Perceived Peer Behavior and Parental Support as Correlates of Marijuana Use: The Role of Age and Gender

INTRODUCTION

Parental support and perceptions of peer behavior on substance use are well-studied, but precisely how their associations vary as a function of age, and how those age-specific patterns vary by gender, remain unknown components of the developmental process underlying substance use.

METHODS

Using data from an 18-year longitudinal study of predominantly African-American students at high-risk for high school dropout in Flint, Michigan (baseline average age = 14.8 years), we examined longitudinal associations between past 30-day marijuana use and three self-reported variables: perceived friend drug use, perceived friend aggression, parental support. We used varying-coefficient regression models to semiparametrically estimate how covariate effects on past 30-day marijuana use vary smoothly as a function of age; gender differences in these age-specific coefficient trajectories were also tested.

RESULTS

In the unadjusted tests, the risk-enhancing effect of perceived friend drug use decreased with age in both genders, but the effect of perceived friend aggression varied only in females; in both cases, gender differences were not significant. In males, parental support had protective effects that decreased with age. The effect of both parental support differed in females, with less protective baseline effects and no evidence of age-variation. Adjusted models simultaneously including both friend and parental variables produced qualitatively similar results.

CONCLUSIONS

Prevention strategies focusing on social exposures may be more effective if they are age- and gender-specific. In particular, interventions focusing on perceived peer behaviors may be more appropriate during adolescence, and those involving parental relationships may be more appropriate for males.

Perceptual abnormalities in clinical high risk youth and the role of trauma, cannabis use and anxiety

Recent research suggests that perceptual abnormalities are a group of diverse experiences, which have been associated with trauma, cannabis use, and anxiety. Of the attenuated psychotic symptoms that are present in youth at clinical high risk (CHR) of psychosis, perceptual abnormalities tend to be one of the most frequently endorsed symptoms. However, very few studies have explored perceptual abnormalities and their relationships with the above environmental and affective factors in a CHR sample. Four hundred and forty-one CHR individuals who met criteria for attenuated psychotic symptom syndrome (APSS) determined by the Structured Interview for Psychosis-risk Syndromes (SIPS) were assessed on the content of their perceptual abnormalities, early traumatic experience, cannabis use and self-reported anxiety. Logistic regression analyses suggested that both simple auditory and simple visual perceptual abnormalities were more likely to be reported by CHR who had early traumatic experiences, who are current cannabis users, and who have higher levels of anxiety. Multiple regression analysis revealed that only trauma and anxiety were independent predictors of both simple auditory and simple visual perceptual abnormalities. It is possible that examining subtypes of perceptual abnormalities in CHR leads to an improved understanding of the prevalence of such symptoms.

Perceived harm as a mediator of the relationship between social norms and marijuana use and related consequences among American Indian youth

BACKGROUND

American Indian (AI) youth are at increased risk for marijuana use with marijuana use rates on or near reservations 1.6-4.8 times higher compared to non-AI youth in the same regions (Stanley et al., 2014). One outcome of the changing social and legal acceptance of marijuana is a decrease in perceived risk among adolescents. It is unknown whether these changes in perceptions of marijuana-related harm will presage higher rates of use among AI youth. Perceptions of others use (i.e., descriptive norms) and approval (i.e., injunctive norms) are consistent predictors of marijuana use and consequences. Moreover, large scale surveys have shown that gender is an important moderator of the relationship between norms and marijuana use in AI samples.

METHOD

The current study is a large epidemiologic study of 7th-12th grade self-identified American Indian students (N=3050). We examined the direct relations between descriptive and injunctive norms and marijuana use/consequences among AI youth, as well as the mediating role of perceived harm and the moderating role of gender.

RESULTS

Results of a multi-group path analysis revealed a similar pattern of findings for males and females. In addition, there were direct effects for descriptive but not injunctive norms on marijuana use/consequences, and the sequential pathway from norms to use/consequences via perceived harm held.

DISCUSSION

Findings suggest that normative perceptions and perceived harm are antecedents of marijuana use/consequences and are prime targets for large scale interventions on AI reservations.

