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iObjective/i: This report aims to identify US mutual help group (MHG) participants' psycho-socio-behavioral profiles.iMethod/i: We used data from the 2015-2018 National Survey on Drug Use and Health and the sample included 1022 adults with past-year substance use disorders (SUD). We conducted a latent class analysis to identify subgroups of MHG participants and estimated multinomial logistic regression models to examine the associations between sociodemographic/intrapersonal characteristics and class membership.iResults/i: Analyses identified three latent classes. Class 1 (iLow-Risk group/i, 54%) reported low risks in all correlates except for serious psychological distress (SPD, 33%). Class 2 (iPsychological Distress group/i, 30%) demonstrated high risks of major depressive episodes (86%) and SPD (93%). Class 3 (iCriminal Justice System Involvement group/i, 16%) showed high involvement in arrests (100%) and drug-related arrests (67%) and moderate risks for SPD (54%) and behavioral problems, e.g., drug selling (46%) and theft (35%). Compared to Class 1, Class 2 was more likely to be female, out of the labor force, and to show high risk propensity, and Class 3 was more likely to have lower education and drug use disorders. Class 3 was also less likely to be older, belong to the "other" racial/ethnic category, have lower English proficiency, and report alcohol use disorder.iConclusions/i: The three subgroups of the US MHG participant population illustrate the complex and heterogeneous psycho-social-behavioral profiles of MHG participants with SUD. MHG referral's effectiveness may be augmented by tailoring it to the patient/client's specific psycho-socio-behavioral profile.

At least 60% of individuals with anxiety disorders report sleep disturbances. Shared physiological mechanisms might explain their co-occurrence. Scientific literature related to medical cannabis, a promising therapeutical candidate for these conditions, increased about 15 times in the last 10 years. However, assessments of cannabinoid exposure, anxiety, and sleep are inconsistent across studies, and the quality of the evidence is not often evaluated. We developed a Scoping Review to examine the current knowledge on these gaps related to cannabinoid use for anxiety and sleep disturbances.This protocol provides detailed information on how the scoping review will be conducted. It shows the inclusion criteria for studies on the topic of interest as well as the search strategies for the following databases: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, LILACS, and PsycINFO. We present the methodological aspects for screening, data extraction, and data charting. In addition, we proposed to evaluate the quality of the evidence by applying critical appraisal tools according to the study designs.Adherence to this protocol will allow the research team to effectively and reliably synthesize research evidence on the effect of cannabinoids on anxiety symptoms and sleep disturbances.

Medical marijuana (MMJ) was legalized in November 2016 with the passing of Amendment 2 in the state of Florida. Since the legalization, many studies have been conducted to understand the direct effect medical marijuana has on specific medical conditions. Unlike most allopathic drugs, medical marijuana does not target single ailments or specific conditions and does not follow precise recommending guidelines. There is scarce knowledge on how patient characteristics, including medical conditions, affect a physician's direct recommendations and registry limits. To obtain insight on the effect patient characteristics have on the clinical decision-making process, we conducted ten qualitative interviews of medical marijuana physicians who are certified to order medical marijuana for patients in Florida. Interview topics ranged from typical daily practice to specific recommendations for patient histories. Each interview was transcribed and thematically analyzed. Five major patient characteristics that influence a physician's recommendation emerged from the interviews: patient medical history, co-medications, lifestyle, marijuana experience level and counter-indications. Each category was analyzed further to understand how the characteristics influenced the practice of recommending and ordering product. Physicians emphasized the equivalent importance of reviewing a patient's medical history, lifestyle, and past marijuana experiences while also expressing the need to look holistically at the individual patient. Instead of the characteristics determining what the physician recommends for the patient and orders through the registry, the characteristics dictate the education given to the patient so that the patient may lead and determine their own individual care.

BACKGROUND AND AIMS: Although poor decision-making (DM) has been correlated with problematic cannabis use (CU), cross-sectional designs make it difficult to determine whether poor DM represents an antecedent and/or consequence of CU. The current study measured bidirectional associations between CU and DM among adolescents over 2 years and compared these findings to those observed with episodic memory, which is consistently reported as a consequence of CU. We also measured the role of DM as a risk factor for cannabis use disorder (CUD) onset. DESIGN: Two-year longitudinal study with five bi-annual assessments. PARTICIPANTS: Participants were 401 adolescents aged 14–17 years at baseline. SETTING: Miami, Florida, USA. MEASUREMENTS: CU frequency and CUDs were assessed at each time-point through the Drug Use History Questionnaire and Structured Clinical Interview for DSM-IV respectively. Neurocognition was assessed at odd time-points throughout the Iowa Gambling Task, Game of Dice Task and Cups Task [decision-making (DM)] and the Wechsler Memory Scale IV and California Verbal Learning Test II (episodic memory). We used latent growth curve modeling to examine bidirectional influences between CU and neurocognition over time. We applied discrete time survival analyses to determine whether baseline DM predicted CUD onset. FINDINGS: Greater lifetime CU frequency was associated with poorer episodic memory at baseline (bs = −14.84, −16.44, Ps = 0.038, 0.021). Greater CU escalation predicted lesser gains in immediate episodic memory (b = −0.05, P = 0.020). Baseline DM did not predict CU escalation (b = 0.07, P = 0.421), nor did escalation in CU predict changes in DM (b = 0.02, P = 0.352). Baseline DM also did not predict CUD onset (adjusted OR = 1.01, 95% confidence interval = 0.98–1.06). CONCLUSIONS: This study replicates findings that poorer episodic memory in adolescents appears to be a consequence of cannabis use, even among adolescents at earlier stages of use. Poor decision-making does not appear to be either a consequence of or a risk factor for escalating cannabis use or onset of cannabis use disorder among adolescents.

