Optimal scaling of the CAST and of SDS Scale in a national sample of adolescents

Executive functions and addictions: a Structural Equation Modeling Approach and the Italian validation of the Adult Executive Functioning Inventory (ADEXI)

INTRODUCTION

the work aims to observe the associations between psychoactive substance use and gambling and executive functioning as well as to validate the Italian version of the "Adult Executive Functioning Inventory" (ADEXI) scale.

METHODS

data were collected through a representative cross-sectional study among 5,160 people (18-84 years old) called IPSAD® (Italian Population Survey on Alcohol and Other Drugs). Structural Equation Modeling (SEM) was performed to explore the associations between ADEXI and other behaviors measured with standardized questionnaires. Cronbach α has been performed to investigate the psychometric properties of the Italian version of the ADEXI scale.

RESULTS

SEM showed that both WM and INH were correlated with problematic cannabis use (WM r = 0.112; INH r = 0.251) and gambling (WM r = 0.101; INH r = 0.168), while problematic alcohol use was correlated only with INH (r = 0.233). Cronbach α for the WM subscale was 0.833 (CI 0.826-0.840), while for INH was 0.694 (CI 0.680-0.708).

CONCLUSION

results pointed out a strong correlation between addictions (substance-related and non-substance-related) and WM and INH impairments among the adult general population. Moreover, the ADEXI scale could be considered a valuable tool for general population surveys to detect working memory and inhibition characteristics.

Development and Pilot Testing of an Experimental Cannabis Marketplace: Toward Evaluating the Impact of Cannabis Policy on Consumer Choices

Introduction: The legal landscape of recreational cannabis production and consumption is rapidly expanding, driving a need to inform empirically supported cannabis regulatory policy. A behavioral economic framework integrating economic constructs (e.g., price, substitutability) with psychology and decision-making sciences, has previously been applied to tobacco regulatory sciences through the use of experimental marketplaces. However, experimental marketplaces have not yet been applied to understand cannabis choice behaviors or study ways to minimize risks from use. Herein, we describe the development and initial feasibility testing of an Experimental Cannabis Marketplace (ECM). The ECM can serve as an experimental platform relevant to evaluating the impact of regulatory policies on cannabis choices and use behavior. Methods: The ECM was designed to resemble an online cannabis dispensary. Adults aged 21 and older with past month cannabis use and past month purchase from a recreational dispensary were recruited online. To test the feasibility and acceptability of the ECM, 62 people completed the ECM shopping task and provided feedback on the ECM prototype. Participants also reported about their typical purchases from real-world dispensaries. Results: Nearly all participants rated the ECM as very (80.65%) or somewhat (16.13%) easy to navigate, and rated task instructions as at least mostly clear (100%). The majority (75.81%) said cannabis products available in the ECM were mostly the same or exactly the same as at their typical dispensary. Participant purchase choices in actual dispensary purchases closely matched ECM purchases, with 88% of product choices in typical real-world cannabis dispensaries matching the ECM products purchased. Discussion: Initial testing of the ECM indicates it is an acceptable and feasible tool for understanding cannabis purchasing and choice behavior. These preliminary findings suggest that the ECM mimics cannabis dispensary settings with people making similar choices to those made in the real world.

Attention-Deficit/Hyperactivity Disorder and Unhealthy Lifestyle in Adolescence: Unforeseen Role of Allostatic Overload and Psychological Well-Being

Unhealthy lifestyle behaviors (ULBs) are common in early adolescence and could be worsened by Attention-Deficit/Hyperactivity Disorder (ADHD), as well as by specific psychosocial factors, such as stress and unbalanced (i.e., too high or low scores of) psychological well-being (PWB) dimensions. This multi-center study aimed to evaluate how interactions between ADHD symptoms and psychosocial factors associated with ULBs (i.e., Allostatic Overload and multidimensional Psychological Well-Being), considered as moderators, could affect the adoption of ULBs during adolescence. A total of 440 fourteen-year-old adolescents were recruited from six upper secondary schools in Bologna and Rome (Italy) and completed self-report questionnaires on ULBs, ADHD, and psychosocial factors. Relations between ADHD symptomatology and specific ULBs (i.e., impaired sleep, problematic Internet use) were moderated by variables deemed as "negative" (i.e., Allostatic Overload) or "positive" (i.e., PWB dimensions of Self-Acceptance, Personal Growth, Positive Relations, Purpose in Life, Environmental Mastery): when the "negative" moderator is absent and the levels of the "positive" moderators are higher, ULBs decrease among students with lower ADHD symptomatology but increase among students with more severe ADHD. Based on ADHD severity, interventions should aim at promoting a state of euthymia, which consists in balanced PWB dimensions and reflects the optimal level of well-being to fulfill one's own potential and self-realization.

