Nurturant-involved parenting and adolescent substance use: Examining an internalizing pathway through adolescent social anxiety symptoms and substance refusal efficacy

Research has clearly established the important role of parents in preventing substance use among early adolescents. Much of this work has focused on deviance (e.g., antisocial behavior, delinquency, and oppositional behavior) as a central pathway linking parenting behaviors and early adolescent substance use. This study proposed an alternative pathway; using a four-wave longitudinal design, we examined whether nurturant-involved parenting (Fall sixth grade) was inversely associated with adolescent drunkenness, marijuana use, and cigarette use (eighth grade) through social anxiety symptoms (Spring sixth grade) and subsequent decreases in substance refusal efficacy (seventh grade). Nurturant-involved parenting is characterized by warmth, supportiveness, low hostility, and low rejection. Analyses were conducted with a sample of 687 two-parent families. Results indicated that adolescents who were in families where fathers exhibited lower levels of nurturant-involved parenting experienced subsequent increases in social anxiety symptoms and decreased efficacy to refuse substances, which in turn was related to more frequent drunkenness, cigarette use, and marijuana use. Indirect effects are discussed. Findings were not substantiated for mothers' parenting. Adolescent gender did not moderate associations. The results highlight an additional pathway through which parenting influences youth substance use and links social anxiety symptoms to reduced substance refusal efficacy.

Perspectives on substance use among youth with chronic medical conditions and implications for clinical guidance and prevention: A qualitative study

Increasing numbers of youth globally live with a chronic illness. These youth use alcohol and marijuana at levels equal to or greater than their healthy peers and, when using, are at elevated risk for regular or problem use and adverse consequences to their condition. Little is known about whether behavioral theories commonly invoked to explain adolescent substance use apply to this group, limiting our ability to develop, tailor and target preventive interventions. We interviewed youth ages 16-19 years in care for a chronic disease to gain knowledge of this group's perspectives on substance use risk, decision-making, and preferences for clinical guidance. Interviews were transcribed and thematically analyzed. Three principal themes emerged: first, having a chronic disease frames understanding of and commitment to health protecting behaviors and impacts decisions to avoid behaviors that carry risks for disease complications and flares; second, developmental impulses typical of adolescence can amplify an adolescent's propensity to take risks despite medical vulnerability and direct youth toward maladaptive choices to mitigate risk; and third, poor knowledge about effects of substance use on specific features of a disease shapes perceived risk and undermines health protecting decisions. Youth navigate these issues variously including by avoiding substance use at a specific time or entirely, using while cognitively discounting risks and/or adjusting treatment outside of medical advice. Their perceptions about substance use are complex and reveal tension among choices reflecting a chronic illness frame, developmental impulses, and knowledge gaps. Delivery of targeted guidance in healthcare settings may help youth navigate this complexity and connect patient-centered goals to optimize health with health protecting behavioral decisions.

Cannabis use motives on weekends versus weekdays: Direct and indirect relations with cannabis use and related problems

College cannabis users report using more cannabis during the weekend than on weekdays, yet little attention has been paid to the role of weekend and weekday-specific motives for use. The present investigation evaluated the impact of weekend and weekday-specific cannabis motives on cannabis use and related problems among current (past-3 month) cannabis using undergraduates (N = 276). Participants reported more cannabis use motives during the weekend than weekday. Enhancement and social motives were greater than coping, conformity, and expansion motives during weekends. Enhancement and conformity motives were indirectly related to problems via cannabis use frequency for both weekdays and weekends. Yet social, coping, and expansion motives were indirectly related to problems via cannabis use frequency for only weekdays. Findings support the differential impact of weekend and weekday-specific motives on cannabis use and related problems.

Differential Role of Cannabis Use Motives in Predicting Impairment Across Three Measures

OBJECTIVE

Previous research has demonstrated the utility of motivational models of cannabis use to predict the frequency of use and associated negative consequences. However, few existing studies have simultaneously investigated a range of motives across different measures of use-related problems, which limit the ability to assess the differential role various motives play. The purpose of the current study was to examine cannabis use motives as predictors of three measures of cannabis use risk.