Kratom (Mitragyna speciosa) use is associated with polysubstance use (PSU) and use disorders. However, additional research on PSU heterogeneity in populations using this novel psychoactive substance is necessary. The authors investigated patterns of past 12-month PSU among US adults reporting past 12-month use of kratom and at least one additional substance.Latent class models were fit using 2019 National Survey on Drug Use and Health (NSDUH) data which was collected from 412 US adults reporting past 12-month use of kratom and at least one of 11 additional substances.Three distinct profiles were identified: "marijuana/alcohol/tobacco" (63.3%), "marijuana/alcohol/tobacco + psychedelics" (19.3%), and "marijuana/alcohol/tobacco + psychedelics/heroin/prescriptions" (17.4%).This is the first epidemiological study in which a latent class analysis was used to identify unique PSU profiles among US adults using kratom and other substances. Understanding the profiles of people using kratom in relation to the use of other drugs might help guide screening interventions, treatment needs, and policy.

Introduction Electronic cigarettes are now the most commonly used form of tobacco product among youth in the United States. Current evidence suggests that although e-cigarettes are perceived as less harmful and preferred over combustible cigarettes by adolescents, adolescents who try e-cigarettes are at greater risk of transitioning to combustible cigarettes. The genetic and environmental contributions to liability for e-cigarette use have not yet been examined using a behavioral genetic design. Methods Behavioral genetic models of lifetime and current e-cigarette use and friends who use e-cigarettes were examined among female monozygotic and dizygotic twins. Results A total of 41 female twin pairs (65.9% monozygotic twins; age = 19.7, SD = 1.6) with complete data on the study variables were included in the present analyses. The majority of the sample (68.1%) had at least some friends who use e-cigarettes. Additive genetic effects on e-cigarette use were not present, but the shared environment explained 98.7% of the variance in lifetime e-cigarette use, 96.6% in current e-cigarette use, and 94.9% in affiliation with friends who use e-cigarettes. Conclusion This first study on the behavioral genetics of e-cigarette use among adolescents and young adults suggest that environmental factors shared by twins within a family seem to play a predominant role in the initial stages of e-cigarette use, a finding that is consistent with what has been found for tobacco. The findings emphasize the importance of continuing population-based tobacco control interventions to reduce the burden of e-cigarette use among adolescents. Implications The shared environment significantly influences the initiation and regular use of electronic cigarettes and affiliation with friends who use electronic cigarettes among adolescent and young adult females. These findings underscore the importance of formulating preventive interventions that mitigate the social effects of familial influences on e-cigarette use through social skills training, education on harms of e-cigarettes for young people, or altering social norms regarding initiation of novel tobacco products.

Background While accumulated evidence has shown that the prevalence of cannabis use among pregnant women in the US has increased in recent years, little is known about the specific subpopulations affected. The aim of this study was to estimate the prevalence and correlates of the perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of past 30-day cannabis use among US pregnant women. Methods We analyzed data from 2,247 pregnant women 14 to 44 years of age surveyed in the 2015 to 2017 cross-sectional National Survey on Drug Use and Health. Analyses account for the sampling design. Primary outcomes included perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of cannabis use. We conducted multivariable logistic and negative binomial regression models to assess the associations between the primary outcomes and multiple correlates. Results Among US pregnant women, 21.6% (95% CI=19.4, 23.8) did not perceive any risk associated with weekly cannabis use, 5.3% (95% CI=4.2, 6.5) used cannabis in the past 30 days, and among past-month users, the average number of days of use was 15.6 (95% CI=13.5, 17.7). Pregnant women living below the poverty line were both more likely to perceive no risk of weekly cannabis use (aOR=1.8; 95% CI=1.3, 2.5) and use cannabis more often in the past 30 days (aOR=2.9; 95% CI=1.5, 5.7) than pregnant women within an income bracket of more than two times the federal poverty threshold. Age, race, trimester of pregnancy, co-use of tobacco and/or alcohol were also associated with these outcomes. Conclusion Younger age, living in poverty, early trimester of pregnancy, and co-use of tobacco and/or alcohol increased the odds of cannabis use among pregnant women. As cannabis legalization spreads and cannabis use is increasingly perceived as safe, there is a growing need for research to determine the reasons why women in the identified at-risk subgroups are using cannabis during pregnancy.

Objectives: This study uses a nationally representative sample of adults to investigate racial-ethnic differences in reasons for cannabis use among those reporting past 12-month misuse of prescription opioids for pain relief. Methods: Data from the 2015-2019 National Surveys on Drug Use and Health were used to study 3,093 adults 18 to 49 years old reporting past 12-month pain-related prescription pain reliever (opioid) misuse. Logistic regressions assessed the association between past 12-month cannabis use – (non medical vs. any medical) – and multiple socio-demographic, psycho-social and drug use correlates. NSDUH analysis weights were applied to accommodate for the sampling design. Results: Half of individuals who reported misuse of prescription opioids for pain relief used cannabis in the past 12-months. In this sample of cannabis users, 87.6% (95%CI = 86.1, 88.9) used non-medically, and 12.4 (95%CI = 11.1, 13.9) used for both medical and recreational reasons. Individuals with past 12 months diagnosis of opioid use disorder were 1.8 (95%CI = 1.29, 2.63) times as likely to be medical cannabis users compared to those without a disorder. Conclusions: The findings indicate that medical cannabis might be an alternative for nearly one in eight individuals misusing pain relievers to alleviate their pain, primarily those with an opioid use disorder. Despite increased rates of cannabis use among males and non-Hispanic Whites in the general population, no gender or racial-ethnic differences were found in the selected sample. Future studies should investigate simultaneous use and the analgesic effects of co-use in this sample.

Background Kratom (Mitragyna speciosa) is an opioid-like psychoactive substance not approved by the U.S. Food and Drug Administration that could be used due to its euphoric, stimulant, and analgesic effects. Kratom is gaining popularity in the U.S. and becoming a reason of concern among pediatricians. Methods Data from the 2019 National Survey on Drug Use and Health were analyzed to estimate the prevalence and identify correlates of lifetime and past 12-month kratom use among 13,397 U.S. adolescents. Multivariable logistic regression models were conducted to assess the associations of interest. Results Lifetime and past 12-month prevalence of kratom use was .44% (95% confidence interval [CI] .32–.60) and .27% (95% CI .18–.40), respectively. Past 12-month cigarette use was associated with lifetime kratom use (adjusted odds ratio 2.60, 95% CI 1.07–6.35). Past 12-month cannabis use was associated with past 12-month kratom use (adjusted odds ratio 2.48, 95% CI 1.15–5.35). Conclusions This first report on the epidemiology of adolescent kratom use provides a baseline to assess kratom use trends in future years and identify potential correlates of use among adolescents.