Changes in marijuana use symptoms and emotional functioning over 28-days of monitored abstinence in adolescent marijuana users

RATIONALE

Advancing marijuana prevention and intervention efforts are important given the decreasing perception of harm among adolescents and increasing marijuana legalization.

OBJECTIVES

This study evaluates how a monitored abstinence protocol may contribute to emotional functioning and changes in marijuana problems that can enhance successful outcomes for non-treatment-seeking adolescent marijuana users.

METHODS

Adolescent marijuana users (n = 26) and demographically matched controls (n = 30) completed 28 days of monitored abstinence confirmed by biweekly urine toxicology. Participants were given measures of emotional functioning, marijuana use symptoms, and reward sensitivity during monitored abstinence.

RESULTS

All participants (n = 56) completed the protocol, and 69% of marijuana users (n = 18 of 26) were confirmed abstinent for 28 days, with all users showing decreasing marijuana use. Reductions in subsyndromal depression, positive marijuana use expectancies, and poor sleep quality were observed by the end of the monitored abstinence period (n = 26, p values < .05). Marijuana users also reported more attentional impulsivity and less responsiveness to reward stimuli during the second week of abstinence compared to controls. Later age of onset of regular marijuana use and more cumulative lifetime use were associated with a greater degree of emotional change and increased recognition of the negative effects of marijuana use.

CONCLUSIONS

Monitored abstinence programs may be beneficial in reducing marijuana use, subsyndromal emotional distress symptoms, and changing beliefs about marijuana use. Future prevention and intervention efforts may consider targeting reward sensitivity and impulsivity, in addition to marijuana use, expectancies, and emotional functioning.

Daily-level associations between PTSD and cannabis use among young sexual minority women

INTRODUCTION

Sexual minority women have elevated trauma exposure and prevalence of posttraumatic stress disorder (PTSD) compared to heterosexual women and they are also more likely to use cannabis, although no research has examined relationships between PTSD and cannabis use in this population. Daily-level methodologies are necessary to examine proximal associations between PTSD and use.

METHODS

This study included 90 trauma-exposed young adult women who identified as sexual minorities (34.4% identified as lesbian and 48.9% identified as bisexual) and evaluated daily-level associations between their PTSD symptoms and cannabis use. Participants were assessed at two measurement waves, one year apart, each consisting of 14 consecutive daily assessments.

RESULTS

Cannabis use occurred on 22.8% of the days. Results from generalized linear mixed effects models showed that a person's mean level of PTSD symptom severity across days was strongly associated with same-day likelihood of cannabis use (OR=2.67 for 1 SD increase in PTSD score; p<0.001). However, daily deviation from one's average PTSD score was not associated with cannabis use on the same day.

CONCLUSIONS

Findings suggest that PTSD severity may confer general risk for cannabis use, rather than being a state-dependent risk factor.

Risk is still relevant: Time-varying associations between perceived risk and marijuana use among US 12th grade students from 1991 to 2016

BACKGROUND

Perceived risk of harm has long been a key preventive factor for adolescent marijuana use. However, in recent years, perceived risk has decreased markedly and marijuana use has increased only slightly, leading to new questions about their association. This study investigates the magnitude and stability of the US adolescent marijuana risk/use association from 1991 to 2016, overall and by gender and race/ethnicity.

METHODS

Self-reported data on past 12-month marijuana use, perceived risk of regular marijuana use, gender, and race/ethnicity were obtained from 275,768 US 12th grade students participating in the nationally representative Monitoring the Future study. Time-varying effect modeling (TVEM) was used to examine the marijuana risk/use association over time.

RESULTS

Both before and after controlling for gender and race/ethnicity, perceived risk was a strong protective factor against adolescent marijuana use. The magnitude of the great risk/use association strengthened for Hispanic students; remained generally stable over time for 12th graders overall, males, females, and White students; and weakened for Black students. The magnitude of the moderate risk/use association strengthened for 12th graders overall, males, females, White and Hispanic students, but did not continue to strengthen for Black students from 2005 onwards. In general, marijuana use prevalence decreased over time within all levels of perceived risk.

