Assessing the Association Between E-Cigarette Use and Exposure to Social Media in College Students: A Cross-Sectional Study

Background: Social media platforms provide an indirect medium for encouraging e-cigarette use between individuals and also serve as a direct marketing tool from e-cigarette brands to potential users. E-cigarette users share information via social media that often contains product details or health-related claims. Objective: Determine whether e-cigarette use is associated with exposure to e-cigarettes on social media in college students. Methods: Data from a sample of 258 college students was obtained via a clicker-response questionnaire (90% response rate). Demographic, lifetime and current e-cigarette/cigarette use, and e-cigarette exposure via social media (peer posts or advertisements) were examined. Logistic regression was used to assess the relationship between lifetime and current e-cigarette use and viewing peer posts or advertisements on social media while adjusting for cigarette use and self-posting about e-cigarettes. Results: Overall, 46% of participants reported lifetime e-cigarette use, 16% current e-cigarette use, and 7% were current dual users of e-cigarettes and cigarettes. There were positive and significant associations between lifetime e-cigarette use and viewing peer posts (aOR = 3.11; 95% CI = 1.25–7.76) as well as advertisements (aOR = 3.01; 95% CI = 1.19–7.65) on e-cigarettes via social media after adjusting for cigarette use. Current e-cigarette use was only significantly associated with viewing peer posts via social media (aOR = 7.58; 95% CI = 1.66–34.6) after adjusting for cigarette use. Conclusions/Importance: Almost half of college students view peer posts and advertisements on e-cigarettes via social media. This exposure is associated with individual e-cigarette use. Continued efforts to examine online e-cigarette content are needed to help future interventions decrease e-cigarette use.     

Time Trends and Policy Gaps: The Case of Alcohol Misuse Among Adolescents in Lebanon

Background: Monitoring studies are crucial for informing and reforming local policies. Objectives: Using the Lebanon 2005 and 2011 Global School-based Student Health Surveys (GSHS), alcohol time trends were described, policy gaps were identified, and harm reduction policy recommendations were made. Methods: In 2005 and 2011, 100 (n = 5109 students) and 44 (n = 2784 students) middle schools were surveyed, respectively. Self-reported cross-sectional data on alcohol use among 7–9th graders in private and public schools was collected including 30-day prevalence, lifetime drunkenness, alcohol-related problems, and sources of alcohol. Results: In 2011, the majority (87%) had alcohol before turning 14. Between 2005 and 2011, past 30-day alcohol use had increased by 40% and lifetime drunkenness by 50% in the total sample (122% among females with a narrowing in the gender gap). Drinking was regular for more than a third of the past 30-day drinkers (drank two or more drinks on the days they drank). Male adolescents were more likely to obtain alcohol from “stores” or “through their friends” whereas females’ main source was their “family.” One in twenty reported experiencing alcohol-related problems (e.g., getting into fights with family/friends and skipping school). Conclusion/Importance: Evidence-informed policy implications include enforcing a minimum legal drinking age, regulating alcohol advertising, and marketing particularly those targeting youth and women, and ensuring the availability of youth-friendly services. Public messages to increase awareness among all stakeholders including youth, their parents, and larger community are also needed.     

Correlates of Blunt Smoking Among African American,Hispanic/Latino,and White Adults: Results From the 2014 National Survey on Drug Use and Health

Background: Blunt use is highly prevalent in the United States and has been associated with several negative health consequences, such as an increased risk for cardiovascular and pulmonary diseases. Although recent studies have identified characteristics (e.g., gender) that are associated with blunt use, it is unclear if these factors correlate with blunt use equally across racial/ethnic groups. Methods: Using cross-sectional data from the 2014 National Survey on Drug Use and Health, this study aimed to determine if demographic, health and substance use correlates of current (i.e., past 30-day) and lifetime blunt use were similar across 37,628 non-Hispanic African American, Hispanic/Latino and non-Hispanic White adults. Results: Findings revealed 8.3% of African American, 3.3% of Hispanic/Latino and 2.5% of White adults reported current blunt smoking. Across all racial/ethnic groups, age and current and lifetime cigarette and illicit drug use were associated with current and lifetime blunt use. However, gender, educational level, income, current alcohol use and self-reported health status were differentially associated with current and lifetime blunt use across racial/ethnic groups. Employment status and lifetime depression were not associated with blunt use behaviors among any of the racial/ethnic groups. Conclusions: The relationship between gender, socioeconomic status, alcohol use and self-reported health status and blunt use differs among African American, Hispanic/Latino and White adults. Researchers and providers should consider the heterogeneity in factors that are associated with blunt use when designing prevention and treatment interventions for African American, Hispanic/Latino and White adult blunt smokers.     