Psychometric properties of the cannabis abuse screening test (CAST) in a sample of Moroccans with cannabis use

BACKGROUND

The Cannabis Abuse Screening Test (CAST) is a widely used screening tool for identifying patterns of cannabis use that have negative health or social consequences for both the user and others involved. This brief screening instrument has been translated into multiple languages, and several studies examining its psychometric properties have been published. However, studies on the factorial validity and psychometric properties of a Moroccan version of the CAST are not yet available. The objective of this study is to validate the CAST, translated, and adapted to the Moroccan Arabic dialect among persons with cannabis use.

METHODS

A total of 370 participants from an addictology center in Fez City, were selected over two phases to form the study sample. First, in phase I, exploratory factor analysis was employed to evaluate the factor structure in the pilot sample (n1 = 150). Subsequently, in the second phase (Phase II), confirmatory factor analysis was utilized to confirm this structure in the validation sample (n2 = 220). All statistical analyses were carried out using the R program.

RESULTS

The CFA unveiled a three-factor structure that showed a good overall fit (χ2/df = 2.23, RMSEA = 0.07, SRMR = 0.02, CFI = 0.99, NFI = 0.98) and satisfactory local parameters (standardized factor loadings between 0.72 and 0.88). The model demonstrates satisfactory reliability and convergent validity, as evidenced by the acceptable values of composite reliability (CR) (0.76-0.88) and average variance extracted (AVE) (0.62-0.78), respectively. The square roots of the AVE exceeded the correlations of the factor pairs, and the heterotrait-monotrait (HTMT) ratio of the correlation values was below 0.85, indicating acceptable discriminant validity.

CONCLUSION

The reliability, convergent validity, and discriminant validity tests all demonstrated that the Moroccan version of the CAST performed well and can be considered a valid tool for screening of problematic cannabis use.

Country and sex measurement invariance of the Cannabis abuse screening test (CAST) in European Youth

BACKGROUND

Monitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils.

METHODS

The data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release.

RESULTS

Configural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway.

CONCLUSION

The CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe.

Non-prescribed pharmaceutical stimulants use among adolescents: A way to self-care or peer success?

BACKGROUND

the use of pharmaceutical stimulants without a medical prescription (PSWMP) among adolescents is considered an established public health issue. The present study aimed to investigate the potential links between different patterns of non-medical use of pharmaceutical stimulants, psycho-social factors, and other risky behaviours (e.g. psychoactive substance use).

METHODS

For this purpose, data from a sample of 14,685 adolescents aged 15-19 participating in the ESPAD®Italia 2019 study were analysed by conducting descriptive analyses and multinomial logistic regressions.

RESULTS

The findings highlight the key role of psycho-social factors and engagement in other risky behaviours in either reducing or promoting the risk of PSWMP use. Particularly, being satisfied with peer relationships and with oneself is significantly associated with lower use of PSWMP. Conversely, the consumption of other psychoactive substances (both legal and illegal) and engagement in other risky behaviours (e.g., gambling and cyberbullying) may increase this phenomenon.

CONCLUSIONS

Considering their representativeness, the results of the present study could be used as groundwork for the development of effective and targeted prevention programs and interventions.