OBJECTIVES This study aims to investigate racial-ethnic differences in reasons for misuse of prescription medications among a nationally representative sample of US adults. METHODS We analyzed data from the 2015-2019 National Surveys on Drug Use and Health. The study population includes US adults (18-49 years old) who reported misuse of 3 types of prescription drugs (stimulants [n = 6139], sedatives and tranquilizers [n = 5643], and pain relievers [n = 8780]) for 3 reasons: medical-only (eg, to help with pain), recreational-only (eg, to get high), or combined medical and recreational reasons. Multinomial logistic regressions assessed the association between reasons of misuse of prescription medications and self-identified race-ethnicity. RESULTS Misuse of the 4 types of prescription medications was primarily motivated by medical reasons (63%-80%). Compared to non-Hispanic Whites, non-Hispanic Blacks (nHB), and Hispanics (H) were less likely to report misuse of pain relievers for combined (nHB: adjusted relative risk ratio [aRRR] = 0.6, 95% confidence interval [CI]: 0.4, 0.7; H; aRRR = 0.7, 95% CI: 0.5, 0.9) or recreational reasons (nHB: aRRR = 0.8, 95% CI: 0.6, 1.0; H; aRRR = 0.7, 95% CI: 0.6, 0.9) rather than medical-only reasons. The odds of misuse of sedatives and tranquilizers for recreational-only reasons as opposed to medical-only reasons were higher among nHB (aRRR = 1.9, 95% CI: 1.3, 2.7) and H (aRRR = 1.9, 95% CI: 1.4, 2.4) than among non-Hispanic Whites. CONCLUSIONS The increased misuse of prescription pain relievers for medical reasons among racial-ethnic minority groups demonstrates a continued need to investigate underlying structural factors driving these behaviors. The higher odds of sedative and tranquilizer misuse for recreational purposes among racial-ethnic minority groups warrant further investigation.

OBJECTIVE Impairments in neurocognitive functioning, including memory and executive functions, have been identified among adult cannabis users; however, less is known about the effects of cannabis use (CU) among adolescent users. Delineating the directionality of associations between CU and neurocognition has been restricted due to the relatively few longitudinal studies examining this question. As such, we examined whether decision-making prospectively predicted CU, and whether increases in CU were associated with changes in decision-making and episodic memory among a sample consisting predominantly of adolescent cannabis users. METHOD Adolescents (n = 401), aged 14-17 at baseline, completed 3 (biannual) assessments across a 1-year period. Latent growth curve analyses in structural equation models were conducted to examine potential associations between decision-making and growth in CU, and associations between change in CU and change in decision-making or episodic memory performance. RESULTS Significant cross-sectional associations were observed between greater CU and poorer decision-making and episodic memory performance (p < .05), consistent with our hypotheses and prior findings. However, decision-making performance did not predict change in CU frequency across 1 year. Neither was change in decision-making associated with changes in CU. However, increasing cannabis use was associated with worsening immediate (but not delayed) episodic memory. CONCLUSIONS Our findings suggest that poorer decision-making does not put teens at relatively early stages of cannabis use at risk for further escalation in use over one year. However, increasing cannabis use over the same period was associated with declines in immediate memory. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background While accumulated evidence has shown that the prevalence of cannabis use among pregnant women in the US has increased in recent years, little is known about the specific subpopulations affected. The aim of this study was to estimate the prevalence and correlates of the perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of past 30-day cannabis use among US pregnant women. Methods We analyzed data from 2,247 pregnant women 14 to 44 years of age surveyed in the 2015 to 2017 cross-sectional National Survey on Drug Use and Health. Analyses account for the sampling design. Primary outcomes included perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of cannabis use. We conducted multivariable logistic and negative binomial regression models to assess the associations between the primary outcomes and multiple correlates. Results Among US pregnant women, 21.6% (95% CI=19.4, 23.8) did not perceive any risk associated with weekly cannabis use, 5.3% (95% CI=4.2, 6.5) used cannabis in the past 30 days, and among past-month users, the average number of days of use was 15.6 (95% CI=13.5, 17.7). Pregnant women living below the poverty line were both more likely to perceive no risk of weekly cannabis use (aOR=1.8; 95% CI=1.3, 2.5) and use cannabis more often in the past 30 days (aOR=2.9; 95% CI=1.5, 5.7) than pregnant women within an income bracket of more than two times the federal poverty threshold. Age, race, trimester of pregnancy, co-use of tobacco and/or alcohol were also associated with these outcomes. Conclusion Younger age, living in poverty, early trimester of pregnancy, and co-use of tobacco and/or alcohol increased the odds of cannabis use among pregnant women. As cannabis legalization spreads and cannabis use is increasingly perceived as safe, there is a growing need for research to determine the reasons why women in the identified at-risk subgroups are using cannabis during pregnancy.

Aims Time to first cigarette (TTFC) after waking is a highly regarded and readily measured manifestation of a tobacco dependence process. We aim to estimate short TTFC as it occurs very soon after the onset of cigarette smoking (CS) in a community sample of newly incident smokers, all 12–21 years of age, and to study risk variation with the age of CS onset. Methods United States National Surveys on Drug Use and Health, 2004–2017, drew large nationally representative samples of 12-to-21-year-old community residents, and used computerized self-interviews to measure tobacco cigarette smoking, the Fagerstrom TTFC construct, and related variables. A ‘short’ TTFC was defined as smoking the first cigarette after waking up within 30 min vs. ‘long’ TTFC or smoking more than 30 min. We studied 8188 newly incident smokers, all assessed within six months after the first puff. Estimated age-specific cumulative incidence proportions (CIP) and odds ratios (OR) are estimated and compared, with due attention to complex survey design and weights. Results Among underage newly incident smokers (12–17 years old), an estimated 5.2% experienced short TTFC within 6 months after CS onset (95% CI = 4.4%, 6.2%), versus 3.7% for older new smokers (18–21 years; 95% CI = 2.8%, 4.6%). Underage smokers are 1.5 times more likely to develop short TTFC compared to older initiates (95% CI = 1.1, 2.1). No male-female variations are seen, but exploratory analysis disclosed findings that involve Census-defined race-ethnicity subgroups. Non-Hispanic African-American initiates are twice as likely to develop short TTFC, and Hispanic initiates are less likely to develop short TTFC, as compared with non-Hispanic White smokers. Conclusions Based on US community samples our study offers new evidence about TTFC formation observed within six months after the first puff when cigarette smoking starts before age 18 years.