METHOD

Participants (N = 229) who reported cannabis use within the past 30 days completed the Marijuana Motives Measures, as well as measures of typical smoking behavior and risk: Cannabis Use Disorders Identification Test-R (CUDIT-R; screening measure of hazardous cannabis use), Marijuana Problem Index (MPI; measure of broad psychosocial problems), and cannabis use disorder according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

RESULTS

Cannabis use motives-particularly coping, enhancement, and conformity-contributed to the prediction of cannabis-related impairment beyond gender and the frequency of recent use. Among the motives scales, coping emerged as the most robust predictor across the three impairment measures and was the only motive to add unique variance to predictions of DSM-5 symptoms. Enhancement and conformity motives were predictive of the screening measure (CUDIT-R scores), and enhancement motives was also predictive of a measure of broad psychosocial problems related to cannabis use (MPI scores).

CONCLUSIONS

The results highlight the differential role various marijuana use motives play across related but distinct measures of impairment.

Impulsivity facets and substance use initiation: A comparison of two models of impulsivity

Several types of impulsivity have been linked to various substance use outcomes. The UPPS-P framework has received major focus within the field of substance use research. However, this framework is not without limitation. An alternative framework is the Two-Factor Model of impulsivity, which posits that rash impulsivity and reward drive are the central, if not sufficient, domains of impulsivity. Unfortunately, the extant literature is quite limited in terms of work that have directly compared the UPPS-P framework to the Two-Factor Model of impulsivity, particularly in prospective designs focused on the initiation of common, problematic forms of substance use among adolescents (i.e., alcohol and marijuana use). In the current study, the UPPS-P measures were compared to dedicated measures of the Two-Factor Model of impulsivity in a sample of Chilean adolescents who were lifetime abstainers of alcohol or marijuana use at baseline (N = 541) to predict the initiation of use for these substances at a one-year follow-up. Results showed that the Two-Factor Model had superior predictive utility compared to the UPPS-P measures, and only rash impulsivity and reward drive were significant predictors in a multivariate model that simultaneously considered UPPS-P and Two-Factor Model assessments. Overall, the current findings indicate that the Two-Factor Model should be considered to index risk of substance use initiation to guide prevention efforts and highlight the importance of direct comparisons of alternative measurement and theoretical frameworks of impulsivity within the field of substance use research.

Attentional bias to cannabis cues in cannabis users but not cocaine users

Attentional bias to drug cues has been associated with the problematic use of drugs, including cannabis. The cognitive mechanisms underlying this bias are not fully understood. The purpose of this study was to determine whether cannabis-cue attentional bias is associated with disruptions in attentional processing. To this end, a novel cannabis-cue visual probe task that incorporated eye tracking technology and attention-based metrics derived from signal detection theory was administered to seventeen individuals who reported daily/near-daily cannabis use. Seventeen individuals with cocaine use disorder were also enrolled as a clinical-control group. Cannabis and neutral images were briefly presented side-by-side on a computer screen, followed by the appearance of a "go" or "no-go" target upon offset of both images to permit assessment of attention-based performance. Cannabis users exhibited attentional bias to cannabis cues, as measured by fixation time and response time, but not cue-dependent disruptions on subsequent attentional performance. Cocaine users did not display an attentional bias to cannabis cues but did display poorer attentional performance relative to cannabis users. These results indicate that attentional bias to cannabis cues is selective to cannabis use history and not associated with impaired attentional processing.

Associations of Father's Lifetime Cannabis Use Disorder with Child's Initiation of Cannabis Use, Alcohol Use, and Sexual Intercourse by Child Gender

BACKGROUND

Early initiation of alcohol use, cannabis use, and sexual intercourse among adolescents is an important public health concern in the United States. Parents' history of substance use disorder is an important contributing factor for children's problem behaviors.

OBJECTIVES

The associations of fathers' lifetime cannabis use disorder with children's initiation of cannabis use, alcohol use, and sexual intercourse were examined. In addition, child's gender was considered as a moderator of each association.

METHODS

Data from two companion longitudinal studies was utilized, the Rochester Youth Developmental Study and its intergenerational extension, the Rochester Intergenerational Study. Multiple linear regression analyses were conducted to examine the associations of the father's lifetime cannabis use disorder with the child's initiation of cannabis use, alcohol use, and sexual intercourse. To test gender differences in the associations, the study sample was stratified by child's gender.

