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Majid Moshirfar,1– 3 Austin J Waite,4 James H Ellis,5 Rachel Huynh,5 John Placide,6 Matthew R Barke,6 Shannon E McCabe,1,7 Yasmyne C Ronquillo,1 Phillip C Hoopes Jr,1 Michael J Bradley,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4A.T. Still University College of Osteopathic Medicine in Arizona, Mesa, AZ, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA; 7Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To assess visual outcomes over time of femtosecond laser-assisted cataract surgery compared to standard phacoemulsification cataract surgery.Design: A retrospective, single-center comparative study.Methods: Patient data including demographics, ocular biometry, pre- and postoperative visual acuity, postoperative complications, primary (uncorrected distance visual acuity over time) and secondary visual outcomes (uncorrected near visual acuity, best distance visual acuity, patient complaints, satisfaction, and postoperative surgery) were gathered and statistically analyzed. Demographic differences between patients receiving femtosecond-laser assisted cataract surgery (FLACS) versus standard phacoemulsification cataract surgery (PCS) were corrected for outcome comparison. Safety, efficacy, predictability, and stability were analyzed for each procedure and compared.Results: A total of 155 eyes in PCS and 143 eyes in FLACS were analyzed at 1 week, 3 months, and 1 year using odds ratio. The odds ratio of being 20/20 or better and 20/40 or better at the specified time periods were similar and statistically insignificant at all time periods analyzed except 20/20 or better for uncorrected distance visual acuity (UDVA) at 1 year (p=0.0001) and uncorrected near visual acuity (UNVA) at 1 week (p=0.02). In both cases, the odds of being 20/20 or better favored FLACS. Mean UDVA, UNVA, and best distance visual acuity (BDVA) were all similar and statistically insignificant between the two groups. Postoperative patient complaints, safety, efficacy, predictability, and stability between the two groups showed no statistical significance.Conclusion: Despite the odds ratio of being 20/20 or better favoring FLACS for UDVA at 1 year and UNVA at 1 week, the mean logMAR UDVA, BDVA, and UNVA were similar and statistically insignificant between the FLACS and PCS groups at 1 week, 3 months, and 1 year. Differences in visual acuity were likely due to differences other than surgical approaches. While both FLACS and PCS are appropriate approaches to cataract surgery, one does not appear to be superior when assessing longitudinal markers for visual acuity, safety, efficacy, predictability and stability.Keywords: cataract surgery, cataracts, femtosecond-laser assisted cataract surgery, phacoemulsification cataract surgery, uncorrected distance visual acuity, best distance visual acuity, uncorrected near visual acuity

Majid Moshirfar,1– 3 William B West Jr,4 Dallin C Milner,5 Shannon E McCabe,1 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA; 3Utah Lions Eye Bank, Murray, UT, 84107, USA; 4University of Utah School of Medicine, Salt Lake City, UT, 84132, USA; 5University of Colorado School of Medicine, Aurora, CO, 80045, USACorrespondence: Majid Moshirfar Tel +1-801-568-0200Fax +1-801-563-0200Email cornea2020@me.comAbstract: We report an unusual presentation of presumed mitomycin C toxicity with possible subsequent hypersensitization to other medication toxicities. A 50-year-old female presented three months after photorefractive keratectomy with intraoperative mitomycin C for the management of persistent epithelial defects, corneal haze, and edema. She was found to have used an expansive and rapidly changing medical regimen which may have caused additional toxicity. These medications included besifloxacin, bromfenac, and ketotifen. Additives such as benzalkonium chloride and DuraSite® may have also contributed. Intraoperative mitomycin C can result in longstanding corneal haze, edema, and delayed epithelial healing in the setting of corneal refractive surgery. These may leave the cornea more susceptible to additional subsequent medication toxicities during the postoperative period. This report describes a case of mitomycin C exposure leading to a prolonged sensitivity to other medication toxicities, which has not been discussed elsewhere in the literature.Keywords: polypharmacy, corneal toxicity, surface ablation, hypersensitivity, medication toxicity, mitomycin corneal toxicity, photorefractive keratectomy

Majid Moshirfar,1– 3 Varshini S Odayar,4 Shannon E McCabe,1,5 Yasmyne C Ronquillo1 1Hoopes Vision Research Center, Draper, UT, 84020, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA; 3Utah Lions Eye Bank, Murray, UT, 84107, USA; 4Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA; 5Mission Hills Eye Center, Pleasant Hill, CA, 94523, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, 11820 State Street, Draper, UT, 84020, USATel +1 801-568-0200Email Cornea2020@me.comPurpose: This review aims to outline current practices and guidelines of corneal donation and eye banking, describes the implications of COVID-19 and emerging diseases on the corneal donor pool, and discusses future trends to improve and increase the efficiency of the processes involved in corneal donation and eye banking.Summary: Corneal screening, preservation, corneal storage, and prevention of systemic disease transmission from donor to recipient have been crucial in shaping the policies of the FDA and eye banks across the world. Eye banks globally have developed varying guidelines and criteria for evaluating the viability of donor corneas. Variables such as the age of the donor, medical history, and potential disease transmission are important screening parameters. While known infectious diseases may be transmissible through the cornea, emerging infectious diseases that are not well studied may be more transmissible than other infections. In particular, coronavirus has impacted corneal transplantation as SARS-CoV-2 expression has been detected in corneal tissue and conjunctiva. In recent years, partial-thickness corneal transplantations have been introduced. Lamellar grafts and other corneal layers are now utilized for transplantation of the specific areas that are damaged.Keywords: donor cornea, eye bank, COVID-19, cornea transplant, keratoplasty, donor recipient

Majid Moshirfar,1– 3 Nour Bundogji,4 Alyson N Tukan,4 James H Ellis,5 Shannon E McCabe,1,6 Ayesha Patil,5 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA; 2John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarMedical Director Hoopes Vision Research Center, Hoopes Vision Research Center, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To report visual outcomes following surgical correction of myopic astigmatism with Visian Toric implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA, USA) at a single tertiary refractive center in the United States.Patients and Methods: Toric ICL was implanted in 96 eyes (55 patients) with mean preoperative sphere of − 8.98 ± 3.04 diopters (D) and cylinder of − 2.67 ± 1.02 D from December 2018 to February 2021. Primary visual outcomes of efficacy, safety, stability, predictability of refractive correction, and astigmatic analysis were reported at three and twelve months postoperatively. Secondary subjective outcomes included patient-reported dry eye symptoms and glare/halos at postoperative visits. Other secondary outcomes were biometric data and postoperative vault over time.Results: At three and twelve months, 75 and 46 eyes were evaluated, respectively. At twelve months, the mean manifest refraction spherical equivalent (MRSE) was − 0.23 ± 0.47 D with 93% achieving within ± 1.00 D of target refraction. The manifest refractive cylinder (MRC) at twelve months was − 0.73 ± 0.51 D, with 86% within ± 1.00 D of target. Uncorrected distance visual acuity (UDVA) was 20/20 or better in 74% of eyes at twelve months. No patients lost ≥ 2 lines of corrected distance visual acuity (CDVA) at twelve months. The mean angle of error was − 0.9 ± 10.2° at three months and − 1.6 ± 12.8° at twelve months. One patient required bilateral lens rotation, four patients underwent secondary enhancement with LASIK/PRK, and seven patients underwent postoperative limbal relaxing incisions.Conclusion: This initial single-site experience finds Toric ICL implantation for myopic astigmatism to be safe and effective. Patients can achieve markedly improved UDVA in a single surgery with stable vision over time and minimal adverse subjective symptoms.Keywords: Toric ICL, visian, myopic astigmatism, visual outcomes