CONCLUSIONS

Perceived risk remains a strong protective factor for adolescent marijuana use, and the protective association for moderate risk (vs. no/slight risk) is actually increasing over time. Results suggest that accurate and credible information on the risks associated with marijuana use should remain a key component of prevention efforts.

Differences in reporting of perceived acute effects of alcohol use, marijuana use, and simultaneous alcohol and marijuana use

BACKGROUND

Although there are serious negative harms associated with simultaneous alcohol and marijuana (SAM) use, little is known about the self-reported acute effects of SAM use and how they may be similar to or different than effects experienced when using alcohol or marijuana only. The current study examines the perceived acute effects of SAM use, compared to using alcohol or marijuana only, as well as demographic and substance use predictors of overall SAM effects.

METHODS

Participants were a community sample of young adults ages 18-23 participating in a longitudinal study on social role transitions and substance use during young adulthood. Young adults who reported SAM use at least once in their lifetime were selected for the present analyses (N=315; mean age=21.42; 58% female) and reported the effects they experienced from typical alcohol use, marijuana use, and SAM use.

RESULTS

There were significant differences in the extent to which young adults perceived the effects depending on the substances used. Most effects (i.e., clumsy, confused, dizzy, difficulty concentrating) were rated strongest when engaging in SAM use, compared to typical alcohol or marijuana use alone. Feeling high and feeling marijuana effects were rated strongest when engaging in marijuana use alone compared to SAM use, but feeling drunk was greater during SAM use compared to alcohol use alone. Greater alcohol use and increased time spent high during typical SAM use were associated with greater overall SAM effects.

CONCLUSIONS

When young adults engage in SAM use they report experiencing greater negative physiological and cognitive effects.

Marijuana Use and Organ Transplantation: a Review and Implications for Clinical Practice

PURPOSE OF REVIEW

Physicians of all disciplines must rapidly adjust their clinical practices following the expansion of marijuana legalization across the country. Organ transplantation teams are uniquely struggling in this gray zone with eight states having passed laws explicitly banning the denial of transplant listing based on a patient's use of medical marijuana. In this review, we examine the clinical evidence of marijuana use in transplant patients to enable psychiatric providers to meaningfully contribute to the relevant medical and psychiatric aspects of this issue in a unique patient population.

RECENT FINDINGS

There is no consensus among experts regarding marijuana use in transplantation patients. There are extant case reports of post-transplant complications attributed to marijuana use including membranous glomerulonephritis, ventricular tachycardia, and tacrolimus toxicity. However, recent studies suggest that the overall survival rates in kidney, liver, lung, and heart transplant patients using marijuana are equivalent to non-users. Transplant teams should not de facto exclude marijuana users from transplant listing but instead holistically evaluate a patient's candidacy, integrating meaningful medical, psychiatric, and social variables into the complex decision-making process. Psychiatric providers can play a key role in this process. Appropriate stewardship over donor organs, a limited and precious resource, will require a balance of high-clinical standards with inclusive efforts to treat as many patients as possible.

The association between regular marijuana use and adult mental health outcomes

OBJECTIVE

The present study is a prospective examination of the relationship between regular marijuana use from adolescence through young adulthood and mental health outcomes at age 33.

METHODS

Data came from a gender-balanced, ethnically diverse longitudinal panel of 808 participants from Seattle, Washington. Outcomes included symptom counts for six mental health disorders. Regular marijuana use was tracked during adolescence and young adulthood. Regression analyses controlled for demographics and early environment, behaviors, and individual risk factors.

RESULTS

Nonusers of marijuana reported fewer symptoms of alcohol use disorder, nicotine dependence, and generalized anxiety disorder than any category of marijuana users. More persistent regular marijuana use in young adulthood was positively related to more symptoms of cannabis use disorder, alcohol use disorder, and nicotine dependence at age 33.