RESULTS

The average age of first cannabis use (b = -3.71, p < .05), alcohol use (b = -3.65, p < .05), and sexual intercourse (b = -2.94, p < .05) among daughters of fathers with a lifetime cannabis use disorder was lower than that of their counterparts after adjusting for all other control variables, whereas no significant differences were detected in a father-son relationship.

CONCLUSIONS

Homotypic continuity of cannabis use, as well as heterotypic continuity from the father's cannabis use to the child's alcohol use and sexual intercourse existed in a father-daughter relationship. These findings suggest that family-based interventions for female adolescents whose father has suffered from a cannabis use disorder be developed to prevent better adolescents' early substance use and sexual intercourse.

Age moderates the association between frequent cannabis use and negative schizotypy over time

The current study examined whether age and frequent cannabis use interact to influence the trajectories of positive and negative schizotypy over time. Participants were 155 cannabis users, aged 15-24 years old, assessed over a 12-month period at 6-monthly intervals. The analyses examined the influence of age, frequent use, and time on positive and negative schizotypy. The current study found that among frequent cannabis users, younger age was associated with increased negative schizotypy over time, while among occasional cannabis users, younger age was associated with decreasing negative schizotypy over time. The current findings have implications for understanding how cannabis use may influence psychosis risk differently depending on age and frequency of use, as well as bring together past mixed findings on the relationship between negative schizotypy and cannabis use.

Effects of chronic marijuana use on driving performance

OBJECTIVES

The effects of marijuana on driving pose a significant public health concern. More studies on chronic marijuana use in driving are needed. The study objectives were to (1) assess differences in the Standardized Field Sobriety Test (SFST) and driving performance outcomes between chronic medical marijuana users and nonusers and (2) identify a cutoff tetrahydrocannabinol (THC) concentration above which chronic medical marijuana users demonstrate driving impairment.

METHODS

This prospective cross-sectional study assessed 31 chronic marijuana users and 41 nonusers. Rapid Detect Saliva Drug Screen 10-panel was administered to all participants. Participants were given a simple visual reaction time test (SVRT) and SFST consisting of the horizontal gaze nystagmus (HGN), the one leg stand (OLS), and the walk and turn (WAT) tests. The STISIM Drive M100 driving simulator assessed driving performance. Driving parameters included standard deviation of speed (SDS), deviation of mean lane position, off-road accidents, collisions, pedestrians hit, and car-following modulus, delay, and coherence. Cannabinoid blood plasma was obtained from marijuana users.

RESULTS

Marijuana users and nonusers did not differ in age (40.06 ± 13.92 vs. 41.53 ± 15.49, P = .6782). Marijuana users were more likely to fail the SFST (P = .005) and the WAT (P = .012) and HGN (P = .001) components. Marijuana users had slower SVRT (P = .031), less SDS (P = .039), and lower modulus (P = .003). Participants with THC >2 ng/mL (P = .017) and TCH >5 ng/mL (P = .008) had lower SDS. Participants with THC >2 ng/mL (P = .021) and THC >5 ng/mL (P = .044) had decreased modulus.

CONCLUSION

Chronic marijuana users had slower reaction times, deviated less in speed, and had difficulty matching a lead vehicle's speed compared to nonusers. The effects on SDS and modulus were present at cutoffs of 2 and 5 ng/mL.

Developmental pathways of adolescent cannabis use: Risk factors, outcomes and sex-specific differences

BACKGROUND

Characterizing patterns of adolescent cannabis use (CU), as well as risk factors and outcomes uniquely associated with these pathways is essential for informing treatment and prevention efforts. Yet, few studies have examined these issues among youth at-risk of engaging in problematic cannabis use. Further, research accounting for use of other substances or sex differences in patterns of CU remains exceedingly sparse.

METHODS

Trajectory-based modeling was used to identify underlying CU pathways among a predominantly Hispanic (90%) sample of at-risk youth (n = 401; 46% female) across adolescence (ages∼14-18), controlling for baseline substance use and participant demographics. Adolescent psychopathology (i.e., conduct disorder, attention deficit hyperactivity disorder, anxiety, and depression) was examined as a predictor and outcome of CU.