Majid Moshirfar,1– 3 James Ellis,4 Daniel Beesley,5 Shannon E McCabe,1,6 Adam Lewis,7 William B West Jnr,4 Yasmyne Ronquillo,1 Phillip Hoopes Snr1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Utah School of Medicine, Salt Lake City, UT, USA; 5Brigham Young University, Provo, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USA; 7Kansas City University College of Osteopathic Medicine, Kansas City, MO, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, Hoopes Vision, Draper, UT, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To compare the visual performance of the AcrySof IQ PanOptix trifocal intraocular lens and the TECNIS Symfony extended depth-of-focus lens at near and distance visual ranges.Methods: A total of 146 patients (221 eyes) who underwent phacoemulsification and cataract extraction and received either a PanOptix or Symfony lens from January 2019 to July 2020 were included in the study (83 PanOptix non-toric, 30 PanOptix toric, 70 Symfony non-toric, and 38 Symfony toric). Uncorrected distance (UDVA), uncorrected near (UNVA), and corrected distance (CDVA) visual acuity were assessed at one-day, one-month, and three-months postoperatively. Averages of UDVA, UNVA, and CDVA were taken to evaluate which lens was superior at near and distance visual ranges. Secondary outcome measures including glare, halo, dryness, and problems with night vision were documented at each postoperative visit.Results: At one month postoperatively, the average UNVA was 0.16 ± 0.14 logMAR in the PanOptix group and 0.21 ± 0.14 logMAR in the Symfony group (P=0.007); the average UDVA for the PanOptix group was 0.09 ± 0.13 logMAR compared to the Symfony group at 0.10 ± 0.14 logMAR (P=0.67); and the average CDVA was 0.02 ± 0.05 logMAR in the PanOptix group and 0.00 ± 0.04 logMAR in the Symfony group (P=0.11). At three months postoperatively, there were no statistically significant differences in UNVA, UDVA, or CDVA between the two groups (P=0.18, 0.79, 0.68 respectively). There was no statistically significant difference in secondary outcome measures at one- and three-months (P=0.49, 0.10 respectively).Conclusion: The AcrySof IQ PanOptix trifocal intraocular lens appears to afford better UNVA compared to the TECNIS Symfony extended depth-of-focus intraocular lens at one-month postoperatively, though this difference was not seen at three months postoperatively. There is no statistically significant difference in UDVA and CDVA between the two groups at postoperative day one, one-month, and three-months.Keywords: visual acuity, intraocular lens, trifocal lens, extended depth-of-focus lens

Majid Moshirfar,1– 3 Adam L Lewis,4 James H Ellis,5 Shannon E McCabe,1,6 Yasmyne C Ronquillo,1 Phillip C Hoopes Sr1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4Kansas City University, Kansas City, MO, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarMedical Director Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comIntroduction: Retained lens fragments in the anterior chamber following cataract extraction (CE) with phacoemulsification are rare but can lead to significant patient morbidity. Our study aimed to identify risk factors associated with retained lens fragments.Methods: Patients who underwent cataract surgery and subsequently identified to have retained lens fragments in the anterior segment were included. Incidence per year, patient demographics, visual acuity, ocular biometrics, surgical technique, surgeon performing CE, and outcomes were collected retrospectively and compared to a control group.Results: Twenty-four patients were identified with retained lens fragments, with an incidence of 0.10%. The mean age was 76 years ± 6.72 (60– 80) compared to 63 ± 11.41 (22– 86) in the control group (p < 0.001). Patients with UDVA 20/150 or worse experienced a greater average improvement in visual acuity compared to patients with UDVA better than 20/150 (logMAR 0.46 vs logMAR 0.05). The mean intraocular pressures before (CE), after CE but before fragment removal, and following fragment removal were 14 mmHg ± 2.59, 19 mmHg ± 8.20, and 11 mmHg ± 2.75, respectively. Twenty-two patients presented with inferiorly located fragments. Statistically significant biometrics include mean anterior chamber depth (3.1 mm ± 0.37 vs 3.33 mm ± 0.39, p = 0.01) and lens thickness (4.77 mm ± 0.44 vs 4.35 mm ± 0.44, p = < 0.001). Yearly incidence rates per surgeon ranged from 0.00% to 0.85%. In 2003 and 2004, one surgeon had significantly higher incidence rates (0.31 and 0.40%) compared to the average combined rate of all surgeons throughout the study (0.10), with p values of 0.001 and 0.003, respectively. The mean number of days between CE and fragment removal was 26 ± 40 (1– 138).Conclusion: Increased patient age, shallow anterior chamber depth, and thick lens may be risk factors for retained lens fragments. There may be additional surgeon-specific risk factors. Phacoemulsification technique (Divide-and-Conquer versus Horizontal Chop) showed no significant difference.Keywords: retained lens fragments, phacoemulsification, cataract surgery, complications of cataract surgery, refractory corneal edema

Majid Moshirfar,1– 3 Robert J Thomson,4 William B West Jnr,5 Shannon E McCabe,1,6 Thomas M Sant,5 Margaret H Shmunes,7 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USA; 7Burrell College of Osteopathic Medicine, Las Cruses, NM, USACorrespondence: Majid MoshirfarMD Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To report the outcomes of sequential posterior chamber phakic intraocular lens (PC-pIOL) with corneal refractive surgery in conventional (PC-pIOL prior to refractive surgery) and reverse (refractive surgery prior to PC-pIOL) bioptics for treating high myopic astigmatism.Setting: Tertiary refractive center, Draper, Utah, USA.Design: Retrospective case series.Methods: Medical records of patients who underwent planned bioptics were reviewed. Surgery involved PC-pIOL placement using an implantable collamer lens (ICL) with preceding or subsequent LASIK or PRK. Pre- and postoperative manifest spherical equivalent (SEQ), visual acuity, and PC-pIOL vault were analyzed.Results: Of the 51 eyes present at 12 months postoperatively, 49 eyes (96%) achieved target SEQ within ± 1.00 D and an identical amount achieved refractive astigmatism ≤ 1.00 D. Post-bioptics eyes achieved a postoperative UDVA equal to or better than preoperative CDVA in 45 eyes (88%). Efficacy and safety indices were 1.08 ± 0.20 (41 eyes) and 1.13 ± 0.22 (44 eyes) for conventional bioptics and 0.99 ± 0.42 (7 eyes) and 1.15 ± 0.38 (7 eyes) for reverse bioptics eyes at 12 months. The maximum PC-pIOL vault of conventional bioptics eyes (27 eyes) within 6 months before and after LASIK/PRK was 385 ± 159 μm and 377 ± 135 μm, respectively (P = 0.71).Conclusion: Bioptics for high myopic astigmatism was safe and effective. Reverse bioptics, although not as traditional, could provide similar results. Additionally, the PC-pIOL vault does not appear to be affected by LASIK/PRK.Keywords: bioptics, LASIK, PRK, posterior chamber phakic IOL, high myopic astigmatism, visual outcomes

Majid Moshirfar,1– 3 Dallin C Milner,4 Preston A Baker,5 Shannon E McCabe,1 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Colorado School of Medicine, Aurora, CO, USA; 5McGovern Medical School, University of Texas Health Science Center, Houston, TX, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT 84020, USATel +1 801-568-0200Email Cornea2020@me.comAbstract: The incidence of herpes simplex keratitis (HSK) in patients following corneal refractive surgery is higher than in the general population, and several case reports of ocular morbidity in HSK infection following corneal refractive surgery have been published. HSK is listed by the American Academy of Ophthalmology as a relative contraindication to corneal refractive surgery, although specifics have not been further elucidated. This review summarizes the current literature regarding reactivation of HSK following corneal refractive surgery and provides a guideline for considering corneal refractive surgery in a patient with a previous history of HSK. Based on the current literature, we recommend that corneal refractive surgery is appropriate for patients with a history of HSK without multiple recurrences who have had no evidence of disease for at least one year. In addition to a thorough history and physical examination, we also recommend these patients begin 400 mg twice daily of oral acyclovir or valacyclovir 500 mg once daily for two weeks prior to surgery and continue this regimen for at least two weeks postoperatively or while on topical steroids.Keywords: herpetic keratitis, LASIK, PRK, PTK, herpes prophylaxis, SMILE, HSV, shingles, varicella zoster, cytomegalovirus, CMV

