental education and substance use was statistically mediated by each element of diminished alternative reinforcement at Wave 2. Lower parental education at Wave 1 was associated with lower alternative reinforcement at Wave 2, which in turn was associated with greater likelihood of alcohol (range of β indirect effects  : -0.007 [95% CI = -0.016, -0.001] to -0.01 [95% CI = -0.018, -0.004]) and marijuana (βs: -0.011 [95% CI = -0.022,-0.002] to -0.018 [95% CI = -0.035, -0.005]) use at Wave 3. Parental education was not associated with use of combustible tobacco products or other drugs at Wave 3 adjusting for Wave 1 combustible tobacco and other drug use, respectively (ps ≥ 0.061)., Conclusion: Diminished access to and engagement in substance-free enjoyable activity may in part underlie socioeconomic disparities in adolescent alcohol and marijuana use risk. Increasing substance-free enjoyable activities may be useful in substance abuse prevention in socioeconomically disadvantaged youth., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: Electronic cigarettes (e-cigarettes) could have a multifaceted effect on public health by changing the likelihood that: (a) non-smokers and non-users of marijuana subsequently transition to cigarette and marijuana use, respectively, and/or: (b) cigarette smokers subsequently quit smoking. We analyzed data from a longitudinal study of Hispanic young adults in Los Angeles, California to determine whether e-cigarette use is associated with subsequent cigarette or marijuana use over a one-year period., Methods: Survey data were collected from 1332 Hispanic young adults (59% female, mean age=22.7 years, SD=0.39 years) in 2014 and 2015. Logistic regression analyses examined the association between e-cigarette use in 2014 and cigarette/marijuana use in 2015, controlling for age, sex, and other substance use., Results: In 2014, prevalence of past-month use was 9% for e-cigarettes, 21% for cigarettes, and 23% for marijuana. Among past-month cigarette nonsmokers in 2014, those who were past-month e-cigarette users in 2014 were over 3 times more likely to be past-month cigarette smokers in 2015, compared with those who did not report past-month e-cigarette use in 2014 (26% vs. 7%; OR=3.32, 95% CI=1.55, 7.10). Among past-month marijuana non-users in 2014, those who were past-month e-cigarette users in 2014 were nearly 2 times more likely to be past-month marijuana users in 2015 (24% vs. 12%;OR=1.97, 95% CI=1.01, 3.86). Among past-month cigarette and marijuana users in 2014, e-cigarette use in 2014 was not associated with a change cigarette and marijuana use, respectively, in 2015., Conclusions: Among Hispanic young adults, e-cigarettes could increase the likelihood of transitioning from non-user to user of cigarettes or marijuana and was not associated with smoking cessation., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: This study examined socioeconomic disparities in adolescent substance use utilizing a behavioral economic theoretical framework. We tested the hypothesis that teens of lower (vs. higher) socioeconomic status (SES) are vulnerable to substance use because they engage in fewer pleasurable substance-free activities that provide reinforcement and may deter substance use., Method: In a cross-sectional correlational design, 9th grade students (N=2839; mean age=14.1years) in Los Angeles, California, USA completed surveys in Fall 2013 measuring SES (i.e., parental education), alternative reinforcement (engagement in pleasurable substance-free activities, e.g., hobbies), substance use susceptibility, initiation, and frequency, and other factors., Results: For multi-substance composite outcomes, lower parental education was associated with greater likelihood of substance use initiation in the overall sample, frequency of use among lifetime substance users, and susceptibility to substance use in never users. Substance-specific analyses revealed that lower parental education was associated with higher likelihood of initiating cigarettes, alcohol, and marijuana use as well as greater susceptibility to use cigarettes in never smokers. Each inverse association between parental education and substance-related outcomes was statistically mediated by diminished alternative reinforcement; lower parental education was associated with lower engagement in alternative reinforcers, which, in turn, was associated with greater substance use susceptibility, initiation, and frequency., Conclusion: These results point to a behavioral economic interpretation for socioeconomic disparities in adolescent substance use. Replication and extension of these findings would suggest that prevention programs that increase access to and engagement in healthy and fun activities may reduce youth socioeconomic health disparities related to substance use., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Heightened negative affect during acute tobacco abstinence in women relative to men could be an important factor underlying sex differences in smoking motivation. However, little controlled experimental work addresses this hypothesis. The current study investigated sex differences in withdrawal-related negative affect, time to start smoking on a lab analogue smoking lapse task, and the interrelation between sex, withdrawal-related negative affect, and smoking lapse behavior. Following a baseline session, current smokers (women: n = 68, men: n = 131) attended two counterbalanced lab sessions (16 hours smoking abstinence and ad libitum smoking) during which they completed self-report measures of mood and withdrawal symptoms followed by a laboratory analogue smoking lapse task. In this task participants are monetarily rewarded for delaying smoking. Performance on this task serves as an analogue model of smoking lapse behavior by measuring smoker's capability to resist temptation to smoke under conditions where abstinence is advantageous. Females showed greater abstinence induced increases in composite negative affect as well as several particular negative affect states (i.e., POMS Anger, Anxiety, Depression, and Confusion, ps < .05) but no differences in abstinence induced changes in other forms of affect or craving. Females also exhibited marginally greater abstinence induced decreases in their willingness to delay smoking for money (p = .10), which was mediated by abstinence induced increases in anger (p < .05). These results suggest that differential sensitivity to abstinence induced negative affect, particularly anger, could underlie sex specific smoking patterns. Negative affect during tobacco abstinence may be an important factor for understanding and treating nicotine addiction in women., (PsycINFO Database Record (c) 2013 APA, all rights reserved)