Psychometric properties of CAST for early detection of problematic cannabis use in Spanish adolescents

The high prevalence rates of cannabis use in adolescents and its early onset constitutes a major public health problem, raising the need for its early detection. The availability of validated tools to analyze early cannabis use is essential to detect problematic use at an early age. The Cannabis Abuse Screening Test (CAST) (Legleye et al., 2007) is widely applied in Europe; however, the CAST cut-off scores vary according to the setting, the screening objective, and the correction version (CAST-f or CAST-b), creating therefore confusion in its application. Moreover, the psychometric properties of the CAST as a tool for detecting problematic cannabis use are understudied. To fill this gap, such psychometric properties have been analyzed in a sample of Spanish adolescents while using different cut-off scores for CAST-f and CAST-b. Based on our findings, the optimal cut-off scores are 2 points for CAST-b and 4 points for CAST-f. The internal reliability of CAST-f (α = 0.83) and CAST-b (KR-20 = 0.80) are satisfactory. Factorial analysis suggested the assumption of a one-dimension model. The CAST seems to be a valid and reliable tool for early screening of problematic cannabis use in Spanish adolescents.

Adolescent anxiety and depression: burden of disease study in 53,894 secondary school pupils in the Netherlands

BACKGROUND

Prevalence rates of anxiety and depression in adolescence are rising markedly in early adolescence. It is important to quantify the non-fatal disease burden of anxiety and depression, such that early interventions can be well targeted, and resources can be allocated in a just and optimal way. This study aimed to estimate the non-fatal disease burden of anxiety and depression with and without suicidal ideation in girls and boys aged 13, 14, and 15 years.

METHODS

Participants were 53,894 secondary school pupils who completed health questionnaires between September 2018 and July 2019. A design-based approach was used for complex survey data with post-stratification weights and taking clustering at school-level into account. At individual level, disability weights (DWs) were calculated for each disorder. At population level, DWs were multiplied by the point-prevalence per one thousand population of the respective disorders to compute years lived with disability (YLD). DWs and YLD of anxiety and depression were calculated with and without adjustment for comorbid eating disorders, substance use disorders and somatic illnesses.

RESULTS

The unadjusted DW of depression with suicidal ideation (0.30) was greater than without suicidal ideation (0.26), and both were greater than the DW of anxiety (0.24). A similar ranking was obtained after adjusting for comorbidities. At population level, where the prevalence of the disorders come into play, the YLD disease burden was greatest for anxiety, followed by depression with suicidal ideation and depression without suicidal ideation with 17.40, 9.85, and 5.28 YLD per one thousand population, unadjusted for comorbidities. This pattern was the same after adjustment, but then the total YLD of depression with and without suicidal ideation was similar to the YLD of anxiety (12.47 and 12.46, respectively). Girls showed a significantly greater YLD burden of anxiety and depression than boys, but no differences were found between different age groups.

CONCLUSIONS

From an individual clinical perspective, depression, especially when accompanied by suicidal ideation, was identified as a major health concern, especially in girls. From a public health perspective, both anxiety and depression, especially when accompanied by suicidal ideation, were identified as major drivers of disease burden, again most notably in girls.

The Relationship Between Affective and Obsessive-Compulsive Symptoms in Internet Use Disorder

We investigated the relationships and diagnostic power of symptoms associated with affective disorders, obsessive-compulsive disorder, and drug addictions on Internet use disorder. Moreover, we tested whether Internet use disorder is characterized by a specific network of symptoms. One-hundred-and-four young adults (78 women) were assessed in laboratory using self-report measures of Internet addiction, alcohol use disorder, cannabis abuse, depression, anxiety, and stress symptoms, impulsiveness, and obsessive-compulsive symptoms. Only hoarding, obsessing, and depression symptoms were positively linked to Internet use disorder severity, with hoarding having greater power and accuracy than other obsessive-compulsive and affective symptoms. Only individuals with mild-moderate Internet use disorder were characterized by a network of strong and positive associations of affective and obsessive-compulsive symptoms. These findings may encourage future longitudinal studies aimed at identifying potential clinical criteria for the diagnosis of Internet use disorder and treatment targets.