RESULTS

Three trajectories of adolescent CU were identified, with most youth (74%) engaging in relatively "low" levels of use, followed by ∼12% exhibiting an early-initiating "chronic" course, and 14% "escalating" in use. Although boys and girls both experienced increased levels of CU across adolescence, boys were more likely to exhibit escalating and chronic patterns of use. Findings revealed unique associations between adolescent CU pathways and facets of psychopathology; most notably, the relatively robust and bidirectional association between CU trajectories and conduct problem symptoms.

CONCLUSIONS

Specific facets of psychopathology may confer unique associations with CU across development, including the initiation and exacerbation of CU during adolescence.

Content, Exposure, and Effects of Public Discourses about Marijuana: A Systematic Review

This review presents a comprehensive picture of research studies about marijuana-related content in news, social media, and advertisements. Studies that examined the extent of people's exposure to the messages and its effects were also included. A total of 27 peer-reviewed journal articles and one thesis were located, of which 16 analyzed the content, four contained information about people's exposure to the messages, and ten examined the effects. Over time, news coverage shifted from negative to slightly positive toward marijuana use. Social media and advertisements were overwhelmingly favorable toward marijuana use and legalization by claiming social, romantic, and health benefits of marijuana use while completely downplaying risks. A majority of social media accounts were also run by advocacy groups and industry interests, rather than individuals who were simply sharing opinions or experiences. Furthermore, absence of health authorities among the highly popular social media accounts about marijuana was notable. The news, social media, and advertising messages about marijuana were widely used by the members of public, which in turn generated some demonstrable effects on the audience's marijuana-related perceptions and behaviors. The public and policymakers need to become aware of this information environment for potential marijuana users and take more proactive measures to protect vulnerable populations.

Associations between marijuana use and tobacco cessation outcomes in young adults

Marijuana and tobacco co-use is common among young adults, and findings are mixed regarding the association between marijuana use and smoking cessation outcomes. This study examined the longitudinal relationships between marijuana use and smoking cessation outcomes among young adults (aged 18-25 years; N = 500) enrolled in a 3-month smoking cessation intervention on Facebook. At baseline and 3, 6, and 12 months, participants reported their marijuana use and their smoking behaviors (seven-day point prevalence abstinence from smoking, cigarettes per day, quit attempts) and readiness to quit. Longitudinal analyses controlled for experimental condition and adjusted for baseline stage of change, baseline average cigarettes per day, sex, alcohol use, and age participants began smoking regularly. Use of marijuana by young adult smokers was associated with a lower likelihood of reduced smoking (OR = 0.71, 95% CI [0.51, 0.98], p = .036) and a lower likelihood of abstaining from smoking (OR = 0.56, 95% CI [0.35, 0.90], p = .017) in the past seven days, as assessed over 12 months of follow-up. Use of marijuana was not significantly associated with perceptions of or engagement in the smoking cessation intervention, stage of change for quitting smoking, or tobacco quit attempts (all p's > 0.08). Study findings indicate that while marijuana use is unrelated to motivation to quit tobacco and engage in cessation interventions, marijuana use is associated with less success in reducing and abstaining from tobacco. Additional support and targeted tobacco cessation strategies to address challenges associated with marijuana co-use may be needed.

The interplay between externalizing disorders polygenic risk scores and contextual factors on the development of marijuana use disorders

Externalizing disorders have been extensively linked to substance use problems. However, less is known about whether genetic factors underpinning externalizing disorders and environmental features interact to predict substance use disorders (i.e., marijuana abuse and dependence) among urban African Americans. We examined whether polygenic risk scores (PRS) for conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD) interacted with contextual factors (i.e., parental monitoring, community disadvantage) to influence risk for marijuana use disorders in a sample of African American youth. Participants (N=1,050; 44.2% male) were initially recruited for an elementary school-based universal prevention trial in a Mid-Atlantic city and followed through age 20. Participants reported on their parental monitoring in sixth grade and whether they were diagnosed with marijuana abuse or dependence at age 20. Blood or saliva samples were genotyped using the Affymetrix 6.0 microarrays. The CD and ADHD PRS were created based on genome-wide association studies conducted by Dick et al. (2010) and Demontis et al. (2017), respectively. Community disadvantage was calculated based on census data when participants were in sixth grade. There was an interaction between the CD PRS and community disadvantage such that a higher CD PRS was associated with greater risk for a marijuana use disorder at higher levels of neighborhood disadvantage. This finding should be interpreted with caution owing to the number of significance tests performed. Implications for etiological models and future research directions are presented.