Majid Moshirfar,1– 3 Andrew C Thomson,4 William B West Jr,5 MacGregor N Hall,4 Shannon E McCabe,1 Robert J Thomson,4 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, 11820 S. State Street Suite #200, Draper, UT 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To assess a single site’s initial experience with SMILE for the treatment of myopic astigmatism and compare outcomes and vector analysis results with the US Food and Drug Administration (FDA) results and published literature.Patients and Methods: Forty-eight eyes (29 patients) with mean preoperative sphere of − 5.11 ± 1.31 diopters (D) and cylinder of − 1.12 ± 0.60 D underwent SMILE. Visual acuity, refractive, and vector analysis outcomes as well as subjective measures were reported at three and twelve months postoperatively and compared with FDA results and the published literature between 2014 and 2020 involving treatment of patients with mean cylinders of >− 0.50 to ≤− 3.00 D.Results: At three and twelve months, 43 and 32 eyes were evaluated, respectively. At twelve months, mean cylinder power was reduced to − 0.38 ± 0.38 D with 78.1% achieving ≤± 0.50 D. Uncorrected distance visual acuity (UDVA) ≥ 20/20 was achieved in 77.4% of eyes by twelve months with 100% achieving ≥ 20/30 UDVA. No loss of corrected distance visual acuity was observed in eyes seen at twelve months. Correction index (CI) at twelve months was 0.90 indicating overall undercorrection of 10%. Twelve-month CI was 0.96, 0.90, and 0.83 in eyes with preoperative cylinders of

Craig F McCabe, Shannon E McCabeMcCabe Vision Center, Murfreesboro, TN, USABackground: The aim of this study was to compare patient-perceived relief of ocular itch, nasal symptoms, and eye drop comfort when allergic conjunctivitis was treated with bepotastine besilate 1.5% versus olopatadine hydrochloride 0.2%.Methods: This randomized, observer-masked, single-center, crossover study included 30 patients with ocular itching associated with allergic conjunctivitis accompanied by nasal symptoms. Patients were treated with bepotastine besilate 1.5% twice daily (7 am and 4 pm) or olopatadine hydrochloride 0.2% once daily (7 am) for 14 days. Following a 7-day washout period during which only preservative-free artificial tears were used twice daily, patients were crossed over to the alternative treatment for 14 days. Parameters evaluated by twice-daily patient diaries included each treatment's ability to relieve ocular itch, ability to relieve itchy/runny nose, ability to relieve ocular allergy symptoms, and eye drop comfort. At the conclusion of the study, patients were also asked to identify which agent provided better all-day relief of ocular itching, better all-day relief of itchy/runny nose, superior comfort, and for which treatment they would prefer a prescription.Results: According to the mean daily diary responses, bepotastine besilate 1.5% provided significantly better relief of evening ocular itch, relief of morning and evening itchy/runny nose, and relief of morning and evening ocular allergy symptoms. At study end, 63.3% and 66.7% of patients preferred bepotastine besilate 1.5% for all-day relief of ocular itching and all-day relief of itchy/runny nose, respectively. At study end, there was no significant difference in the number of patients preferring one treatment over the other for comfort. Overall, 66.7% of patients stated that they would prefer to treat their allergic conjunctivitis with bepotastine besilate 1.5% over olopatadine hydrochloride 0.2%.Conclusion: Based on their evaluation of therapeutic performance, patients preferred bepotastine besilate 1.5% over olopatadine hydrochloride 0.2% by two-to-one for the treatment of allergic conjunctivitis.Keywords: allergic conjunctivitis, bepotastine besilate, olopatadine hydrochloride, patient preference

This study examines race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern research university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were generally more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. The findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

The authors investigated the medical use, illicit use, and diversion of 4 distinct classes of abusable prescription medication (sleeping medication, sedative or anxiety medication, stimulant medication, and pain medication) in a random sample of undergraduate students. In spring 2003, 9,161 undergraduate students attending a large, public, midwestern research university in the United States self-administered a Web-based survey. The prevalence rate for illicit use within the past year was highest for pain medication, followed by stimulant medication, sedative or anxiety medication, and sleeping medication. Women generally reported higher past-year medical use rates. However, undergraduate men reported higher illicit use rates. The illicit use-medical use ratio for stimulant medication was the highest among the 4 classes of prescription drugs. Medical users of stimulants for attention deficit hyperactivity disorder were the most likely to be approached to divert their medication. Multivariate results indicated that illicit users of prescription drugs were more likely to use other drugs than were students who did not use prescription drugs illicitly. The authors provide evidence that prescription drug abuse is a problem among college students. [ABSTRACT FROM AUTHOR]

To assess the prevalence and motives for illicit use of prescription stimulants and alcohol and other drugs (AODs), associated with these motives, the authors distributed a self-administered Web survey TO a random sample of 9,161 undergraduate college students. Of the study participants, 8.1% reported lifetime and 5.4% reported past-year illicit use of prescription stimulants. The most prevalent motives given for illicit use of prescription stimulants were to (1) help with concentration, (2) increase alertness, and (3) provide a high. Although men were more likely than women were to report illicit use of prescription stimulants, the authors found no gender differences in motives. Regardless of motive, illicit use of prescription stimulants was associated with elevated rates of AOD use, and number of motives endorsed and AOD use were positively related. Students appear to be using these prescription drugs non-medically, mainly to enhance performance or get high. [ABSTRACT FROM AUTHOR]

Web-based surveys are used as research tools in a wide range of disciplines. Web-based surveys present a unique set of challenges concerning survey design, not known in previous survey modes. The flexibility of screen design allows for Web-based surveys to take on many appearances, some having a negative impact on data quality. In this article, we propose and illustrate several Web-based survey design standards developed by researchers based on several projects involving Web-based surveys. These standards have been developed from theory and practice and should provide practical advice for researchers and a platform for future research in Web-based survey design. [ABSTRACT FROM AUTHOR]

AIMS: To examine the prevalence rates and correlates of non-medical use of prescription stimulants (Ritalin, Dexedrine or Adderall) among US college students in terms of student and college characteristics. DESIGN: A self-administered mail survey. SETTING: One hundred and nineteen nationally representative 4-year colleges in the United States. PARTICIPANTS: A representative sample of 10 904 randomly selected college students in 2001. MEASUREMENTS: Self-reports of non-medical use of prescription stimulants and other substance use behaviors. FINDINGS: The life-time prevalence of non-medical prescription stimulant use was 6.9%, past year prevalence was 4.1% and past month prevalence was 2.1%. Past year rates of non-medical use ranged from zero to 25% at individual colleges. Multivariate regression analyses indicated non-medical use was higher among college students who were male, white, members of fraternities and sororities and earned lower grade point averages. Rates were higher at colleges located in the north-eastern region of the US and colleges with more competitive admission standards. Non-medical prescription stimulant users were more likely to report use of alcohol, cigarettes, marijuana, ecstasy, cocaine and other risky behaviors. CONCLUSIONS: The findings of the present study provide evidence that non-medical use of prescription stimulants is more prevalent among particular subgroups of US college students and types of colleges. The non-medical use of prescription stimulants represents a high-risk behavior that should be monitored further and intervention efforts are needed to curb this form of drug use. [ABSTRACT FROM AUTHOR]