INTRODUCTION Previous research has demonstrated that externalizing symptoms, cannabis use problems, and poor decision-making abilities are each independently related to risky sexual behavior (RSB). However, few studies have examined the joint effect of these factors on RSB among a sample of adolescents. METHODS The current study addresses this gap in the literature by examining how externalizing disorder symptoms, cannabis use, and decision-making abilities interact to predict RSB among a sample of adolescents (n = 204; Mage = 15.5) at-risk for escalation in cannabis use. Poisson regression was used for all analyses, and simple slope difference tests were used for all post-hoc analyses. RESULTS A greater number of externalizing symptoms, more problems from cannabis use, and more risk disadvantageous choices on the Cups Task (CT) total trials and more risk disadvantageous choices on the CT-gain trials predicted greater RSB endorsement. Findings also highlight significant interactions between cannabis use problems and CT-total and -gain trial performance, as well as between cannabis use problems and externalizing symptoms in predicting RSB. CONCLUSION Current treatment and prevention approaches to reduce RSB among adolescents may benefit from incorporating techniques that improve decision-making skills.

Introduction Associations between anxiety symptoms and cannabis use have been previously explored, yet the directionality of these associations remains highly debatable. The present study aims to prospectively examine patterns of cannabis use and anxiety during adolescence focusing on their co-development and bidirectional influences. Methods Adolescents ( n = 250) of predominantly Hispanic ethnicity, aged 14–17 at baseline, exposed to drugs, alcohol, or cigarettes completed three (bi-annual) assessments across a 1-year period. Latent growth curve modeling (LGCM) and parallel process growth curves were conducted to examine potential associations in the joint development of anxiety and cannabis use. Results Our results suggest that, during adolescence, early cannabis use has a greater influence on prospective reports of anxiety, than vice versa. Specifically, adolescents exhibiting higher initial levels of cannabis use displayed more persisting self-reported anxiety across time, as compared to those with less frequent use (b = 0.28, p = 0.024). In contrast, early levels of anxiety were not found to influence rates of change in cannabis use. These analyses considered concurrent depression, alcohol, and nicotine use. Conclusions Our findings suggest that prevention and targeted intervention programs for cannabis use in adolescence would benefit from anxiety management strategies; in order to reduce subsequent anxiety associated with cannabis use. Future studies should continue to employ longitudinal designs across larger time periods and aim to replicate these findings with more diverse samples.

Objective: Relative to the vast literature that employs measures of decision-making (DM), rigorous examination of their psychometric properties is sparse. This study aimed to determine whether three measures of DM assess the same construct, and to measure invariance of this construct across relevant covariates. Method: Participants were 372 adolescents at risk of escalation in cannabis use. DM was assessed via four indices from the Cups Task, Game of Dice Task (GDT), and Iowa Gambling Task (IGT). We used confirmatory factor analysis to assess unidimensionality of the DM construct, and moderated nonlinear factor analysis (MNLFA) to examine its measurement invariance. Results: The unidimensional model of DM demonstrated good fit. MNLFA results revealed that sex influenced mean DM scores, such that boys had lower risk-taking behaviors. There was evidence of differential item functioning (DIF), such that IQ and age moderated the IGT intercept and GDT factor loading, respectively. Significant effects were retained in the final model, which produced participant-specific DM factor scores. These scores showed moderate stability over time. Conclusions: Indices from three DM tasks loaded significantly onto a single factor, suggesting that these DM tasks assess a single underlying construct. We suggest that this construct represents the ability to make optimal choices that maximize rewards in the presence of risk. Our final DM factor accounts for DIF caused by covariates, making it comparable across adolescents with different characteristics. (JINS, 2019, 25, 661–667)

Background This paper examines the epidemiology of extra-medical use of prescription medications for sleep among a nationally representative sample of U.S. adults. Methods We analyzed data from the 2015–2018 National Surveys on Drug Use and Health. The sample includes 3410 U.S. adults who reported extra-medical use of prescription medications for sleep. Multinomial logistic regression models identified correlates of type of drug used [i.e., sedatives and/or tranquilizers-only (ST-only), prescription pain relievers-only (PPR-only), or sedatives, tranquilizers, and prescription pain relievers (ST + PPR)], and logistic regression models identified correlates of reasons for extra-medical use (i.e., sleep-only vs. sleep and recreational). Results About 60% (95%CI = 58.9, 63.5) of the sample reported extra-medical use of ST-only, followed by PPR-only (29.9%, 95%CI = 27.5, 32.5), and ST + PPR (8.9%, 95%CI = 7.7, 10.4). Recreational use was reported by 28.4% (95% CI = 26.5, 30.4) of the sample. The odds of extra-medical use of PPR-only (aRRR = 3.1, 95%CI = 2.1, 4.5) and ST + PPR (aRRR = 1.9, 95%CI = 1.2, 3.1) as opposed to ST-only, were greater among Non-Hispanic Blacks than Non-Hispanic Whites. Compared to non-alcohol users, those with a past-12 months diagnosis of alcohol use disorder were more likely to use ST + PPR rather than ST-only (aIRR = 2.0, 95%CI = 1.1, 3.7). Non-Hispanic Blacks (aOR = 0.6, 95%CI = 0.4, 08) and individuals living in rural areas (aOR = 0.5, 95%CI = 0.3, 09) were less likely to report extra-medical use of prescription medications for recreational reasons than Non-Hispanic Whites and those residing in large metropolitan areas, respectively. Conclusions Extra-medical use of PPR-only and ST + PPR as an aid to sleep, is prevalent among Non-Hispanic Blacks, young adults, and those residing in rural areas. Most individuals reported that extra-medical use of prescription medications was primarily motivated by sleep reasons, rather than by sleep and recreational reasons. Potential interventions include access to sleep treatments, education on the effectiveness and risk associated with extra-medical use and co-use of prescription medications for sleep, and research on sleep-related disparities.