CONCLUSIONS

Findings highlight the importance of avoiding regular marijuana use, especially chronic use in young adulthood. Comprehensive prevention and intervention efforts focusing on marijuana and other substance use might be particularly important in the context of recent legalization of recreational marijuana use in Washington and other U.S. states.

Freshman year alcohol and marijuana use prospectively predict time to college graduation and subsequent adult roles and independence

OBJECTIVE

This study examined how freshman year substance use prospectively predicted time to college graduation, and whether delayed graduation predicted postponed adoption of adult roles and future substance use.

PARTICIPANTS

Participants were part of a longitudinal study that began in 2004. The first analyses focused on freshman year (N = 2,050). The second analyses corresponded to a subset of participants at age 27 (N = 575).

METHODS

Measures included self-reported substance use, adult role adoption, and university reported graduation dates.

RESULTS

Results indicated that frequent binge drinking and marijuana use during freshman year predicted delayed college graduation. Those who took longer to graduate were more likely to have lower incomes and were less likely to obtain a graduate degree. Taking 5-6 years to graduate was associated with greater likelihood of alcohol-related problems.

CONCLUSIONS

Findings support the importance of interventions during freshman year of college to decrease substance use and promote timely graduation.

Trajectories of marijuana use from late childhood to late adolescence: Can Temperament × Experience interactions discriminate different trajectories of marijuana use?

Informed by developmental ecological and epigenetic theory, the current study examined three aims concerning adolescent marijuana use with a large community sample (N = 755; gender = 53% female) and six annual assessments that spanned 11-18 years of age. First, the natural history of adolescent marijuana use was modeled using a two-part latent growth curve analysis. Second, the validity of the mixtures was examined with a broad array of known correlates of adolescent marijuana use. Third, temperament (e.g., surgency, effortful control, and negative affect) was tested as individual differences that would enter into statistical interactions with peer substance use and prior alcohol and cigarette use to distinguish trajectories of marijuana use. The results suggested that escalations in marijuana use were observed for some youth who initiated marijuana use early in adolescence. Youth whose marijuana use did escalate substantially (10%) were distinguished on temperament, conduct disorder, peer delinquency, and pubertal development at baseline. Furthermore, hypothesized interactions between surgency and both peer substance use and prior substance use discriminated different patterns of marijuana use. The findings are discussed with respect to strategies for timing and content of preventive interventions.

Adolescents at risk for drug abuse: a 3-year dual-process analysis

AIMS

To test longitudinal additive and synergistic dual-process models in youth at documented risk for drug use. The specific dual-process approach examined suggests that engaging in drug use behaviors results from a dynamic interplay between automatically activated associative memory processes and executive reflective/control processes.

DESIGN

This 3-year, three-wave population-based prospective study used mobile computer-based assessments.

SETTING

Self-directed computer assessments were completed in school settings in the Los Angeles metropolitan area, California, USA.

PARTICIPANTS

Seven hundred and twenty-five at-risk adolescents (44% female) in continuation high schools were recruited during 9th grade (age at recruitment, 14-16).

MEASUREMENTS

Key outcome measures included past year alcohol, marijuana and cigarette use at each assessment. Predictors included working memory capacity (WMC), associative memory, the interaction term WMC by associative memory, sex, age, ethnicity and acculturation.

FINDINGS

A significant cross-sectional interaction revealed tobacco-relevant associations were weaker predictors of cigarette use among males with higher WMC than among those with lower WMC (P < 0.004). Alternatively, drug-relevant associations were stronger predictors of past year alcohol (P < 0.001) and marijuana use (P = 0.02) among females with higher WMC than among those with lower WMC. Longitudinal analyses revealed no significant interactions after adjusting for predictive effects of previous drug use. With respect to WMC, females with higher WMC were less likely to use marijuana at 2-year follow-up (P = 0.03). First-order effects of drug-related associations predicted greater alcohol and marijuana use prospectively in males at 1- and 2-year follow up (P ≤ 0.03), and greater past year alcohol and marijuana use in females at 1-year follow up (P ≤ 0.03).