This study examined the feasibility of using a Web-based survey to collect alcohol and other drug use data from secondary school students in an urban school district in the Midwest. A Web-based survey was self-administered by a random sample of 6th through 11th grade students in the spring of 2002. The final sample consisted of 1,536 secondary school students (781 women and 755 men). The sample was 57% White, 40% African American, and 3% from other racial and ethnic groups. Several indicators of data quality were examined including response rate, absenteeism, refusals, substantive data, and data processing time. The study achieved a response rate of 89.1%. The results of the present study provide evidence that a Web-based survey can be successfully implemented in an economically and racially diverse urban sample of secondary students. While researchers conducting survey research within secondary schools should consider using Web-based survey approaches, additional research is needed to compare Web-based surveys to more traditional approaches to collecting data. [ABSTRACT FROM AUTHOR]

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

This randomized experiment examined survey mode effects for self-reporting illicit drug use by comparing prevalence estimates between a Web-based survey and a mail-based survey. A random sample of 7,000 traditional-aged undergraduate students attending a large public university in the United States was selected to participate in the spring of 2001. Students were randomly assigned to self-administer a survey via the Web or U.S. mail. The Web survey produced a significantly higher response rate than the U.S. mail survey. The prevalence estimates of illicit drug use (lifetime and past year) did not differ significantly between the two survey modes. The findings provide preliminary evidence that Web and U.S. mail surveys produce similar results regarding illicit drug use among undergraduate students. Although additional research is needed involving more diverse samples, these findings bode well for using Web surveys in college-based research. [ABSTRACT FROM AUTHOR]

Objectives: To assess how frequently and adequately information relating to the possibility of non-accidental injury (NAI) is documented and considered by doctors assessing pre-school children with burns and scalds in the accident and emergency (A&E) department, and to determine the effect of introducing a routine reminder mechanism into the A&E notes, coupled with an improved programme of NAI education and awareness.Methods: The records of 100 pre-school children attending an A&E department with a burn or scald were reviewed against nine pre-determined standards. Changes in policy were instituted, through a programme of education and the use of a reminder checklist, and the next 100 cases re-audited against the same checklist.Results: Groups one and two were similar in their demographic characteristics. The reminder checklist was included in 60% of group two notes, and when included was completed in 97%. The child protection register was rarely consulted. There was a statistically significant increase in recording the following: time that the injury had occurred, the consistency of the history, the compatibility of the injury with the history given, the consideration of the possibility of NAI, the general state and behaviour of the child and the presence or absence of any other injuries. The rate of referral for a further opinion regarding the possibility of NAI increased from 0 to 3%, but failed to reach statistical significance.Conclusions: Prevailing awareness and documentation regarding the possibility of NAI was found to be poor, but a programme of intervention combining education and the use of a reminder checklist improved both awareness and documentation of NAI, as well as referral rates for further assessment. This strategy may prove applicable to children of all ages and injury types, reducing the number of cases of child abuse that are overlooked in the A&E department. [ABSTRACT FROM AUTHOR]

Abstract In this commentary we highlight limitations with the way nonmedical use of prescription medications has been measured in U.S. national studies. We also offer an alternative way of conceptualizing the nonmedical use of prescription medications for future study.

Objective: The aim of this study was to describe the prevalence and correlates of nonmedical prescription drug misuse (PDM) in a state population of youths in residential care for antisocial behavior.Method: Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 Missouri youths. Participants were predominantly male (87.0%), averaged 15.5 (SD = 1.2) years of age, and constituted 97.7% of the service population sampled.Results: Overall, 314 youths (43.4%) reported lifetime PDM; 33.7%, 32.0%, and 11.2% had misused prescription opioids, tranquilizers, and barbiturates, respectively. Prescription drug misusers were significantly older, and larger proportions were girls, were White, and resided in small towns, compared with non-prescription drug misusers. Prescription drug misusers evidenced significantly more varied, frequent, and problematic psychoactive drug use; evidenced higher levels of distressing psychiatric symptoms; and were nearly twice as likely to have been diagnosed with a psychiatric disorder, compared with non-prescription drug misusers. Traumatic life events, experiences of criminal victimization, and suicidal ideation were significantly more prevalent in the histories of prescription drug misusers, compared with non-prescription drug misusers. In multiple logistic regression models, older age; White racial status; prior inhalant, marijuana, and LSD (lysergic acid diethylamide) use; residence in a small town; and impulsivity were associated with increased risk for PDM.Conclusions: Adolescents in residential care for antisocial behavior have high rates of PDM, as well as comorbid psychiatric and behavioral problems. Youths served in institutional settings should be routinely screened and treated for PDM and co-occurring disorders. [ABSTRACT FROM AUTHOR]

Background: Substance use and substance use disorders (SUD) are prevalent among college students. Information about the gap between substance use treatment need versus treatment receipt can guide efforts to increase service access. This study examined past-year DSM-5 SUD and receipt of treatment among US college students., Methods: Past-year DSM-5 SUD and treatment receipt were estimated among a sample of 6115 college students aged 16 and older and a comparison group of non-students from the 2021 National Survey on Drug Use and Health, weighted to be nationally representative. Among the college student sample, multiple logistic regression was used to identify factors associated with past-year SUD. Bivariate analyses were used to compare socio-demographic and substance use differences between college students who received treatment and those who had an SUD but did not receive treatment., Results: Weighted prevalence of past-year SUD among college students was 21.8 %. Only 4.6 % of students who had an SUD received treatment in any setting. Relative to non-students with SUD, proportionately fewer college students with SUD received treatment. Among college students, age, sex, past-year psychological distress, and past-year substance use were significantly associated with past-year SUD; and receipt of treatment differed significantly by age, insurance type, level of education, and enrollment status. College students who received treatment had greater prevalence of stimulant, opioid, tranquilizer, and poly-SUDs and more severe SUD symptomology than those who did not receive treatment., Conclusion: Additional efforts are needed to engage college students with SUDs in acceptable, evidence-based treatment services., Competing Interests: No conflict declared., (© 2024 Published by Elsevier B.V.)

Purpose: National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013-2019), and the associations with symptomatic alcohol and other drug use., Methods: Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity-attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex., Results: In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity-attraction discordance., Conclusion: These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objective: This study examined daily associations between alcohol use, cannabis use, and simultaneous alcohol and cannabis/marijuana (SAM) use with the likelihood of hooking up (uncommitted sexual encounter that may or may not include intercourse)., Method: We used a longitudinal measurement burst ecological momentary assessment (EMA) design with 3-week EMA bursts with daily measurements repeated quarterly across 12 months. 1,009 (57 % female, Mean age = 20.00 [SD = 3.21]) Texan adolescents and young adults ages 15-25 participated in the study. Mixed effects logistic regression models were estimated using maximum likelihood estimation to evaluate the associations between substance use and hooking up., Results: Within-person results indicated that participants were more likely to hook up on days with alcohol use and on days with cannabis use, but not on days with SAM use. Participants were also more likely to hook up on drinking days with higher-than-usual alcohol use. Between-person results indicated that participants who used alcohol more often or cannabis more often on average were more likely to hook up, and participants who tended to drink more on drinking days were more likely to hook up., Conclusions: Given the significant daily-level associations between alcohol and cannabis use and hooking up behavior, public health initiatives should focus on developing interventions to reduce alcohol and cannabis use and promote safer hooking up behavior among adolescents and young adults., 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. Published by Elsevier Ltd.)