BACKGROUND Alzheimer's disease (AD) is a common and severe neurodegenerative disorder. Human telomeres are fundamental for the maintenance of genomic stability and play prominent roles in both cellular senescence and organismal aging. Regulation of telomere length (TL) is the result of the complex interplay between environmental and genetic factors. Alterations in TL are increasingly being studied as a possible risk factor for AD, and published studies on TL in AD show discrepant results, highlighting the need for a meta-analysis. METHODS In the current study, we carried out a meta-analysis of published studies of TL in AD patients and healthy controls. PubMed, Web of Science and Google Scholar databases (from inception to September 2015) were used to identify relevant articles reporting TL in humans with AD, from which we retrieved data such as sample size, experimental methods, and mean TL for cases and controls. A random-effects model was used for meta-analytical procedures. RESULTS The meta-analysis included 13 primary studies and demonstrated a significant difference in TL between 860 AD patients and 2,022 controls, with a standardized mean difference of -0.984 (confidence interval: -1.433 to -0.535; p value

Background Existing evidence suggest that cannabis may impair driving and is the most prevalent drug identified in drivers. Males exhibit an excess risk for driving under the influence of drugs or alcohol compared to females. We assessed sex differences in the association between the reason for cannabis use (medical, recreational, or both) and driving under the influence of cannabis (DUIC). Methods A sample of 17,405 past 12-month cannabis users (18 + years old) were analyzed from the 2016–17 National Survey on Drug Use and Health. Multivariable logistic regression was used to assess the interaction of sex and reason for cannabis use on DUIC using predicted probabilities. Results Among cannabis users in the sample, 88.1% used for recreational reasons, 7.8% used for medical reasons, and 4.1% used for medical and recreational reasons. The probability of DUIC was as low as 20% among female medical only users, and as high as 40% among male combined medical and recreational users. Females showed more similar probabilities of DUIC across reasons of use (range 20% to 25%s) than males (range 28% to 40%). The difference in the probability of DUIC between combined medical and recreational users and recreational only users was significantly greater among males than among females (Δ 0.1, p Conclusions The observed effects of sex and reasons for cannabis use on DUIC suggests a need for targeted educational interventions, particularly among males reporting combined medical and recreational marijuana use.

This chapter focuses on international trends. Mainly, the chapter provides estimates that illustrate generally stable recent trends in the frequency and occurrence of use in most countries for which survey data have been distributed, with some noteworthy exceptions to this stability. The chapter offers a first approximation of a global tour of cannabis smoking estimates and trends and covers evidence on the hypothesized possibility of a narrowing of the male–female difference in risk of becoming a cannabis user. The chapter closes with thoughts on an International Cannabis Products Safety Commission that is needed to keep track of trends and to investigate hypotheses about psychoses and other hazards attributed to consumer end-user ingestion of cannabis products.

BACKGROUND: In contrast to research on more restricted samples of drug users, epidemiological studies open up a view of death rates and survivorship of those who have tried heroin a few times, with no acceleration toward sustained use patterns often seen in treatment and criminal justice samples. At their best, epidemiological estimates of heroin effects on risk of dying are not subject to serious selection biases faced with more restricted samples. METHODS: Data are from 7207 adult participants aged 18-48 years in United States Epidemiologic Catchment Area Program field surveys, launched in 1980-1984. US National Death Index (NDI) records through 2007 disclosed 723 deaths. NDI enabled estimation of heroin-associated risk of dying as well as survivorship. RESULTS: Estimated cumulative mortality for all 18-48 year old participants is 3.9 deaths per 1000 person-years (95% confidence interval, CI=3.7, 4.2), relative to 12.4 deaths per 1000 person-years for heroin users (95% CI=8.7, 17.9). Heroin use, even when non-sustained, predicted a 3-4 fold excess of risk of dying prematurely. Post-estimation record review showed trauma and infections as top-ranked causes of these deaths. CONCLUSIONS: Drawing strengths from epidemiological sampling, standardized baseline heroin history assessments, and very long-term NDI follow-up, this study of community-dwelling heroin users may help clinicians and public health officials who need facts about heroin when they seek to prevent and control heroin outbreaks. Heroin use, even when sporadic or non-sustained, is predictive of premature death in the US, with expected causes of death such as trauma and infections. Language: en

Latinos are more likely to delay HIV testing, present to care with an AIDS defining illness, and die within one year of learning their HIV-positive status than non-Latino blacks and whites. For this paper, we explore the role of partner-relationship characteristics and health behaviors, in predicting HIV testing among Latina adult women who engaged in risky sexual behaviors (i.e., unprotected vaginal and/or anal sex). Data from a convenience sample of 168 Latina adult women who engaged in risky sexual behavior in the year prior to assessment were analyzed for this paper. Rates and predictors of HIV testing among this sample were assessed after a five-year follow-up. Descriptive and analytical estimates include incidence rates and adjusted odds ratios (AOR) from multilevel models. At five-year follow-up, 63.7% (n = 107) women reported having been tested for HIV, of whom 12.2% (n = 13) were women who never tested before. Main reasons for not having been tested at follow-up included: low risk perception (62.1%) and trusting their partner(s)/being in a monogamous relationship/knowing their partner's HIV status (17.2%). Predictors of HIV testing included: age (AOR: 0.96; 95% CI = 0.92-0.99), provider endorsement of HIV testing (AOR: 4.59; 95% CI = 1.77-11.95), poor quality of their romantic relationships (AOR: 1.12; 95% CI = 1.03-1.26), and knowing the HIV sero-status of sexual partner (AOR: 3.61; 95% CI = 1.46-8.95). This study characterizes a group of Latina women at high risk for HIV infection and their HIV testing behaviors. Our findings underscore the need of increasing access to quality health-care services and HIV behavioral interventions, and to strengthen the adherence to HIV/sexually transmitted disease testing recommendations and guidelines among local health-care providers serving the Latino community in South Florida.