Affect and cannabis use in daily life: a review and recommendations for future research

BACKGROUND

Although cannabis is often used for the purposes of relieving negative affective states such as anxiety and depression, the associations between cannabis use and affect in daily life are unclear. Ecological momentary assessment (EMA) has been used to study these associations in individuals' natural environments, providing more ecological validity, minimizing retrospective bias, and allowing for the analysis of within-individual processes over time. This review focuses on studies that utilized EMA to examine daily-life associations of cannabis use and negative and positive affective states.

METHODS

We review the findings of the 19 articles that met inclusion criteria, including clinical and community samples.

RESULTS

Results provide equivocal evidence regarding relations between cannabis use and affect for community samples. Findings are mixed for clinical samples as well, but more consistent patterns emerge for general negative affect (NA) and anger/hostility at the momentary level; cannabis use may be more likely following increased NA and lead to decreases in NA and anger/hostility in psychiatric populations.

CONCLUSIONS

Findings support a negative reinforcement hypothesis for clinical samples in terms of general NA and anger/hostility. However, discrepancies among studies point to a need to thoroughly characterize samples, consider motives for and expectancies of use, improve quantification of cannabis use, and consider co-use with other substances. Additional design recommendations are also offered for future studies.

A Comparison of Motivations for Marijuana Use in HIV-Positive and HIV-Negative Adults

While medicinal marijuana use is common among persons with HIV, it is not known whether persons with HIV are more motivated to use marijuana medically compared to HIV-negative counterparts. This study examined motivations for marijuana use in a sample of 94 HIV+ and HIV- adults. Participants used marijuana 21.27 days in the last 30 days on average. HIV+ participants reported using marijuana for medical reasons more often than HIV- participants, but HIV+ and HIV- participants did not differ in other domains. Problematic marijuana use was associated with motives, regardless of HIV status. Motives were associated with mental and physical health functioning, but there were no interactions between motivations and HIV status. Overall this study found that motivations were similar for HIV+ and HIV- participants. Future research including qualitative work to further understand motivations would benefit the field, as would research examining the effectiveness of marijuana in treating physical symptoms.

Factors associated with hazardous alcohol use and motivation to reduce drinking among HIV primary care patients: Baseline findings from the Health & Motivation study

BACKGROUND

Limited primary care-based research has examined hazardous drinking risk factors and motivation to reduce use in persons with HIV (PWH).

METHODS

We computed prevalence ratios (PR) for factors associated with recent (<30 days) hazardous alcohol use (i.e., 4+/5+ drinks in a single day for women/men), elevated Alcohol Use Disorders Identification Test (AUDIT) scores, and importance and confidence (1-10 Likert scales) to reduce drinking among PWH in primary care.

RESULTS

Of 614 participants, 48% reported recent hazardous drinking and 12% reported high alcohol use severity (i.e., AUDIT zone 3 or higher). Factors associated with greater alcohol severity included moderate/severe anxiety (PR: 2.07; 95% CI: 1.18, 3.63), tobacco use (PR: 1.79; 1.11, 2.88), and other substance use (PR: 1.72; 1.04, 2.83). Factors associated with lower alcohol severity included age 50-59 years (PR: 0.46; 0.22, 2.00) compared with age 20-39 years, and having some college/college degree (PR: 0.61; 0.38, 0.97) compared with ≤high school. Factors associated with greater importance to reduce drinking (scores >5) included: moderate/severe depression (PR: 1.43; 1.03, 2.00) and other substance use (PR: 1.49; 1.11, 2.01). Lower importance was associated with incomes above $50,000 (PR: 0.65; 0.46, 0.91) and marijuana use (PR: 0.65; 0.49, 0.87). HIV-specific factors (e.g., CD4 and HIV RNA levels) were not associated with alcohol outcomes.

CONCLUSIONS

This study identified modifiable participant characteristics associated with alcohol outcomes in PWH, including anxiety and depression severity, tobacco use, and other substance use.