Background: Many national studies fail to account for discordance between sexual orientation dimensions (e.g. a mismatch between sexual identity and sexual attraction) or sexual identity fluidity (e.g. changes in sexual identity over time). Objective: To examine the longitudinal relationships among sexual identity fluidity/stability, sexual orientation discordance/concordance, and alcohol and other drug use disorder symptoms. Methods: The study used nationally representative longitudinal data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) study of US adolescents and adults ( N = 24,591). Results: Substance use disorder symptoms were most prevalent (45.8%) among bisexual-stable females relative to all other sexual identity subgroups. The adjusted odds ratios (AORs) of substance use disorder symptoms were significantly higher among bisexual-stable females vs. heterosexual-stable females in all models (AOR range: 1.94-2.32), while no such associations were found for males. Sexual identity-attraction discordant females had significantly greater AORs (17/20 instances) of substance use disorder symptoms compared to concordant females; this finding was not as consistent for males (6/20 instances). Conclusion: Sexual orientation discordance was significantly associated with substance use disorder symptoms, especially among females discordant in their sexual identity and attraction. Bisexual-stable and discordant females are at highest risk of developing symptomatic substance use; it is vital that they receive screening, no matter where they are in their coming out process. This study highlights pitfalls of relying solely on cross-sectional data using a single sexual orientation dimension to understand the relationship between sexual orientation and substance use disorder.

We aimed to assess the probability of past-year DSM-5 alcohol use disorder (AUD) and past-year moderate-to-severe DSM-5 AUD as a function of past-year ethnic discrimination among U.S. Latino/Hispanic adults and as a function of past-year discrimination types among Latino/Hispanic sexual minorities (SM). We used data from the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions-III ( n  = 36,309 U.S. adults aged ≥18 years). Our sample consisted of 6,954 Latino/Hispanic adults. Multivariable logistic regression analyses estimated the association of past-year ethnic discrimination with past-year AUD and past-year moderate-to-severe AUD among the overall Latino/Hispanic population. We tested the association between discrimination types (i.e. none, ethnic or sexual orientation discrimination, both) with AUD and moderate-to-severe AUD among Latino/Hispanic SM adults. Among Latino/Hispanic adults, 13.4% met criteria for past-year AUD and 6.4% met criteria for past-year moderate-to-severe AUD. Ethnic discrimination was significantly associated with AUD (AOR = 1.09, 95% CI = 1.07-1.12) and moderate-to-severe AUD (AOR = 1.10, 95% CI = 1.06-1.13). Latino/Hispanic SMs who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for AUD (AOR = 3.44, 95% CI = 1.97-6.03) and moderate-to-severe AUD (AOR = 2.69, 95% CI = 1.25-5.82) compared to those who did not experience discrimination. Discrimination is a risk factor for AUD and moderate-to-severe AUD among Latino/Hispanic overall and SM populations.

Purpose: This national prospective multicohort study examined the relationship between US adolescents' use of stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) and subsequent risk of nonmedical stimulant use (i.e., nonmedical use of prescription stimulants and cocaine use) during young adulthood, relative to nonstimulant therapy and population controls., Methods: Nationally representative multicohort panels of 11,905 US 12th-grade students were surveyed via self-administered questionnaires at baseline (age 18) and followed prospectively over six years into young adulthood (ages 19‒24)., Results: There were no statistically significant differences between adolescents who used stimulant therapy for ADHD compared to those who used only nonstimulant medications and population controls in their adjusted odds of nonmedical stimulant use incidence or prevalence during young adulthood, after adjusting for baseline covariates., Discussion: The findings offer preliminary support that adolescents who use prescription stimulant or nonstimulant medications for ADHD when clinically indicated are not at greater risk for nonmedical stimulant use during young adulthood., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants)., Methods: National longitudinal multicohort panels (baseline cohort years 2005-2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19-24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM., Results: Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood., Conclusions: Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM., Competing Interests: Dr. Wilens reports consultant work for 3D Therapeutics; receiving book royalties from Cambridge University Press, Elsevier, and Guilford Press; having a licensing agreement with 3D Therapeutics and Ironshore; and serving as a clinical consultant to Bay Cove Human Services, Gavin House, Massachusetts General Hospital, Major and Minor League Baseball, and the National Football League. The other authors report no financial relationships with commercial interests.

Introduction: Research examining prospective links of e-cigarette use with cigarette, marijuana, and other substance use has been limited largely to 1-2-year follow-up periods and focused on younger adolescents. This study examined longitudinal associations of e-cigarette use with cigarette, marijuana, and other substance use initiation among U.S. adolescents and young adults (AYAs) across an eight-year period., Methods: Adolescent (ages 12-17) and young adult (ages 18-25) data from waves 1-6 of the nationally representative Population Assessment of Tobacco and Health study (2013-2021) were used. Discrete time survival models with time-varying weights were employed to examine the risk of cigarette, marijuana, and other drug use initiation over an eight-year follow-up period among AYAs with no lifetime use of e-cigarettes/other tobacco, lifetime but no past 30-day use of e-cigarettes/other tobacco, past 30-day e-cigarettes only, other tobacco use only, or past 30-day e-cigarette/other tobacco use. We compare our time-varying weighting approach to a traditional time-invariant/complete case weighting approach., Results: Across six follow-up waves, all three past 30-day nicotine/tobacco use groups, including e-cigarettes only, had greater risk for cigarette, marijuana, and other drug use initiation relative to those not using nicotine/tobacco. The three past 30-day nicotine/tobacco use groups did not differ from each other in risk for marijuana use initiation. Associations were smaller in magnitude for young adults compared to adolescents, but significant for both age groups., Conclusions: Substance use initiation risks persist beyond 1-2 years for U.S. AYAs using e-cigarettes. Prevention strategies to reduce AYA e-cigarette use are needed to reduce cancer-related risk., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: To compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) with that of postoperative topical prednisolone acetate (PA) with and without nonsteroidal anti-inflammatory drugs (NSAIDs) for cataract surgery prophylaxis., Design: Retrospective, comparative effectiveness cohort study., Participants: Patients at Kaiser Permanente Northern California from 2018 through 2021., Intervention: Exposure groups included topical PA with or without NSAID and subconjunctival injection of TA (Kenalog; Bristol-Myers-Squibb) 10 mg/ml or 40 mg/ml in a low dose (1.0-3.0 mg) or high dose (3.1-5.0 mg)., Main Outcome Measures: The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of postoperative macular edema (ME) and iritis diagnoses 15 to 120 days after surgery (effectiveness measures) and a glaucoma-related event (safety measure) between 15 days and 1 year after surgery., Results: Of 69 832 eligible patient-eyes, postoperative ME, iritis, and a glaucoma-related event occurred on average in 1.3%, 0.8%, and 3.4% of eyes in the topical groups and 0.8%, 0.5%, and 2.8% of eyes in the injection groups, respectively. In multivariable analysis, compared with the PA reference group, the PA plus NSAID group had a lower OR of ME (OR, 0.88; 95% CI, 0.74-1.04; P = 0.135). and all injection groups had even lower odds, with the high-dose TA 10-mg/ml group reaching statistical significance (OR, 0.64; 95% CI, 0.43-0.97; P = 0.033). A trend of lower odds of a postoperative iritis diagnosis was noted in the high-strength (40 mg/ml) groups. For postoperative glaucoma-related events, compared with PA, the TA 10-mg/ml low-dose group showed lower odds (OR, 0.69; 95% CI, 0.55-0.86; P = 0.001), the TA 10-mg/ml high-dose group showed similar odds (OR, 0.90; 95% CI, 0.70-1.15; P = 0.40), and the TA 40-mg/ml low-dose and high-dose groups showed higher odds of an event occurring (OR, 1.46 [95% CI, 0.98-2.18; P = 0.062] and OR, 2.14 [95% CI, 1.36-3.37; P = 0.001], respectively)., Conclusions: The TA 10-mg/ml high-dose (4 mg) group was associated with a lower risk of postoperative ME and a similar risk of glaucoma-related events compared with the topical groups., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