Factors Associated With Marijuana use and Problems Among College Students in Colorado

Background: Past studies have shown that heavy marijuana use can impact student outcomes. Frequent use and misuse of marijuana have been associated with a range of psychological and personality factors in young adults, but there has been limited research focused on the college environment in states where marijuana has been legalized for recreational purposes.

Objectives: We examined whether marijuana use and problems were associated with a range of demographic, personality, and psychological variables among college students at a midsized Colorado university. Methods: This cross-sectional study included 300 university students who submitted a urine screen and completed measures on marijuana use, problem marijuana use, anxiety, depression, impulsivity, and openness to experience. Results: Last year and recent marijuana use were high (65%, 29%; respectively), as assessed through self-report and a urine screen. Using logistic regression, male sex and greater openness to experience were associated with greater marijuana use when assessed with a urine screen, while greater openness to experience and impulsivity were associated with greater self-reported marijuana use within the last year. In the final step of a hierarchical linear regression model, male sex and greater impulsivity and depression–but not openness to experience, general anxiety or social anxiety–were associated with greater problem marijuana use. Conclusions: This study extends the literature on psychological and personality correlates of marijuana use among college students. It may be useful to assess these correlates to identify students who are at risk of developing problems and in intervening with students with problem use.     

Does harm minimisation lead to greater experimentation? Results from a school smoking intervention trial

Introduction and Aims . Declines in adolescent smoking prevalence have slowed recently, resulting in increased interest and literature in tobacco harm minimisation. To date, harm reduction strategies have focused largely on modifying the product and alternative (safer) mechanisms of nicotine delivery. There has been little exploration of primary harm minimisation to prevent the onset of regular smoking among young people. A major concern expressed about harm reduction interventions and young people is that they may increase experimentation among non‐users. Design and Methods . The Smoking Cessation for Youth Project was a 2‐year school‐based cluster randomised controlled trial conducted in 30 Western Australian schools. Results on the primary outcome showed a significant reduction in regular smoking among 4636 13–15‐year‐olds receiving a harm minimisaton versus standard intervention. This paper addresses the intervention effects on 2078 students who had not smoked at baseline. Results . At 20‐month follow‐up, smoking initiation was slightly lower among intervention students than comparison students (who received a largely abstinence‐based intervention), although this difference did not attain statistical significance (OR = 0.86; 95% confidence interval: 0.68, 1.09). Discussion and Conclusions . This study provided limited evidence to suggest that harm minimisation is a superior approach to abstinence‐based interventions for non‐smokers. However, this intervention did not contribute to increased experimentation among non‐smokers. Although more trials are required, these results indicate that fears of potential negative iatrogenic effects from school‐based harm minimisation interventions may be unwarranted.     

Post-traumatic stress and marijuana outcomes: The mediating role of marijuana protective behavioral strategies

Abstract

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (M_age = 20.26, SD?=?3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30?days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana.     