CONCLUSIONS

Drug-relevant memory associations play a key role in drug use behavior in at-risk youth.

Testing bidirectional associations among emotion regulation strategies and substance use: a daily diary study

BACKGROUND AND AIMS

Alcohol and marijuana are widely used among college students. Emotion regulation strategies have been linked to alcohol and marijuana use, but little attention has been devoted to modeling the directionality of these associations. The aims of the current study were to test whether (a) daytime use of emotion regulation strategies influences the likelihood of evening substance use and (b) evening substance use influences the likelihood of next-day use of emotion regulation strategies.

DESIGN

Longitudinal daily diary data were collected for 30 days via on-line surveys.

SETTING

Northeastern United States.

PARTICIPANTS

A total of 1640 college students (mean age = 19.2 years, 54% female, 80% European American) were recruited each semester between Spring 2008 and Spring 2012.

MEASUREMENTS

Daily diaries assessed emotion regulation strategies (distraction, reappraisal, problem-solving, avoidance) and substance use (any drinking, heavy drinking, marijuana use, co-use of any drinking/heavy drinking and marijuana). Covariates included gender, age, race/ethnicity, fraternity/sorority involvement and baseline depression.

FINDINGS

Daytime distraction [odds ratio (OR) = 0.95], reappraisal (OR = 0.95) and problem-solving (OR = 0.94) predicted lower odds of evening marijuana use (P-values < 0.02). Evening heavy drinking (OR = 0.90) and marijuana use (OR = 0.89) predicted lower odds of next-day problem-solving, with heavy drinking also predicting higher odds (OR = 1.08) of next-day avoidance and marijuana use also predicting higher odds (OR = 1.08) of next-day reappraisal (P-values < 0.03).

CONCLUSIONS

There appear to be reciprocal relations among emotion regulation strategies and substance use: greater daytime use of distraction, reappraisal, and problem solving predicts lower evening substance use, while higher evening substance use predicts higher next-day avoidance and reappraisal but lower next-day problem-solving.

The curvilinear effects of sexual orientation on young adult substance use

Alcohol, tobacco, and marijuana are commonly used by adolescents and linked with harmful health-related outcomes (e.g. injury, dependence). Moreover, heavy episodic (binge) drinking predicts more severe consequences. When examined by sexual orientation, highest rates of substance use have been found among bisexual individuals, with lower use at either end of the spectrum. When examined also by sex, this curvilinear trend is maintained among women but not men. These substance use patterns were identified using group differences (i.e. heterosexual vs. bisexual vs. homosexual). However, evidence suggests that sexual orientation is a continuous, not categorical, variable. This study examined the hypotheses that sexual orientation and commonly used substances (heavy episodic drinking, tobacco, marijuana) would have a quadratic relation among women, but not among men. Six negative binomial regressions tested study hypotheses using data from 7372 participants. Results indicated that sexual orientation had a quadratic relation with heavy episodic drinking, tobacco use, and marijuana use among women, as hypothesized. Additionally, a quadratic relation was found between marijuana use and sexual orientation among men. These findings indicate that women identifying as having mixed sexual orientation are at higher risk than women at either end of the sexual orientation continuum for substance use and related negative outcomes. For men, this is only true for marijuana use and resultant negative consequences. This observed increased use may relate to coping with increased stressors, which has been linked to more problematic use. By better understanding LBG identities and behaviors, clinicians and researchers will be more adept at identifying risk factors and better understanding the nuances across the sexual orientation spectrum.

Sensation seeking and executive deficits in relation to alcohol, tobacco, and marijuana use frequency among university students: Value of ecologically based measures

INTRODUCTION

The development of substance use and addiction has been linked to impaired executive function which relies on systems that converge in the prefrontal cortex. This study examined several measures of executive function as predictors of college student alcohol, tobacco, and marijuana use frequency and abuse.