The inclusion of "something else" as a response option for survey questions about sexual identity has been shown to significantly moderate estimated differences between sexual identity subgroups in the distributions of various health outcomes in national health surveys, specifically for substance use/misuse and reproductive health. This moderation effect may be larger depending on the respondent's race, possibly due to the intersectionality of multiple minority identities and compounding minority stressors. To test this hypothesis, we conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (2015-2019) [n = 18,903 (8510 males, 10,393 females)] in the United States, where respondents were randomly assigned to receive either a four-category version of the sexual identity question that included "something else" as a response option along with lesbian/gay, bisexual, and heterosexual, or a three-category version that omitted "something else." We focused on model-based estimates of distributions of health outcomes across subgroups defined by both race and sexual identity and tested the race moderation hypothesis using three-way interactions involving sexual identity, question type received (four-category vs. three-category), and race (Black, White, and other). Based on this randomized experiment, we found evidence of significant differences between the four-category and three-category question versions of sexual identity, in terms of the associations between sexual identity and several health outcomes, along with moderation of these differences by the respondent's race. For some outcomes, such as wanting a child or another child, the magnitudes of the estimated sexual identity differences among racial minority individuals, specifically between bisexual and heterosexual women, were sensitive to the measurement of sexual identity. These results further suggest a need for improved sexual minority measurement, especially among racial minorities. These differences were also mostly found among women, suggesting further intersectionality of groups exposed to specific stressors., 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 Ltd. All rights reserved.)

Objective: The rising prevalence of daily cannabis use among older adolescents and young adults in the United States has significant public health implications. As a result, more individuals may be seeking or in need of treatment for adverse outcomes (e.g., cannabis use disorder) arising from excessive cannabis use. Our objective was to explore the potential of self-reported motives for cannabis use as a foundation for developing adaptive interventions tailored to reduce cannabis consumption over time or in certain circumstances. We aimed to understand how transitions in these motives, which can be collected with varying frequencies (yearly, monthly, daily), predict the frequency and adverse outcomes of cannabis use., Method: We conducted secondary analyses on data collected at different frequencies from four studies: the Medical Cannabis Certification Cohort Study ( n = 801, biannually), the Cannabis, Health, and Young Adults Project ( n = 359, annually), the Monitoring the Future Panel Study ( n = 7,851, biennially), and the Text Messaging Study ( n = 87, daily). These studies collected time-varying motives for cannabis use and distal measures of cannabis use from adolescents, young adults, and adults. We applied latent transition analysis with random intercepts to analyze the data., Results: We identified the types of transitions in latent motive classes that are predictive of adverse outcomes in the future, specifically transitions into or staying in classes characterized by multiple motives., Conclusions: The identification of such transitions has direct implications for the development of adaptive interventions designed to prevent adverse health outcomes related to cannabis use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: To examine the associations between early onset of nonmedical prescription stimulant use (NPSU) and cocaine use., Methods: Nationally representative samples of high school seniors were surveyed annually. Data were collected via self-administered questionnaires in nationally representative public and private schools in the United States (1976-2020) as part of the Monitoring the Future Study. The sample consisted of 45 cohorts of 12th grade students (N = 121 909). The main outcome was lifetime, past-year, and past-month cocaine use., Results: An estimated one in every 10 (10.1%) individuals reported lifetime NPSU while 8.5% reported any cocaine use. The vast majority of youth (87.2%) initiated NPSU before cocaine among those who reported both substances. Cocaine use was most prevalent among youth who reported early onset of NPSU in 8th grade or earlier (51.7%) followed by those who reported later onset of NPSU in 12th grade (24.7%), and those who never initiated NPSU (3.7%). Binary logistic regression analysis indicated that early onset of NPSU had greater adjusted odds of cocaine use compared to those with later onset of NPSU or those who never reported NPSU. Moreover, the adjusted odds of cocaine use were higher for adolescents who initiated NPSU before or after medical use of prescription stimulants compared to those with no history of medical use or NPSU. Similar results were found for lifetime, past-year, and past-month cocaine use as a function of NPSU onset; this association was stronger among more recent cohorts., Conclusions: Early onset of NPSU appears to be a signal of increased risk of cocaine use among US adolescents. NPSU should be included in screening and early prevention strategies among secondary school students. Health professionals, school officials, and families are encouraged to monitor youth for NPSU based on the increased risk of later cocaine use and related consequences., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drs McCabe, Schepis, Schulenberg, and Veliz report no financial relationships with commercial interests. Dr. Wilens is a consultant for 3D Therapeutics; published Straight Talk About Psychiatric Medications for Kids (Guilford Press) and co-edited ADHD in Adults and Children (Cambridge University Press), Massachusetts General Hospital Comprehensive Clinical Psychiatry (Elsevier), and Massachusetts General Hospital Psychopharmacology and Neurotherapeutics (Elsevier); is co-owner of a copyrighted diagnostic questionnaire (Before School Functioning Questionnaire, BSFQ) and has a licensing agreement with Ironshore; serves as a clinical consultant to the US Minor/Major League Baseball, Gavin House, and Bay Cove Human Services. The authors do not have any additional potential conflicts of interest to disclose.

Background: To assess whether age of onset and duration of stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) are associated with cocaine, methamphetamine, and prescription stimulant misuse during adolescence., Methods: Nationally representative samples of US 10th and 12th grade students (N = 150,395) from the Monitoring the Future study were surveyed via self-administered questionnaires from 16 annual surveys (2005-2020)., Results: An estimated 8.2% of youth received stimulant therapy for ADHD during their lifetime (n = 10,937). More than one in 10 of all youth reported past-year prescription stimulant misuse (10.4%)-past-year cocaine (4.4%) and methamphetamine (2.0%) use were less prevalent. Youth who initiated early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years) did not have significantly increased adjusted odds of cocaine or methamphetamine use relative to population controls (ie, non-ADHD and unmedicated ADHD youth). Youth who initiated late stimulant therapy for ADHD (≥10 years old) and for short duration (<1 year) had significantly higher odds of past-year cocaine or prescription stimulant misuse in adolescence than those initiating early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years). Youth who initiated late stimulant therapy for ADHD (≥10 years) for short duration (<1 year) had significantly higher odds of past-year cocaine, methamphetamine, and prescription stimulant misuse versus population controls during adolescence. No differences in past-year cocaine, methamphetamine, and prescription stimulant misuse were found between individuals who only used non-stimulant therapy for ADHD relative to youth who initiated early stimulant therapy (≤9 years old) and for long duration (≥6 years)., Conclusions: An inverse relationship was found between years of stimulant therapy and illicit and prescription stimulant misuse. Adolescents with later initiation and/or shorter duration of stimulant treatment for ADHD should be monitored for potential illicit and prescription stimulant misuse., (© 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

This randomized experiment tested whether the inclusion of a "something else" response option for a question about sexual identity in a national health survey would significantly moderate estimated differences between sexual identity subgroups in terms of various health outcomes, including substance use and reproductive health. We conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (NSFG; 2015-2019), where two large national half-samples were randomly assigned to receive one of two different versions of a question about sexual identity (a four-category version that included a "something else" response option or a three-category version omitting this option). We focused on national estimates of differences between subgroups defined by sexual identity. Multivariable models indicated that the estimated subgroup differences changed in a statistically significant fashion when using the four-category version of the sexual identity question for several measures, including 16% of male measures (household size, past-year cigarette use, and past-year illicit drug use) and 15% of female measures (wanting a/another child, ever had a sexually transmitted disease, and past-year marijuana use). The absence of a "something else" response option for questions about sexual identity in national health surveys may cause respondents to select options that do not accurately describe their identities, and this can have a significant effect on national estimates of differences between sexual identity subgroups in terms of selected health outcomes., (© 2023. The Author(s).)