Nonacute effects of cannabis use on motivation and reward sensitivity in humans: A systematic review

Reduced motivation is often noted as a consequence of cannabis use. However, prior studies examining this association have suboptimally operationalized motivation and have yielded mixed findings. This review discusses motivation and the closely related construct of reward sensitivity. We summarize the available literature examining associations between motivation and cannabis use, addressing the following questions: (a) Is there evidence for decreased motivation among cannabis users? (b) Is there evidence that lack of motivation among cannabis users is specific to their use of cannabis (rather than to use of other addictive drugs)? and (c) Is there evidence suggesting a causal relationship between cannabis use and motivation? Using PubMed, PsycINFO, and WebofScience, we conducted a literature search of studies examining nonacute effects of cannabis use on motivation, apathy, amotivation, effort, and reward sensitivity in humans. This search yielded 22 studies, which were reviewed in detail. We conclude that, although cross-sectional evidence of a cannabis-specific effect on motivation is equivocal, there is partial support from longitudinal studies for a causal link between cannabis use and reduced motivation. Additionally, we propose that reward sensitivity and motivation represent distinct yet related constructs and that reductions in one may not always lead to reductions in the other. Future work should longitudinally examine associations between cannabis use, motivation, and reward sensitivity; carefully define and operationalize these constructs; and control for the influence of potential confounding factors. (PsycINFO Database Record

Marijuana use among adolescent multiple tobacco product users and unique risks of dual tobacco and marijuana use

BACKGROUND

Adolescence is a peak time for uptake of both tobacco and marijuana (dual use). This study aimed to identify clusters of lifetime tobacco and marijuana use patterns and associated risk factors, and to determine whether dual tobacco and marijuana use is uniquely associated with greater risk than use of either tobacco or marijuana alone.

METHOD

High school students participated in a survey during Fall 2014 (N = 976; 68% Hispanic; 57% parental education < high school). Items from national youth surveys were used to measure lifetime and current use of tobacco products, marijuana, alcohol, drug use, and other risk behaviors, and literature-based surveys were used to measure psychological constructs.

RESULTS

Latent Class Analysis identified three clusters of lifetime tobacco use patterns (no tobacco, one or two products, and more than two products), each with a correspondingly distinct profile of risk behaviors; risk escalated with use of more tobacco products. Multinomial modeling characterized personal, environmental, and behavioral correlates of dual lifetime tobacco and marijuana use, including lower parental monitoring, lower grades, higher guilt, higher lifetime alcohol and drug use, and more substance use by friends, in reference to single lifetime use of either tobacco or marijuana.

CONCLUSION

Broader use of tobacco (i.e., more products) was associated with numerous risk factors. Dual lifetime use of tobacco and marijuana was associated with numerous risks compared to single use of either tobacco or marijuana. Longitudinal work is needed to understand temporal relationships between risk variables to determine optimal timing for interventions to reduce harmful behaviors.

Impact of Marijuana Legalization in Colorado on Adolescent Emergency and Urgent Care Visits

PURPOSE

Approximately 6%-8% of U.S. adolescents are daily/past-month users of marijuana. However, survey data may not reliably reflect the impact of legalization on adolescents. The objective was to evaluate the impact of marijuana legalization on adolescent emergency department and urgent cares visits to a children's hospital in Colorado, a state that has allowed both medical and recreational marijuana.

METHODS

Retrospective review of marijuana-related visits by International Classification of Diseases codes and urine drug screens, from 2005 through 2015, for patients ≥ 13 and < 21 years old.

RESULTS

From 2005 to 2015, 4,202 marijuana-related visits were identified. Behavioral health evaluation was obtained for 2,813 (67%); a psychiatric diagnosis was made for the majority (71%) of these visits. Coingestants were common; the most common was ethanol (12%). Marijuana-related visits increased from 1.8 per 1,000 visits in 2009 to 4.9 in 2015. (p = < .0001) CONCLUSIONS: Despite national survey data suggesting no appreciable difference in adolescent marijuana use, our data demonstrate a significant increase in adolescent marijuana-associated emergency department and urgent cares visits in Colorado.

Perceptions of driving after marijuana use compared to alcohol use among rural American young adults

INTRODUCTION AND AIMS

Substance use contributes to motor vehicle crashes, the leading cause of death among young adults. The current qualitative study examined perceptions of the acceptability and harms associated with driving after marijuana versus alcohol use in rural America. Illuminating rural perspectives is critical given that the motor vehicle fatality rate is twice as high in rural as in urban areas in the USA.