Substance Misuse Subtypes Among Women Convicted of Homicide

ABSTRACT

Background: The proportion of women incarcerated is growing at a faster pace than that for men. The reasons for this important increase have been mainly attributed to drug-using lifestyle and drug-related offenses. About half of female inmates have history of substance misuse and one third demonstrate high impulsiveness levels. The objectives of this study were to (a) identify subtypes of alcohol and drug problems and impulsiveness among women convicted of homicide, and (b) examine the association between psychosocial and criminological features and the resulting clusters. Methods: Data come from 158 female inmates serving a sentence for homicide in the Penitentiary of Sant’Ana in São Paulo State, Brazil. Latent class analysis was used to group participants into substance misuse and impulsiveness classes. Results: Two classes were identified: nonproblematic (cluster 1: 54.53%, n = 86) and problematic (cluster 2: 45.57%, n = 72) ones. After controlling for several psychosocial and criminological variables, cluster 2 inmates showed an earlier beginning of criminal activities and a lower educational level than their counterparts. Conclusions: To recognize the necessities of specific groups of female offenders is crucial for the development of an adequate system of health politics and for the decrease of criminal recidivism among those offenders who have shown higher risk.     

Changes Over One Semester in Drinking Game Playing and Alcohol Use and Problems in a College Student Sample

One-hundred ninety-five alcohol-using college students completed a questionnaire in early September, at the beginning of the fall semester, then completed a follow-up questionnaire in mid-November, near the end of the semester. The questionnaires included items on levels of alcohol use, the Eysenck I.7 measure of impulsiveness and venturesomeness, alcohol expectancies, perceived norms for alcohol use, reasons for drinking, and aspects of drinking game playing. As predicted, those students who were 18 years of age and younger, nearly all of them 1st-year students, significantly increased their levels of alcohol use during their first semester in college. While increases in reasons for drinking were significantly predictive of increased alcohol use and problems in first-year and older students, increases in expectancies of alcohol effects and in frequencies of drinking game playing were significantly predictive of increases in alcohol use and problems only for first-year students. The present results provide further evidence of the importance of drinking games in the socialization of college students into problematic alcohol use.     

Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver,Canada

Background: Studies have found that gay, bisexual, and other men who have sex with men (GBM) have higher rates of mental health conditions and substance use than heterosexual men, but are limited by issues of representativeness. Objectives: To determine the prevalence and correlates of mental health disorders among GBM in Metro Vancouver, Canada. Methods: From 2012 to 2014, the Momentum Health Study recruited GBM (≥16 years) via respondent-driven sampling (RDS) to estimate population parameters. Computer-assisted self-interviews (CASI) collected demographic, psychosocial, and behavioral information, while nurse-administered structured interviews asked about mental health diagnoses and treatment. Multivariate logistic regression using manual backward selection was used to identify covariates for any lifetime doctor diagnosed: (1) alcohol/substance use disorder and (2) any other mental health disorder. Results: Of 719 participants, 17.4% reported a substance use disorder and 35.2% reported any other mental health disorder; 24.0% of all GBM were currently receiving treatment. A lifetime substance use disorder diagnosis was negatively associated with being a student (AOR = 0.52, 95% CI [confidence interval]: 0.27–0.99) and an annual income ≥$30,000 CAD (AOR = 0.38, 95% CI: 0.21–0.67) and positively associated with HIV-positive serostatus (AOR = 2.54, 95% CI: 1.63–3.96), recent crystal methamphetamine use (AOR = 2.73, 95% CI: 1.69–4.40) and recent heroin use (AOR = 5.59, 95% CI: 2.39–13.12). Any other lifetime mental health disorder diagnosis was negatively associated with self-identifying as Latin American (AOR = 0.25, 95% CI: 0.08–0.81), being a refugee or visa holder (AOR = 0.18, 95% CI: 0.05–0.65), and living outside Vancouver (AOR = 0.52, 95% CI: 0.33–0.82), and positively associated with abnormal anxiety symptomology scores (AOR = 3.05, 95% CI: 2.06–4.51). Conclusions: Mental health conditions and substance use, which have important implications for clinical and public health practice, were highly prevalent and co-occurring.     