Background and Purpose: Our study examined individual-, interpersonal-, community-, and policy-level associations with nicotine/tobacco use among gender-varying and gender-stable U.S. individuals., Methods: Data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (n = 33,197 U.S. adolescents and adults aged ≥14 years) and state-level gender minority policy data were used. Using multivariable logistic regression, the odds of past-30-day nicotine/tobacco use at W4 were estimated as a function of gender stability/variability, psychological distress, number of tobacco products used by family/friends, anti-tobacco marketing exposure, and change in gender minority-related policies from 2015 to 2017., Results: Gender-varying individuals had higher odds of nicotine/tobacco use compared with gender-stable individuals (AOR range = 1.7-2.3, p < .01). In the overall sample, positive change in gender minority policy protections (tallied from medium to high) was associated with lower odds of any nicotine/tobacco, other tobacco, and poly-tobacco use (AOR = 0.8, p < .05) compared to states with no change in their negative policies. Anti-tobacco marketing exposure was associated with lower odds of any tobacco, cigarette, e-cigarette, and poly-tobacco use compared with those who had no anti-tobacco marketing exposure (AOR = 0.9, p < .05). Higher psychological distress (AOR range = 1.7-2.4, p < .001) and an increasing number of tobacco products used by family/friends (AOR range = 1.1-1.3, p < .001) were associated with increased odds of nicotine/tobacco use., Conclusions: Multilevel prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-varying and gender-stable individuals., (© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Prescription benzodiazepines are among the most commonly used and misused controlled medications. The authors aimed to examine transitions from medical use of prescription benzodiazepines to prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms during adulthood., Methods: Eleven national cohorts of U.S. 12th graders (N=26,575) were followed up from ages 18 (1976-1986) to 50 (2008-2018). Prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms were examined with prevalence estimates and multivariable logistic regression., Results: By age 35, 70.9% of respondents had not used or misused prescription benzodiazepines, 11.3% reported medical use only, 9.8% indicated both medical use and misuse, and 14.1% reported misuse only. In analyses adjusted for demographic and other characteristics, adults reporting only medical use of prescription benzodiazepines by age 35 had higher odds of later prescription benzodiazepine misuse (adjusted OR [AOR]=2.17, 95% CI=1.72-2.75) and prescription opioid misuse (AOR=1.40, 95% CI=1.05-1.86) than respondents ages 35-50 who never used prescription benzodiazepines. More frequent medical use of prescription benzodiazepines by age 35 was associated with increased risk for substance use disorder symptoms at ages 40-50. Any history of prescription benzodiazepine misuse by age 35 was associated with higher odds of later prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms, compared with no misuse., Conclusions: Prescription benzodiazepine use or misuse may signal later prescription drug misuse or substance use disorders. Medical use of prescription benzodiazepines by age 35 requires monitoring for prescription drug misuse, and any prescription benzodiazepine misuse warrants an assessment for substance use disorder., Competing Interests: Dr. Wilens has been a consultant to 3D Therapeutics, Bay Cove Human Services, Gavin Foundation, and Major and Minor League Baseball; has a licensing agreement with Ironshore for the Before School Functioning Questionnaire; and receives book royalties from Cambridge University Press, Elsevier, and Guilford Press. The other authors report no financial relationships with commercial interests.

Introduction: Youth with incarcerated parents experience more adverse childhood experiences than other youth, placing them at higher risk for mental health and substance use disorders. Despite their increased risk, these youth may be less likely to access mental health services, particularly given their racial and ethnic makeup. Therefore, this study aimed to assess racial and ethnic disparities in access to mental health services for youth with incarcerated parents., Methods: This secondary data analysis used longitudinal data from 2016 to 2019 from the Adolescent Brain Cognitive Development Study. Logistic regression models assessed the relationships among incarceration, cumulative childhood experiences, DSM-5 diagnoses, and mental health services. Additional analyses stratified these models by race and ethnicity. All analyses were performed in 2022., Results: Youth with incarcerated parents were more likely to report 4 or more childhood experiences (51% vs 14%; AOR=3.92; 95% CI=3.3, 4.65; p<0.001) and to have received mental health services (25% vs 15%; AOR=1.89; 95% CI=1.6, 2.21; p<0.001) than unexposed youth. However, Black youth with incarcerated parents (19% vs 34%; AOR=0.38; 95% CI=0.27, 0.52; p<0.001) and Latinx youth with incarcerated parents (10% vs 17%; AOR=0.5; 95% CI=0.33, 0.76; p<0.001) were significantly less likely to report receiving mental health services than White youth with incarcerated parents and non-Latinx youth with incarcerated parents, respectively., Conclusions: Youth with incarcerated parents were more likely to report utilization of mental health services, but significant racial and ethnic disparities exist between Black and Latinx youth with incarcerated parents compared with that among White and non-Latinx youth with incarcerated parents. There is a continued need to expand mental health services to youth with incarcerated parents and to address racial and ethnic disparities in access to care., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Importance: The prescribing of stimulant medications for attention-deficit/hyperactivity disorder (ADHD) has increased in the US. Prescription stimulants are one of the most commonly misused controlled substances during adolescence. Despite a 10-fold increase in stimulant-related overdose deaths in the past decade, the transitions from prescription stimulants to illicit stimulants (eg, cocaine, methamphetamine) remain relatively unknown in longitudinal population-based studies., Objective: To determine the longitudinal transitions from adolescents' prescription stimulant exposure (ie, stimulant therapy for ADHD and prescription stimulant misuse [PSM]) to later cocaine and methamphetamine use during young adulthood., Design, Setting, and Participants: National longitudinal multicohort panels of US 12th grade public and private school students in the coterminous US were assessed annually (baseline cohort years 2005-2017 [between March and June]) and followed up across 3 waves over a 6-year period to 23 to 24 years of age (follow-up years 2011-2021 [between April and October])., Exposure: History of self-reported stimulant therapy for ADHD at baseline., Main Outcomes and Measures: Incidence and prevalence of past-year use of cocaine and methamphetamine during young adulthood (19-24 years of age)., Results: Among 5034 students enrolled at baseline (2589 [52.0%] female), 470 (10.2% [95% CI, 9.4%-11.2%]) reported use of stimulant therapy for ADHD, 671 (14.6% [95% CI, 13.5%-15.6%]) reported PSM only, and 3459 (75.2% [95% CI, 73.9%-76.4%]) reported neither (and served as population controls). In controlled analyses, there were no statistically significant differences between adolescents who reported stimulant therapy for ADHD at baseline compared with population controls in the adjusted odds of transitioning to later cocaine or methamphetamine initiation or use during young adulthood (19-24 years of age). In contrast, PSM during adolescence in those not treated with stimulants for ADHD had significantly higher odds of transitioning to later cocaine or methamphetamine initiation and use during young adulthood compared with population controls (adjusted odds ratio, 2.64 [95% CI, 1.54-4.55])., Conclusions and Relevance: In this multicohort study, adolescents' stimulant therapy for ADHD was not associated with increased risk of later cocaine and methamphetamine use during young adulthood. Adolescents' prescription stimulant misuse offered a signal for subsequent cocaine or methamphetamine use and warrants monitoring and screening.