Association patterns of cannabis abuse and dependence with risk of problematic non-substance-related dysregulated and addictive behaviors

Co-occurrence of drug misuse with other dysregulated behaviors is common. This study was aimed at exploring the associations between the risk of presenting a clinically relevant condition involving non-substance-related addictive or dysregulated behaviors (as measured by the MultiCAGE CAD-4 screening), and cannabis abuse/dependence (CAST/SDS) scores, and the role of gender therein. Participants were recruited using stratified probabilistic sampling at the University of Granada. Mann-Whitney’s U tests were used to compare male and female students in SDS and CAST scores. Associations between gender and MultiCAGE scores were estimated using the γ ordinal correlation index, and tested with χ². For each MultiCAGE dimension, a Poisson-family mixed-effects model was built with either SDS or CAST as the main input variable, while controlling for nicotine and alcohol dependence, and relevant sociodemographic variables. Incidence rate ratios (IRR) were computed for SDS/CAST effects, and the significance threshold was family-wise Bonferroni-corrected. Gender differences were significant for cannabis dependence/abuse and all MultiCAGE scores for non-substance-related conditions, with males showing higher risk scores for excessive gambling, excessive internet use, excessive video gaming, and hypersexuality, and females presenting higher scores in dysregulated eating and compulsive buying. Cannabis dependence and abuse were significantly associated with a higher risk of problematic video gaming. These associations were mostly driven by males. Importantly, although risk of problematic video gaming was specifically associated with cannabis abuse/dependence, there was only a weak non-significant association between problematic video gaming and alcohol use scores. Risk of alcohol use problems, in turn, was strongly associated with all other non-substance-related problems (problematic gambling, excessive Internet use, dysregulated eating, compulsive buying, and hypersexuality). These differential associations can cast light on the etiological similarities and dissimilarities between problematic substance use and putative addictive behaviors not involving drugs.

Screening for Unhealthy Drug Use: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Illicit drug use is among the most common causes of preventable morbidity and mortality in the US.

OBJECTIVE

To systematically review the literature on screening and interventions for drug use to inform the US Preventive Services Task Force.

DATA SOURCES

MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials through September 18, 2018; literature surveillance through September 21, 2019.

STUDY SELECTION

Test accuracy studies to detect drug misuse and randomized clinical trials of screening and interventions to reduce drug use.

DATA EXTRACTION AND SYNTHESIS

Critical appraisal and data abstraction by 2 reviewers and random-effects meta-analyses.

MAIN OUTCOMES AND MEASURES

Sensitivity, specificity, drug use and other health, social, and legal outcomes.

RESULTS

Ninety-nine studies (N = 84 206) were included. Twenty-eight studies (n = 65 720) addressed drug screening accuracy. Among adults, sensitivity and specificity of screening tools for detecting unhealthy drug use ranged from 0.71 to 0.94 and 0.87 to 0.97, respectively. Interventions to reduce drug use were evaluated in 52 trials (n = 15 659) of psychosocial interventions, 7 trials (n = 1109) of opioid agonist therapy, and 13 trials (n = 1718) of naltrexone. Psychosocial interventions were associated with increased likelihood of drug use abstinence (15 trials, n = 3636; relative risk [RR], 1.60 [95% CI, 1.24 to 2.13]; absolute risk difference [ARD], 9% [95% CI, 5% to 15%]) and reduced number of drug use days (19 trials, n = 5085; mean difference, -0.49 day in the last 7 days [95% CI, -0.85 to -0.13]) vs no psychosocial intervention at 3- to 4-month follow-up. In treatment-seeking populations, opioid agonist therapy and naltrexone were associated with decreased risk of drug use relapse (4 trials, n = 567; RR, 0.75 [95% CI, 0.59 to 0.82]; ARD, -35% [95% CI, -67% to -3%] and 12 trials, n = 1599; RR, 0.73 [95% CI, 0.62 to 0.85]; ARD, -18% [95% CI, -26% to -10%], respectively) vs placebo or no medication. While evidence on harms was limited, it indicated no increased risk of serious adverse events.

CONCLUSIONS AND RELEVANCE

Several screening instruments with acceptable sensitivity and specificity are available to screen for drug use, although there is no direct evidence on the benefits or harms of screening. Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations.