Understanding the Association Between Relative Sociability Prototypes and University Students' Drinking Intention

Background: Evaluations of “the prototypical nondrinker” and of “the prototypical regular drinker” have been demonstrated to hold associations with more harmful drinking behavior, yet the extent to which the relative evaluation of these prototypes is associated with drinking intention remains to be tested. Objectives: To explore whether relatively unfavorable nondrinker prototypes are associated with increased drinking intention and whether this relationship is moderated by personality variables. Methods: Among a student sample (n = 543), alcohol-related sociability prototype measures were used to compute an index of the perceived sociability of regular drinkers relative to nondrinkers (“relative sociability prototypes”). Measures of drinking intention, conscientiousness, extraversion and sensation seeking impulsivity were also taken. Results: Most students perceived the prototypical nondrinker unfavorably relative to the prototypical regular drinker (91%, n = 493). Simple slopes analyses indicated that extraversion moderated the strength of the relationship between relative sociability prototypes and drinking intention such that relatively negative evaluations of nondrinkers were only associated with increased intention to get drunk among more extraverted students. Conclusions/Importance: Prospective data and behavioral measures are needed to substantiate these findings, which suggest links between relative evaluations of nondrinkers, harmful drinking intention and personality traits. Evidence suggests that by challenging prejudicial beliefs concerning nondrinkers (as “unsociable”) and by targeting more extraverted students, safer drinking plans might be encouraged.     

Dual Diagnosis: Variations Across Differing Comorbid Diagnoses

ABSTRACT

Objectives: Increasing numbers of research investigations have documented the coexistence of substance use and other psychiatric disorders in a variety of patient populations. The next step in understanding such comorbidity is the exploration of whether the type of psychiatric disorder coexisting with a substance use disorder makes a difference in terms of the sequellae of the disorders for the patient.

Methods: This study explored a variety of psychosocial/demographic and clinical variables for patients with a substance abuse disorder, differentiating five groups based on the type of coexisting psychiatric disorder: schizophrenia, depression, bipolar disorder, adjustment disorder, and personality disorder. Rates and sequellae of comorbidity for the five groups of patients were explored based on a pool of patients hospitalized at the Alaska Psychiatric Institute (API) between 1993 and 2001. The records of 181 patients with coexisting schizophrenia, 251 with depression, 120 with bipolar disorder, 197 with adjustment disorder, and 145 with personality disorder were utilized to explore psychosocial/demo-graphic and clinical differences and commonalities across groups.

Results: Findings revealed significant differences between the five groups on almost all psychosocial/demographic and clinical variables. For example, patients with coexisting schizophrenia evidence more severe pathology and greater use of hospital resources; patients with coexisting personality disorder were more likely to be involved with the legal system; patients with bipolar disorder were most likely to evidence drug involvement at admission; and patients with adjustment disorders evidenced the fewest psychosocial challenges and a less severe course of treatment.

Conclusion: Results confirmed the need to differentiate comorbid patients based on the type of coexisting other psychiatric disorder. Discussion of the implications of these findings for treatment service planning on an individual-patient and systemic-administrative level is presented.     

Is marijuana identity associated with marijuana use and consequences? An examination of direct and interactive associations

Background: There is relatively little research examining the relationship between identity and marijuana-related outcomes (e.g., marijuana use and consequences). Identity may both directly help shape marijuana use behaviors and moderate the influence of other risk factors on marijuana outcomes. Objectives: The current study examines the relationship between marijuana identity and marijuana-related outcomes among emerging adults and explores whether identity moderates the relationships between nonidentity correlates (e.g., perceived norms and negative affect) of marijuana-related outcomes. Methods: College students who reported marijuana use in the past 12?months completed measures of marijuana identity, perceived norms, negative affect, frequency of marijuana use, and marijuana consequences. Conclusions/Importance: The results indicated that marijuana identity is associated with marijuana use frequency and moderates the relationship between perceived norms and marijuana consequences. The findings have implications for both identity-based and social norms-based interventions targeting problematic marijuana use among emerging adults.     

Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People With Alcohol Dependence

Background: Abstinence-based alcohol interventions are minimally desirable to and effective for chronically homeless individuals with alcohol dependence who have multimorbidity and high publicly funded service utilization and associated costs. Lower-barrier, patient-centered combined pharmacobehavioral interventions may more effectively treat this population. Harm reduction counseling involves a nonjudgmental, empathic style and patient-driven goal setting that requires neither abstinence nor use reduction. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving, is safe and effective for active drinkers, and may thereby support harm reduction goal setting. The aims of this 12-week, single-arm pilot were to initially document some aspects of feasibility, acceptability, and alcohol outcomes following XR-NTX administration and harm reduction counseling for chronically homeless individuals with alcohol dependence. Methods: Participants were currently/formerly chronically homeless, alcohol-dependent individuals (N = 31) from 2 community-based agencies in the US Pacific Northwest. Measures included self-reported alcohol craving, quantity/frequency, problems, and biomarkers (ethyl glucuronide [EtG], liver transaminases). XR-NTX and harm reduction counseling were administered monthly over the 3-month treatment course. Results: Of the 45 individuals approached, 43 were interested in participation. The first injection was received by 31 participants, and 24 complied with all study procedures. Participants reported the treatment was acceptable. Participants evinced decreases in alcohol craving (33%), typical (25%) and peak (34%) use, frequency (17%), problems (60%), and EtG from the baseline to the 12-week follow-up (Ps < .05). Conclusions: XR-NTX and harm reduction counseling are promising means of supporting reductions in alcohol use and alcohol-related harm among chronically homeless, alcohol-dependent individuals.     

Drinking to Cope With Depressive Symptoms and Ruminative Thinking: A Multiple Mediation Model Among College Students

Background: Understanding the potential psychosocial mechanisms that explain (i.e., mediate) the associations between depressive symptoms and alcohol-related problems can improve interventions targeting college students. Objectives: The current research examined four distinct facets of rumination (e.g., problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) and drinking to cope motives as potential explanatory mechanisms by which depressive symptoms are associated with increased alcohol-related problems. Method: Participants were undergraduate students from a large, southeastern university in the United States that consumed at least one drink per typical week in the previous month (n = 403). The majority of participants were female (n = 291; 72.2%), identified as being either White, non-Hispanic (n = 210; 52.1%), or African American (n = 110; 27.3%), and reported a mean age of 21.92 (SD = 5.75) years. Results: Structural equation modeling was conducted examining the concurrent associations between depressive symptoms, rumination facets, drinking to cope motives, and alcohol-related problems (i.e., cross-sectional). There was one significant double-mediated association that suggested that increased depressive symptoms is associated with increased problem-focused thoughts, which is associated with higher drinking to cope motives and alcohol-related problems. Conclusions/Importance: Our results suggests that problem-focused thoughts at least partially explains the associations between depression and maladaptive coping (i.e., drinking to cope), which in turn is related to problematic drinking among college students. Limitations and future directions are discussed.     

Premeditation and Sensation Seeking Moderate the Reasoned Action and Social Reaction Pathways in the Prototype/Willingness Model of Alcohol Use

Background: Drinking can occur because of expectations to drink (reasoned pathway) or because of willingness to drink under certain circumstances (reactive pathway). These pathways are thought to be influenced by different cognitions such as alcohol-related attitudes, norms, or drinking prototypes (Gerrard et al., 2008). Impulsive traits reflect individual differences in the influence of reasoned or reactive factors, however little research has investigated whether impulsivity moderates the effects of cognitive factors predicting alcohol use. Objectives: We tested whether differences in three impulsivity traits (premeditation, sensation seeking and negative urgency) moderated associations of reasoned (risk/disapproval attitudes and social norms) and reactive (prototype) pathway variables on expectation/willingness to drink and recent alcohol use. Methods: We collected data from n = 409 college students; the sample was 67% female, 43% Asian American, with Mdn_age = 19. Hypotheses were tested using multiple regression. Results: Premeditation and sensation seeking moderated reasoned variable effects on expectation and drinking. Among those low on premeditation, risk attitudes were most associated with drinking expectation, with alcohol prototypes most related to recent drinking. These effects declined at higher premeditation levels. Among those high on sensation seeking, risk attitudes were most associated with expectation and drinking, declining at lower sensation seeking levels. There was little evidence of moderation predicting drinking willingness. Conclusions/Importance: Findings imply personality differences may explain association strength between reasoned but not reactive risk behavior pathways with alcohol outcomes. They have ramifications for personalized prevention programs to reduce drinking through cognition change, as alcohol-related cognition influence may differ depending on personality characteristics.