Background: While alcohol use and prescription drug misuse (PDM) are common among adolescents, there is relatively little research on coingestion. This is disquieting as polysubstance use has become a major contributing factor in drug overdose deaths among young people in the United States., Methods: The current research uses multiple years of data from the National Survey on Drug Use and Health (2015-2019) to assess characteristics associated with coingestion among adolescents aged 12 to 17 years ( N = 57,352). Multinomial logistic regression analysis is used to identify characteristics associated with past 30-day PDM with and without alcohol coingestion. The primary objective is to determine how youth experiences with parents, involvement in conventional activities, religiosity, social support, and school status are associated with coingestion., Results: Among adolescents who report past 30-day PDM, 18.6% coingest with alcohol and 77.5% of adolescents who coingest report at least one substance use disorder. Several youth experiences were significantly associated with opioid coingestion including increased conflict with parents (relative risk ratio [RRR], 1.27; 95% confidence interval [CI], 1.07-1.48), lower levels of religiosity (RRR, 0.72; 95% CI, 0.52-0.98), less social support (RRR, 0.36; 95% CI, 0.18-0.69), and not being in school (RRR, 3.86; 95% CI, 1.33-11.17). In addition, emergency department visits, depression, and other substance use behaviors were also significantly associated with coingestion., Conclusions: Findings demonstrate a strong connection between coingestion and substance use disorder among US adolescents. The findings from the current study can inform prevention and intervention efforts by identifying youth experiences and health-related factors that are associated with coingestion., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 American Society of Addiction Medicine.)

Introduction: Tobacco use among gay, lesbian, and bisexual individuals is disproportionately higher than among heterosexual individuals. Identifying the mechanisms behind these differences can inform prevention and cessation efforts aimed at advancing health equity. Internalizing and externalizing symptoms as mediators of tobacco (re)uptake among sexual minority individuals was examined., Methods: Waves 4 and 5 of the Population Assessment of Tobacco and Health (2016-2019) study were analyzed in 2022. Adolescents aged ≥14 and adults years not using tobacco at Wave 4 (n=21,676) were included. Wave 4 sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or something else. Associations of sexual identity with (re)uptake of cigarette use, E-cigarette use, and polytobacco use at Wave 5 were assessed, along with possible mediation of these associations by Wave 4‒internalizing and ‒externalizing symptoms., Results: Internalizing and externalizing symptoms predicted tobacco (re)uptake regardless of sexual identity, particularly for female individuals. Gay/lesbian females (AOR=2.26; 95% CI=1.14, 4.48) and bisexual females (AOR=1.36; 95% CI=1.06, 1.74) had greater odds of E-cigarette (re)uptake than heterosexual females. High internalizing and externalizing symptoms accounted for over one third of the difference in E-cigarette (re)uptake among bisexual compared with that among heterosexual females. Males who reported sexual identity as something-else had lower odds of cigarette (re)uptake than heterosexual males (AOR=0.19; 95% CI=0.06, 0.66); this association was not mediated by internalizing and externalizing symptoms., Conclusions: Internalizing and externalizing symptoms uniquely contribute to E-cigarette (re)uptake among bisexual females. Strategies that reduce sexual minority stressors and resulting psychological distress may help to reduce tobacco use disparities., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Understanding differences in HIV testing among US adults is a crucial step for HIV prevention. This study used cross-sectional data to assess whether HIV testing varies across sexual orientation subgroups and by important psychosocial factors. Data were from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III; n = 36 309, response rate = 60.1%), a nationally representative survey of the US non-institutionalized adult population. Using logistic regression, we examined HIV testing among heterosexual concordant, heterosexual discordant, gay/lesbian, and bisexual adults. Psychosocial correlates included adverse childhood experiences (ACEs), discrimination, educational attainment, social support, and substance use disorders (SUDs). Bisexual (77.0%) and gay/lesbian (65.4%) women had a greater prevalence of HIV testing than concordant heterosexual women (51.6%), and bisexual women had a significantly higher testing prevalence than discordant heterosexual women (54.8%). Gay (84.0%) and bisexual (72.1%) men also had a significantly higher testing prevalence than discordant (48.2%) and concordant (49.4%) heterosexual men. In multivariable models, bisexual men and women (AOR = 1.8; 95% CI = 1.3-2.4) and gay men (AOR = 4.7; 95% CI = 3.2-7.1) had significantly greater odds of HIV testing than heterosexual concordant adults. A higher number of ACEs, greater social support, history of SUDs, and higher educational attainment were positively associated with HIV testing. HIV testing prevalence varied across sexual orientation subgroups; discordant heterosexual men had the lowest prevalence. Health care providers should consider a person's sexual orientation, ACEs, educational attainment, social support, and history of SUDs when evaluating HIV testing needs in the US., Competing Interests: 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., (© 2023 The Author(s).)

Objective: Individuals who are family history positive (FHP) for substance use problems have increased risk for substance use, substance use disorders (SUDs), and psychopathology. Links between FHP status and prescription drug misuse (PDM) have not been well investigated; this study examined PDM in adults 50 and older by FHP status., Methods: Data were from the US NESARC-III ( n  = 14,667). Participants reported their opioid PDM, tranquilizer/sedative PDM, SUD, psychopathology, and family history status (i.e. first- and second-degree relatives with alcohol/substance use problems). Prevalence rates were estimated by FHP status, and logistic regressions compared FHP and family history negative (FHN) groups., Results: FHP status was associated with significantly higher rates of PDM (e.g. past-year opioid PDM, FHP: 3.8%, FHN: 1.5%) and SUD from PDM (e.g. past-year SUD, FHP: 1.2%, FHN: 0.2%); also, prevalence varied by family history density, with the highest rates in those with three or more relatives with substance use problems (e.g. past-year opioid PDM: 5.5%). Overall, 32.2% of FHP individuals with past-year PDM had past-year co-occurring SUD and psychopathology diagnoses, versus 11.0% of FHN individuals., Conclusion: FHP status could inform treatment decisions in adults 50 and older with conditions for which prescription opioids or tranquilizer/sedatives are indicated.

Importance: Recent information on the prevalence of prescription stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) and nonmedical use of prescription stimulants (NUPS) at the school-level among US secondary school students is limited., Objective: To investigate the school-level prevalence of and association between stimulant therapy for ADHD and NUPS among US secondary school students., Design, Setting, and Participants: This cross-sectional study used survey data collected between 2005 and 2020 as part of the Monitoring the Future study (data collected annually via self-administered survey in schools from independent cohorts). Participants were from a nationally representative sample of 3284 US secondary schools. The mean (SD) response rates were 89.5% (1.3%) for 8th-grade students, 87.4% (1.1%) for 10th-grade students, and 81.5% (1.8%) for 12th-grade students. Statistical analysis was performed from July to September 2022., Main Outcome and Measure: Past-year NUPS., Results: The 3284 schools contained 231 141 US 8th-, 10th-, and 12th-grade students (111 864 [50.8%, weighted] female; 27 234 [11.8%, weighted] Black, 37 400 [16.2%, weighted] Hispanic, 122 661 [53.1%, weighted] White, 43 846 [19.0%, weighted] other race and ethnicity). Across US secondary schools, the past-year prevalence of NUPS ranged from 0% to more than 25%. The adjusted odds of an individual engaging in past-year NUPS were higher at secondary schools with higher proportions of students who reported stimulant therapy for ADHD, after controlling for other individual-level and school-level covariates. Students attending schools with the highest rates of prescription stimulant therapy for ADHD had approximately 36% increased odds of past-year NUPS compared with students attending schools with no medical use of prescription stimulants (adjusted odds ratio, 1.36; 95% CI, 1.20-1.55). Other significant school-level risk factors included schools in more recent cohorts (2015-2020), schools with higher proportions of parents with higher levels of education, schools located in non-Northeastern regions, schools located in suburban areas, schools with higher proportion of White students, and schools with medium levels of binge drinking., Conclusions and Relevance: In this cross-sectional study of US secondary schools, the prevalence of past-year NUPS varied widely, highlighting the need for schools to assess their own students rather than relying solely on regional, state, or national results. The study offered new evidence of an association between a greater proportion of the student body that uses stimulant therapy and a greater risk for NUPS in schools. The association between greater school-level stimulant therapy for ADHD and other school-level risk factors suggests valuable targets for monitoring, risk-reduction strategies, and preventive efforts to reduce NUPS.