METHODS

College students (N=321) were administered the Delis-Kaplan Executive Function System (D-KEFS) test battery, the Sensation Seeking Scale V (SSSV), the Frontal Systems Behavioral Scale (FrSBe), the Perceived Stress Scale (PSS), the Michigan Alcohol Screening Test (MAST), the Fagerstrom Test of Nicotine Dependence (FTND).

RESULTS

Alcohol use frequency was predicted by sensation seeking and FrSBe Disinhibition scores, but the latter only emerged as a unique predictor for binge drinking frequency. Sex and Disinhibition, Apathy and Executive Function FrSBe subscales predicted the frequency of tobacco use. FrSBe scores uniquely predicted tobacco use among daily users. Marijuana use frequency was predicted by sensation seeking, sex, perceived stress, and FrSBe Disinhibition scores, but only sensation seeking predicted daily use after controlling for other variables. FrSBe Disinhibition scores reached levels considered to be clinically significant for frequent binge drinkers and daily marijuana users. Sensation seeking emerged as the predominate predictor of the early stages of alcohol and tobacco related problems.

CONCLUSIONS

These results suggest ecologically based self-report measures of frontal lobe function and sensation seeking are significant predictors of use frequency among college students and the extent of frontal dysfunction may be clinically significant among some heavy users.

Family dynamics and alcohol and marijuana use among adolescents: The mediating role of negative emotional symptoms and sensation seeking

The literature indicates a close relationship between family dynamics and psychoactive substance use among adolescents, and multi-causality among substance use-related problems, including personal adolescent characteristics as potential influential aspects in this relationship. The purpose of this study is to investigate the role of emotional symptoms and sensation seeking as mediators in the relationship between family dynamics and alcohol and marijuana use among adolescents. The sample consisted of 571 high school students with a mean age of 14.63, who completed the Communities That Care Youth Survey in its Spanish version. We propose and test a mediation-in-serial model to identify the relationships between the study variables. The results of the mediation models indicate that, in most cases, the relationship between family dynamics and the substance use variables is meaningfully carried through the proposed mediators, first through negative emotional symptoms, and then through sensation seeking. The meaning of the mediation varies as a function of the facet of family dynamics (conflict or attachment) and the use aspect (age of onset, frequency of use, and use intention). We discuss the implications of these findings for intervention and prevention strategies.

Cannabis and alcohol use, affect and impulsivity in psychiatric out-patients' daily lives

BACKGROUND AND AIMS

Cannabis and alcohol are the most commonly used (il)licit drugs world-wide. We compared the effects of cannabis and alcohol use on within-person changes in impulsivity, hostility and positive affect at the momentary and daily levels, as they occurred in daily life.

DESIGN

Observational study involving ecological momentary assessments collected via electronic diaries six random times a day for 28 consecutive days.

SETTING

Out-patients' everyday life contexts in Columbia, MO, USA.

PARTICIPANTS

Ninety-three adult psychiatric out-patients (85% female; mean = 30.9 years old) with borderline personality or depressive disorders, who reported using only cannabis (n = 3), only alcohol (n = 58) or both (n = 32) at least once during the study period.

MEASUREMENTS

Real-time, standard self-report measures of impulsivity, hostility and positive affect, as impacted by momentary reports of cannabis and alcohol use.

FINDINGS

Cannabis use was associated with elevated feelings of impulsivity at the day level [b = 0.83, 95% confidence interval (CI) = 0.17-1.49] and increased hostility at the momentary (b = 0.07, 95% CI = 0.01-0.12) and person (b = 0.81, 95% CI = 0.15-1.47) level. Alcohol use was associated with elevated feelings of impulsivity at the momentary (b = 0.42, 95% CI = 0.13-0.71) and day levels (b = 0.82, 95% CI = 0.22-1.41) and increased positive affect at the momentary (b = 0.12, 95% CI = 0.06-0.18) and day (b = 0.33, 95% CI = 0.16-0.49) levels.

CONCLUSIONS

Cannabis and alcohol use are associated with increases in impulsivity (both), hostility (cannabis) and positive affect (alcohol) in daily life, and these effects are part of separate processes that operate on different time-scales (i.e. momentary versus daily).