Background As drugs remain ubiquitous and their use increasingly viewed as socially normative, vulnerable population groups such as adolescents face continued and growing risk. A better understanding of the factors that discourage individuals from initiating drug use, particularly in enabling scenarios, is therefore needed. This study aims to identify individual, interpersonal and school-contextual factors associated with resistance to using drugs in the presence of a drug use opportunity among adolescents in Bogota, Colombia. Methods Data are analyzed from 724 school-attending adolescents (15.1 years, SD = 1.3) who have had an opportunity to use drugs. Schools were selected in a multistage probability cluster sample. Random intercept multilevel logistic regression models were implemented to estimate the effect of individual, interpersonal and school-contextual level variables on the likelihood of resisting using drugs. Results Drug use resistance was observed in less than half (41.4%) of those students who experienced an opportunity to use drugs. Drug use resistance was strongly associated with having experienced a passive drug use opportunity (AOR = 3.1, 95% CI = 2.0, 4.9), the number of drugs offered (AOR = 0.7, 95% CI = 0.6, 0.8) and family factors such as not having a drug-using first-degree relative (AOR = 2.3, 95% CI = 1.2, 4.3) and a high degree of parental supervision (AOR = 1.9, 95% CI = 1.0, 3.2). Conclusions A large proportion of students who experienced a drug-use opportunity did not initiate drug use despite living in a context of high drug availability and social disorganization. The findings highlight the need for effective family-based drug use prevention interventions within the Colombian context.

Advancing our initial, cross-sectional study, which showed that adult Latinas' mother-daughter attachment relates to their substance use, the current, longitudinal study tests whether mother and daughter attachment scores at baseline predict their substance use over time.We analyzed data from a convenience sample of 133 Latina adult mothers (mean age = 52 years, SD = 10) and 133 Latina adult daughters (mean age = 27, SD = 9) at baseline and at 5-year and 6-year follow-ups after baseline (attrition rate = 16%). Multilevel longitudinal modeling was used to examine the effect of mother-daughter attachment at baseline on their substance use over time.Each unit of increase in the attachment score at baseline is associated with a 0.28 drink decrease in monthly alcohol use (p.05) and a lower likelihood of being a heavy alcohol or other drug user [exp(β) = 0.97, p.01] compared with average attachment score at baseline (M = 91.52, SD = 18.00). Time and older age at baseline are associated with decreased substance use. Being born outside the United States is associated with decreased risk of heavy alcohol or other drug use. Being a mother is associated with increased substance use.The findings of this longitudinal study on adult Latinas indicate that mother-daughter attachment has long-lasting effects on substance use trajectories among adult Latinas. Future research should focus on (a) investigating social and cultural factors mediating this relationship and (b) greater substance use among Latina mothers compared with daughters.

Background Co-use of cannabis and drugs other than cannabis (DOTC) influences the risk of experiencing cannabis disorders. Accordingly, we explored whether speed of transition to drug co-use, the number of DOTC used, and/or being an experimental cannabis-only user, a regular cannabis-only user, or a regular cannabis user who co-uses DOTC (i.e., cannabis-plus user) were associated with decision-making (DM), mental health disorder symptoms, or cannabis use-related characteristics. Methods We analyzed baseline data from a sub-sample of 266 adolescent (ages 14 to 16) cannabis users (CU) participating in an ongoing longitudinal study. Assessments included semi-structured interviews, self-report questionnaires, and measures of drug use, DM (measured via the Iowa Gambling Task), mental health disorders, and cannabis use-related problems. Results Endorsing a larger number of mood disorders symptoms was associated with being a regular cannabis-plus user rather than a regular cannabis-only user (AOR = 1.08, C.I.95% 1.01, 1.15). Poorer DM was associated with a faster transition to co-use, such that for each one unit increase in DM performance, the years to onset of drug co-use increased by 1% ( p = 0.032). Endorsing a larger number of cannabis use-related problems was positively associated with endorsing a larger number of DOTC used ( p = 0.001). Conclusions This study provides new evidence on the process of drug co-use among CU. Specifically, mood disorder symptoms were associated with use of DOTC among regular CU. Furthermore, poorer DM was associated with a faster transition to drug co-use. Poorer DM and mood disorder symptoms may aggravate or accelerate the onset of adverse consequences among adolescent CU.

Background: This study aims to estimate general and racial-ethnic specific cumulative probability of developing dependence among nicotine, alcohol, cannabis or cocaine users, and to identify predictors of transition to substance dependence. Methods: Analyses were done for the subsample of lifetime nicotine (n = 15,918), alcohol (n = 28,907), cannabis (n = 7389) or cocaine (n = 2259) users who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Discrete-time survival analyses were implemented to estimate the cumulative probability of transitioning from use to dependence and to identify predictors of transition to dependence. Results: The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users, and 8.9% for cannabis users. Half of the cases of dependence on nicotine, alcohol, cannabis and cocaine were observed approximately 27, 13, 5 and 4 years after use onset, respectively. Significant racial-ethnic differences were observed in the probability of transition to dependence across the four substances. Several predictors of dependence were common across the four substances assessed. Conclusions: Transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol and cannabis users. Transition to cannabis or cocaine dependence occurred faster than transition to nicotine or alcohol dependence. The existence of common predictors of transition dependence across substances suggests that shared mechanisms are involved. The increased risk of transition to dependence among individuals from minorities or those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations. Published by Elsevier Ireland Ltd.

Aim To estimate the general and racial-ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances.