Increased Resting State Triple Network Functional Connectivity in Undergraduate Problematic Cannabis Users: A Preliminary EEG Coherence Study

An increasing body of experimental data have suggested that aberrant functional interactions between large-scale networks may be the most plausible explanation of psychopathology across multiple mental disorders, including substance-related and addictive disorders. In the current research, we have investigated the association between problematic cannabis use (PCU) and triple-network electroencephalographic (EEG) functional connectivity. Twelve participants with PCU and 24 non-PCU participants were included in the study. EEG recordings were performed during resting state (RS). The exact Low-Resolution Electromagnetic Tomography software (eLORETA) was used for all EEG analyses. Compared to non-PCU, PCU participants showed an increased delta connectivity between the salience network (SN) and central executive network (CEN), specifically, between the dorsal anterior cingulate cortex and right posterior parietal cortex. The strength of delta connectivity between the SN and CEN was positively and significantly correlated with higher problematic patterns of cannabis use after controlling for age, sex, educational level, tobacco use, problematic alcohol use, and general psychopathology (r_p = 0.40, p = 0.030). Taken together, our results show that individuals with PCU could be characterized by a specific dysfunctional interaction between the SN and CEN during RS, which might reflect the neurophysiological underpinnings of attentional and emotional processes of cannabis-related thoughts, memories, and craving.

The Cannabis Abuse Screening Test and the DSM-5 in the general population: Optimal thresholds and underlying common structure using multiple factor analysis

The Cannabis Abuse Screening Test (CAST) aims at screening the problematic use of cannabis. It has never been validated against the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and its relationships with this latter have never been studied. We used a probabilistic telephone survey collected in 2014 (1351 past-year cannabis users aged 15-64) implementing the CAST and a DSM-5 adaptation of the Munich Composite International Diagnostic Interview assessing cannabis use disorders. Data were weighted, and CAST items were considered categorical. Factorial structures were assessed with confirmatory factor analyses; the relationships between the instruments were studied with multiple factor analysis (MFA). One factor for the DSM-5 and two correlated factors for the CAST were the best confirmatory factor analyses solutions. The CAST thresholds for screening moderate/severe and severe cannabis use disorders were 5 (sensitivity = 78.2% and specificity = 79.6%) and 8 (sensitivity = 86.0% and specificity = 86.7%), respectively. The MFA identified two orthogonal dimensions: The first was equally shared by both instruments; the second was the second CAST dimension (extreme frequencies of use before midday and alone, memory problems, and reproaches from friends/family). The CAST structure and screening properties were confirmed. The MFA explains its screening performances by its first dimension and identified the problematic patterns (the second dimension) that are not captured by the DSM-5.

Autonomic stress reactivity and craving in individuals with problematic Internet use

The link between autonomic stress reactivity and subjective urge/craving has been less systematically examined in behavioral addictions (i.e. problematic Internet use) than in substance use disorders. The present study investigated whether problematic Internet users (PU) show enhanced autonomic stress reactivity than non-PU, indexed by lower Heart Rate Variability (HRV) and higher Skin Conductance Level (SCL) reactivity during the Trier Social Stress Test (TSST), whether greater reactivity is related to stronger Internet craving, and whether problematic Internet usage is associated with some dysfunctional psychological features. Based on their Internet Addiction Test scores, participants were divided into PU (N = 24) and non-PU (N = 21). Their heart rate and skin conductance were continuously recorded during baseline, social stressors, and recovery. Craving for Internet usage were collected using a Likert scale before and after the TSST. The SDNN, an overall measure of HRV, was significantly lower in PU than non-PU during baseline, but not during and after stressful task. Furthermore, only among PU a significant negative correlation emerged between SDNN during recovery and craving ratings after the test. No group differences emerged for SCL. Lastly, PU endorsed more mood, obsessive-compulsive, and alcohol-related problems. Our findings suggest that problems in controlling one’s use of the Internet may be related to reduced autonomic balance at rest. Moreover, our results provide new insights into the characterization of craving in PIU, indicating the existence of a relationship between craving for Internet usage and reduced autonomic flexibility.