DESIGN AND METHODS

In 2015-2016, 72 young adults aged 18-25 years (Mage  = 20.2; 50.7% female) living in Montana, USA, participated in 11 focus groups. A list of descriptive codes was generated inductively and two individuals coded participant comments. Discussion, memoing and concept mapping were used to uncover broader themes and transcripts were reviewed for evidence of these themes.

RESULTS

There was shared consensus that, with regard to crash risk, driving after marijuana use was safer than driving after alcohol use. While alcohol was thought to impair driving ability universally, marijuana's impacts depended on individual characteristics (e.g. compensatory behaviours) and the marijuana itself (e.g. type). Participants expressed conflicting beliefs about policies surrounding marijuana use and driving but were more knowledgeable about alcohol-related policies. Participants viewed older adults and those in frontier areas as more disapproving of driving after marijuana use.

DISCUSSION AND CONCLUSIONS

Misinformation about the consequences of driving after marijuana use is common, demonstrating the need for future research and educational interventions. Developing and disseminating guidelines for driving after marijuana use would help marijuana users make informed decisions and mitigate driving-related risks.

Relationship between fMRI response during a nonverbal memory task and marijuana use in college students

Marijuana (MJ) is widely used among college students, with peak use between ages 18-22. Research suggests memory dysfunction in adolescent and young adult MJ users, but the neural correlates are unclear. We examined functional magnetic resonance imaging (fMRI) response during a memory task among college students with varying degrees of MJ involvement. Participants were 64 college students, ages 18-20, who performed a visual encoding and recognition task during fMRI. MJ use was ascertained for 3 months prior to scanning; 27 individuals reported past 3-month MJ use, and 33 individuals did not. fMRI response was modeled during encoding based on whether targets were subsequently recognized (correct encoding), and during recognition based on target identification (hits). fMRI response in left and right inferior frontal gyrus (IFG) and hippocampal regions of interest was examined between MJ users and controls. There were no group differences between MJ users and controls on fMRI response during encoding, although single sample t-tests revealed that MJ users failed to activate the hippocampus. During recognition, MJ users showed less fMRI response than controls in right hippocampus (Cohen's d = 0.55), left hippocampus (Cohen's d = 0.67) and left IFG (Cohen's d = 0.61). Heavier MJ involvement was associated with lower fMRI response in left hippocampus and left IFG. This study provides evidence of MJ-related prefrontal and hippocampal dysfunction during recognition memory in college students. These findings may contribute to our previously identified decrements in academic performance in college MJ users and could have substantial implications for academic and occupational functioning.

Cross-sectional and temporal associations between cyber dating abuse victimization and mental health and substance use outcomes

The purpose of this study was to investigate the cross-sectional and temporal associations between cyber dating abuse victimization (CDAV) and mental health (i.e., anxiety, PTSD, and depression), and substance use (i.e., alcohol, cigarettes, marijuana and hard drugs). We used data from the 5th and 6th waves of an ongoing longitudinal study of ethnically diverse adolescents from seven public high schools in Texas, U.S. Participants were 641 adolescents (63.3% female) with a mean age of 19.1 years (SD = .79) at Wave 5. Analyses suggested that while CDAV was associated with mental health and substance use cross-sectionally, when examining over time, it was only associated with past year hard drug and past month marijuana use. Although long-term mental health effects of CDAV did not emerge in the current study, we identified a temporal link to marijuana and hard drugs, highlighting the need for prevention efforts to incorporate messages about substance use.

Daily Patterns of Marijuana and Alcohol Co-Use Among Individuals with Alcohol and Cannabis Use Disorders

BACKGROUND

The study aims were to examine daily associations between marijuana and alcohol use and the extent to which the association differs as a function of cannabis use disorder (CUD) and/or alcohol use disorder (AUD) diagnosis.