Background Perceived risk is a key concept of behavioral theories used to predict substance use among youth and a core component of drug use prevention interventions. The present study aimed to (1) assess degrees of risk perception of regular marijuana use, (2) identify factors associated with risk perception, and (3) explore the associations between perceived risk and marijuana use and intentions to use marijuana among school-attending adolescents in Bogota, Colombia. Methods Data from 2079 standardized questionnaires administered in 23 schools were analyzed in this study. Schools were selected in a multi-stage probability cluster sample to reflect the socio-economic characteristics of Bogota’s student population. Results Just over 11% of participants perceived regular marijuana use to be a low risk behavior. Older age (>16 years) (adjusted odds ratio = 2.9; 95% confidence interval = 1.4–6.0) and low level of knowledge regarding the physical and psychological harms of illegal drugs (AOR = 2.9; 95%CI = 2.0–4.3) were the strongest predictors of low risk perception, Low perceived risk was also significantly associated with ever having used marijuana (AOR = 2.5; 95%CI = 1.7–3.7), monthly marijuana use among ever marijuana users (AOR = 2.7; 95%CI = 1.4–5.0), and a positive intention to use marijuana within the next 12 months among non-users (AOR = 2.1; 95%CI = 1.4–3.5). Conclusions Consistent with previous findings, perceiving regular marijuana use as a risky behavior functions as a protective factor against the intention to use, use and occasional use of marijuana. Incorporation of this message into drug use prevention activities for non-users and early-stage users may enhance their effectiveness.

Background: Globally, the most widely used set of compounds among the internationally regulated drugs is cannabis. Objective: To review evidence from epidemiological research on cannabis, organized in relation to this field's five main rubrics: quantity, location, causes, mechanisms, and prevention/ control. Method: The review covers a selection of evidence from standardized population surveys, official statistics, and governmental reports, as well as published articles and books identified via MEDLINE, Web of Science, and Google Scholar as of July 2016. Results: In relation to quantity, an estimated 3% to 5% of the world population is thought to have tried a cannabis product, with at least one fairly recent use, mainly extra-medical and outside boundaries of prescribed use. Among cannabis users in the United States, roughly one in 7-8 has engaged in medical marijuana use. In relation to location, prevalence proportions reveal important variations across countries and between subgroups within countries. Regarding causes and mechanisms of starting to use cannabis, there is no compelling integrative and replicable conceptual model or theoretical formulation. Most studies of mechanisms have focused upon a ‘gateway sequence’ and person-to-person diffusion, with some recent work on disability-adjusted life years. A brief review of cannabis use consequences, as well as prevention and control strategies is also provided. Conclusion: At present, we know much about the frequency and occurrence of cannabis use, with too little replicable definitive evidence with respect to the other main rubrics. Given a changing regulatory environment for cannabis products, new institutions such as an independent International Cannabis Products Safety Commission may be required to produce evidence required to weigh benefits versus costs. It is not clear that governmentsponsored research will be sufficient to meet consumer demand for balanced points of view and truly definitive evidence.

Parkinson's disease (PD) is a common and severe movement disorder. Differences in telomere length (TL) have been reported as possible risk factors for several neuropsychiatric disorders, including PD. Results from published studies for TL in PD are inconsistent, highlighting the need for a meta-analysis. In the current work, a meta-analysis of published studies for TL in PD was carried out. PubMed, Web of Science and Google Scholar databases were used to identify relevant articles that reported TL in groups of PD patients and controls. A random-effects model was used for meta-analytical procedures. The meta-analysis included eight primary studies, derived from populations of European and Asian descent, and did not show a significant difference in TL between 956 PD patients and 1284 controls (p value: 0.246). Our results show that there is no consistent evidence of shorter telomeres in PD patients and suggest the importance of future studies on TL and PD that analyze other populations and also include assessment of TL from different brain regions.

Data from the 2000 National Health Interview Survey (NHIS) were analyzed to explore barriers to HIV testing, and intentions to be tested among a nationally representative sample (n = 4,261) of the different Hispanic subgroups living in the United States. Weighted proportions and variances accounting for the complex sample design of the NHIS were estimated using the Taylor series linearization method. Regression estimates are expressed as odds ratios and their 95% confidence intervals. Two thirds of sampled Hispanics had never been tested for HIV (excluding blood donations) and 88% expressed no intention to do so in the near future. Many of the factors that influence the likelihood of having been tested in the past also impact on future HIV testing intentions including age, Hispanic subgroup, high-risk status, and self-perceived HIV risk. Compared to Puerto Ricans, Mexicans (odds ratio [OR] = 1.59, 1.1-2.3) and Mexican/Americans (OR = 1.61, 1.1-2.3) were more likely to never have been tested and Cubans were notably more likely to report negative future testing intentions (OR = 5.63, 2.5-12.8). Among Hispanics who reported high-risk status or high/medium self-perceived HIV risk, more than one quarter had never undergone testing and expressed no intention of doing so in the near future. Recognition of the HIV testing barriers identified in this study is valuable for the development and refinement of current strategies that aim to increase HIV testing practices in the heterogeneous U.S. Hispanic population.

OBJECTIVES: Age-specific incidence estimates are important and useful facts in psychiatric epidemiology, but incidence estimation can be challenging. Methods artifacts are possible. In the United States (US), where the minimum legal drinking age is 21 years, recent cross-sectional field research on 12-to-25-year-olds applied conventional ‘age-at-assessment’ approaches (AAA) for incidence estimation based on 12-month recall. Estimates disclosed unexpected non-linear patterns in age-specific incidence estimates for both drinking onset and for transitioning from 1(st) drink to heavy drinking. Here, our aim is to draw attention to an ‘age-of-onset’ (AOO) alternative to AAA approaches, and to verify whether the AOO approach also discloses non-linearity. METHODS: Yearly data are from US nationally representative samples drawn and assessed for National Surveys on Drug Use and Health, 2002–2014, with standardized audio computer-assisted self-interview assessments for drinking outcomes. RESULTS: Both AAA and AOO approaches show non-linearities, with an unexpected dip in drinking incidence rates after age 18 and before the age 21 minimum legal drinking age. CONCLUSIONS: The age-of-onset approach and the age-at-assessment approach disclosed similar age-specific patterns. We discuss advantages of the age-of-onset approach when non-linear incidence patterns can be anticipated, but we conclude that the age-at-assessment approach has not created an artifactual non-linear pattern.