Age Invariance of the Cannabis Abuse Screening Test in a Probabilistic Sample of Cannabis Users

The Cannabis abuse screening test (CAST) is a short test used for screening those with problematic cannabis use. Recently, its invariance toward age was tested in an Israeli sample of cannabis users, but this study had some sample and methodological limitations: it was conducted in a volunteer sample aged 18-40 and considered the CAST items as continuous variables, although they are based on 5-point Likert scales. We thus tested the CAST invariance toward age (15-24, 25-34, and 35-64 years old) using a French probabilistic sample of 1,351 past-year cannabis users aged 15-64 and using appropriate methods for categorical items and survey weights. Factors retained (non-recreational use and problems) were the same as those mentioned in previous studies. Scalar invariance held for the "problems" factor but only partial scalar invariance was supported for the "non-recreational use" factor. Caution is thus needed when the CAST score is compared across age groups.

Application of randomized response techniques for investigating cannabis use by Spanish university students

Cannabis is the most widely used illicit drug in developed countries, and has a significant impact on mental and physical health in the general population. Although the evaluation of levels of substance use is difficult, a method such as the randomized response technique (RRT), which includes both a personal component and an assurance of confidentiality, provides a combination which can achieve a considerable degree of accuracy. Various RRT surveys have been conducted to measure the prevalence of drug use, but to date no studies have been made of the effectiveness of this approach in surveys with respect to quantitative variables related to drug use. This paper describes a probabilistic, stratified sample of 1146 university students asking sensitive quantitative questions about cannabis use in Spanish universities, conducted using the RRT. On comparing the results of the direct question (DQ) survey and those of the randomized response (RR) survey, we find that the number of cannabis cigarettes consumed during the past year (DQ = 3, RR = 17 approximately), and the number of days when consumption took place (DQ = 1, RR = 7) are much higher with RRT. The advantages of RRT, reported previously and corroborated in our study, make it a useful method for investigating cannabis use. Copyright © 2016 John Wiley & Sons, Ltd.

Energy Drink and Alcohol mixed Energy Drink use among high school adolescents: Association with risk taking behavior, social characteristics

PURPOSE

The aims of the study were to: a) examine the prevalence of energy drink (ED) and alcohol mixed with energy drink (AmED) consumption; b) investigate the relationships between ED and AmED with alcohol, binge drinking and drugs accounting for at risk behaviors among a representative sample of Italian adolescents.

METHODS

A representative sample of 30,588 Italian high school students, aged 15-19years, was studied. Binary and multivariate logistic regression analyses were performed to determine the independent association of the potential predictors' characteristics with the ED and AmED drinking during the last year.

RESULTS

Respectively 41.4% and 23.2% of respondents reported drinking EDs and AmEDs in the last year. Multivariate analysis revealed that consumption of EDs and AmEDs during the last year were significantly associated with daily smoking, binge drinking, use of cannabis and other psychotropic drugs. Among life habits and risky behaviors the following were positively associated: going out with friends for fun, participating in sports, experiencing physical fights/accidents or injury, engaging in sexual intercourse without protection and being involved in accidents while driving.

CONCLUSIONS

This study demonstrates the popularity of ED and AmED consumption among the Italian school population aged 15-19years old: 4 out of 10 students consumed EDs in the last year and 2 out of 10 AmED. Multivariate analysis highlighted the association with illicit drug consumption and harming behaviors, confirming that consumption of EDs and AmEDs is a compelling issue especially during adolescence, as it can effect health as well as risk taking behaviors.

Assessing the structure of the CAST (Cannabis Abuse Screening Test) in 13 European countries using multigroup analyses

Our aims are to describe and explain the structure of the Cannabis Abuse Screening Test (CAST) across countries. Standard statistical analyses fail to describe and explain several variables simultaneously while taking account of the group structure of individuals. The 2011 European School Survey Project on Alcohol and other Drugs (ESPAD): 5204 last-year cannabis users aged 15-16 from 13 European countries. Multigroup principal component analysis (mgPCA) and multigroup partial least squares (mgPLS). MgPCA shows that the CAST has a two-dimensional structure (frequency of use/problems and non-recreational use/dependency symptoms). All the countries present a good concordance with the common structure, except Kosovo, Lichtenstein and Romania. MgPLS shows that three explanative variables (in a total of eight) are mainly related with the CAST (the frequencies of cannabis use in the last 12 months and in the last 30 days and the age at first cannabis use) while Kosovo, Lichtenstein and Romania also present specificities. The CAST structure appears stable in the 13 countries except for Kosovo, Lichtenstein and Romania that also show specific relationships between the CAST variables and their determinants.