METHODS

Timeline Followback interview data was collected in a study of veterans (N = 127) recruited from a Veterans Affairs hospital who reported at least 1 day of co-use of marijuana and alcohol in the past 180 days (22,860 observations). Participants reported 40% marijuana use days, 28% drinking days, with 37% meeting DSM-5 criteria for CUD, 40% for AUD, and 15% for both. Use of marijuana on a given day was used to predict a 3-level gender-adjusted drinking variable (heavy: ≥5 (men)/4 (women) drinks; moderate: 1 to 4/3 drinks; or none: 0 drinks). A categorical 4-level variable (no diagnosis, AUD, CUD, or both) was tested as a moderator of the marijuana-alcohol relationship.

RESULTS

Multilevel modeling analyses demonstrated that participants were more likely to drink heavily compared to moderately (OR = 2.34) and moderately compared to not drinking (OR = 1.61) on marijuana use days relative to nonuse days. On marijuana use days, those with AUD and those with AUD + CUD were more likely to drink heavily (OR = 1.91; OR = 2.51, respectively), but those with CUD were less likely to drink heavily (OR = 0.32) compared to moderately, nonsignificant differences between any versus moderate drinking in interaction models.

CONCLUSIONS

Heavy drinking occurs on days when marijuana is also used. This association is particularly evident in individuals diagnosed with both AUD and CUD and AUDs alone but not in those with only CUDs. Findings suggest that alcohol interventions may need to specifically address marijuana use as a risk factor for heavy drinking and AUD.

Media portrayal of prenatal and postpartum marijuana use in an era of scientific uncertainty

BACKGROUND

Objectives were to characterize how scientific information about prenatal and postpartum marijuana use was presented in online media content, and to assess how media portrayed risks and benefits of such marijuana use.

METHODS

We analyzed online media items (n = 316) from March 2015 to January 2017. A codebook was developed to measure media content in 4 domains: scientific studies, information about health and well-being, mode of ingestion, and portrayal of risks and benefits. Content analysis was performed by two authors, with high inter-rater reliability (mean ĸ = 0.82). Descriptive statistics were used to characterize content, and regression analyses were used to test for predictors of media portrayal of the risk-benefit ratio of prenatal and postpartum marijuana use.

RESULTS

51% of the media items mentioned health risks of prenatal and postpartum marijuana use. Nearly one-third (28%) mentioned marijuana use for treatment of nausea and vomiting in pregnancy. Most media items mentioned a specific research study. More than half of media (59%) portrayed prenatal or postpartum marijuana risks > benefits, 10% portrayed benefits> risks, and the remainder were neutral. While mention of a scientific study was not predictive of the portrayal of the risk-benefit ratio of marijuana use in pregnancy or postpartum, discussion of health risks and health benefits predicted portrayals of the risk-benefit ratio.

CONCLUSIONS

Online media content about prenatal and postpartum marijuana use presented health risks consistent with evidence, and discussed a health benefit of marijuana use for nausea and vomiting in pregnancy. Portrayal of risks and benefits was somewhat equivocal, consistent with current scientific debate.

Associations between coping and marijuana use in a nationally representative sample of adolescents in the United States

Maladaptive coping strategies have been linked with substance use. Little is known, however, about associations between coping and marijuana use in the general U.S. adolescents. We used nationally representative data to examine associations between coping and marijuana use among U.S. adolescents. We hypothesized that marijuana use would be positively associated with both avoidance and distraction coping and negatively associated with problem solving. We calculated adjusted prevalence ratios and odds ratios to assess associations of three coping styles (avoidance, distraction, problem solving) and six coping profiles based on combinations of the styles (adaptive, low on all styles, distracted, high on all styles, avoidant, maladaptive) with lifetime marijuana use and past 12-month frequency of use using data from the National Comorbidity Survey: Adolescent Supplement (n=8476, ages 14-18years). Avoidance and distraction coping were positively and problem solving was negatively associated with lifetime marijuana use. Avoidance coping was positively associated, and problem solving negatively associated, with past 12-month frequency of use. Compared to the adaptive coping profile (low avoidance and distraction, high problem solving), maladaptive profile (high avoidance and distraction, low problem solving) and avoidance profile (high avoidance, low distraction and problem solving) were each positively associated with lifetime marijuana use and past 12-month frequency of use. Avoidance coping, especially in combination with limited problem solving, was positively associated with lifetime marijuana use and past 12-month frequency of use. Our findings have potential to inform interventions for reducing adolescent marijuana use.