This chapter reviews selected research topics and issues in relation to research on polydrug use. It includes a review of the history of the concept of polydrug use and often-referenced terminological confusion in this area of public health research. A pharmacoepidemiological perspective on responses to drug compounds taken in combination is presented, with coverage of sometimes misunderstood concepts such as interaction, antagonism, and synergy. The distinction is made between a description of subgroup variation in responses to a drug and drug–drug interactions for which there is an underlying pharmacological or toxicological theory to guide the research. Finally, there is a selective review of published evidence on population studies of polydrug use, with an emphasis upon investigations with epidemiologically defined populations under study. This review is organized in relation to five main rubrics of epidemiology, and includes topics, issues, and directions for future research on patterns of polydrug use.

Objetivos. Identificar los factores asociados con la membresía a las barras bravas, la incidencia del uso de drogas y la asociación entre membresía y uso de drogas. Materiales y métodos. Se analizan los datos reportados por 1303 adolescentes escolares que participaron en dos etapas (T1 y T2) de un estudio longitudinal realizado en 23 colegios de Bogotá, Colombia entre 2006 y 2007, seleccionados a partir de un muestreo probabilístico estratificado por conglomerados. Se implementaron modelos de regresión logística para estudiar las asociaciones de interés. Resultados. En T1, 8,2% de los encuestados reportaron membresía a las barras bravas. Luego de un año de seguimiento, el 14,2% y el 4,6% de los estudiantes que afirmaron y negaron respectivamente pertenecer a una barra brava, iniciaron el consumo de drogas. La asociación entre membresía a las barras bravas e inicio del uso de drogas permanece después de ajustar por múltiples factores de confusión (RRA: 2,4; IC 95%: 1,2 - 4,7). En el análisis estratificado por sexo, esta asociación permanece significativa únicamente en las mujeres (RRA: 6,1; IC 95%: 2,5 - 15,3). Conclusiones. La membresía a las barras bravas mostró incrementar el riesgo de inicio del uso de drogas, particularmente en las mujeres. Los hallazgos implican que se deben focalizar los esfuerzos preventivos hacia las mujeres en dichos contextos Objectives. To identify the factors associated with barras bravas (soccer fans clubs) membership, the incidence in drug use and the association between membership and drug use. Materials and methods. This report analyzed data from 1303 adolescent scholars who participated in two stages (T1 and T2) of a longitudinal study done in 23 schools of Bogota during 2006- 2007, selected through a probabilistic sampling stratified by clusters. Logistic regression models were implemented in order to evaluate the associations of interest. Results. In T1, 8,2% of the surveyed students reported barras bravas membership. After one year of follow-up, 14,2% of barras bravas members, and 4,6% of non-members, initiated drug use. The association between barras bravas membership and drug use onset remained significant after adjusting for multiple confounding factors (ARR=2,4; 95%CI=1,2-4,7). Sex-stratified analysis indicated that this association remained statistically significant only for females (ARR=6,1; 95%CI=2,5-15,3). Conclusions. Barras bravas membership increases the risk of drug use onset, particularly among females. The findings imply that preventive efforts should be focused on females in these contexts

This study examined patterns and determinants of seeking online health information among a nationally representative sample of 7,028 Jewish and Arab 7th- through 12th-grade students in 158 schools in Israel. Nearly all respondents (98.7%) reported Internet access, and 52.1% reported having sought online health information in the past year. Arab students (63%) were more likely than Jewish students (48%) to seek online health information. Population-group and sex differences in health topics sought online were identified, although fitness/exercise was most common across groups. Multivariate regression models revealed that having sought health information from other sources was the strongest independent correlate of online health information-seeking among Jews (adjusted odds ratio = 8.93, 95% CI [7.70, 10.36]) and Arabs (adjusted odds ratio = 9.77, 95% CI [7.27, 13.13]). Other factors associated with seeking online health information common to both groups were level of trust in online health information, Internet skill level, having discussed health/medical issues with a health care provider in the past year, and school performance. The most common reasons for not seeking online health information were a preference to receive information from a health professional and lack of interest in health/medical issues. The closing of the digital divide between Jews and Arabs represents a move toward equality. Identifying and addressing factors underpinning online health information-seeking behaviors is essential to improve the health status of Israeli youth and reduce health disparities.

Background The Internet is a frequently used source of health information. Adolescents in particular seem to be receptive to online health information (OHI) and often incorporate such information in their decision-making processes. Yet, OHI is often incomplete, inaccurate, or unreliable. This study assessed the quality of Hebrew online (non-user-generated) content on oral contraceptives (OC), with regard to accuracy/completeness, credibility, and usability. Methods Twenty-nine websites in Hebrew, including those of the four Israeli HMOs, were identified and evaluated. The websites were categorized as: HMO, health portal, contraception-specific, promotional-commercial, and life style and women’s health. A set of established content parameters was selected by a family planning expert to assess accuracy/completeness. The Health on the Net Foundation Code of Conduct (HONcode) principles were used to assess the websites’ reliability. Usability was assessed by applying items selected from the Minervation Validation and the University of Michigan’s ′Website Evaluation checklist′ scale. Mean scores, standard deviations (SD), and ranges were calculated for all websites and for category-specific websites. Correlation between dimensions and Inter-rater reliability were also examined. Results The mean score for accuracy/completeness was 50.9% for all websites (SD=30.1%, range 8–100%). Many websites failed to provide complete information, or provided inaccurate information regarding what to do when a pill is missed and when to use back–up methods. The average credibility score for all websites was 70.6% (SD=15.1, range=38=98%). The credibility parameters that were most commonly absent were funding source, authoring, date of content creation and last modification, explicit reference to evidence-based information, and references and citations. The average usability score for all websites was 94.5% (SD=6.9%, range 79–100%). A weak correlation was found between the three quality parameters assessed. Conclusions Wide variation was noted in the quality of Hebrew-language OC websites. HMOs’ websites scored highest on credibility and usability, and contraceptive-specific websites exhibited the greatest accuracy/completeness. The findings highlight the need to establish quality guidelines for health website content, train health care providers in assisting their patients to seek high quality OHI, and strengthen e-health literacy skills among online-information seekers, including perhaps health professionals.