Definitions of Risky and Problematic Cannabis Use: A Systematic Review

Although cannabis is widely used, it remains unclear which consumption patterns are more likely to produce future consequences (risky/hazardous use) or current damage (problematic/harmful use). This unresolved issue contributes to cannabis public health implications. In order to facilitate further consensus, this review analyzes previously used definitions in the literature.

METHODS

This systematic review was performed following the PRISMA guidelines. Articles published before October 2015 in the Medline, Scopus-Elsevier, ISI-Web of Knowledge and Cochrane databases and fulfilling a-priori decided criteria were retrieved. Definitions in preselected websites of national and international organizations addressing drug problems were also included.

RESULTS

Definitions identified in articles (n = 46) and official websites (n = 3) widely varied from each other. Weekly cannabis use was mostly considered risky. Problematic cannabis use was mostly described with the Cannabis Abuse and Screening Test. Evidence-based definitions as well as information on quantities consumed, time-frames and special considerations for risky groups were very limited.

CONCLUSIONS

Working on official definitions is highly necessary as criteria used remain incomplete, leading to increased confusion in the field. Recommendations to improve existing definitions are given.

Transdiagnostic processes linking anxiety symptoms and substance use problems among adolescents

Numerous anxiety syndromes co-occur with substance use problems in adolescents, though the mechanisms underlying these comorbidities are not well understood. There are 3 transdiagnostic processes-anxiety sensitivity (fear of anxiety-related sensations), distress tolerance (capacity to withstand emotional distress), and negative urgency (propensity to respond impulsively to negative emotion)-that have been implicated in various anxiety and substance use problems. To examine whether anxiety sensitivity, distress tolerance, and negative urgency statistically mediated relations between symptoms of 3 different anxiety disorders (social anxiety, generalized anxiety, and panic disorders) and alcohol and cannabis use problems, cross-sectional analysis of high school students in Los Angeles (N = 3002) was assessed via paper and pencil questionnaires. When mediators were entered simultaneously, negative urgency accounted for a significant 33 to 85% of the covariance between anxiety symptomatology and substance use problems over and above the other trandiagnostic processes. This pattern was consistent across all 3 anxiety syndromes and both alcohol and cannabis problems. Anxiety sensitivity and distress tolerance did not account for positive associations between anxiety symptoms and substance use problems. Negative urgency may be an important mechanism underlying the relationship between various types of anxiety and substance use problems in adolescence, and thus represents a possible target for preventive interventions targeting adolescent anxiety and substance use.

Psychiatric comorbidity in adolescent electronic and conventional cigarette use

The popularity of electronic (e-) cigarettes has greatly increased recently, particularly in adolescents. However, the extent of psychiatric comorbidity with adolescent e-cigarette use and dual use of conventional (combustible) and e-cigarettes is unknown. This study characterized psychiatric comorbidity in adolescent conventional and e-cigarette use. Ninth grade students attending high schools in Los Angeles, CA (M age = 14) completed self-report measures of conventional/e-cigarette use, emotional disorders, substance use/problems, and transdiagnostic psychiatric phenotypes consistent with the NIMH-Research Domain Criteria Initiative. Outcomes were compared by lifetime use of: (1) neither conventional nor e-cigarettes (non-use; N = 2557, 77.3%); (2) e-cigarettes only (N = 412, 12.4%); (3) conventional cigarettes only (N = 152, 4.6%); and (4) conventional and e-cigarettes (dual use; N = 189, 5.6%). In comparison to adolescents who used conventional cigarettes only, e-cigarette only users reported lower levels of internalizing syndromes (depression, generalized anxiety, panic, social phobia, and obsessive-compulsive disorder) and transdiagnostic phenotypes (i.e., distress intolerance, anxiety sensitivity, rash action during negative affect). Depression, panic disorder, and anhedonia were higher in e-cigarette only vs. non-users. For several externalizing outcomes (mania, rash action during positive affect, alcohol drug use/abuse) and anhedonia, an ordered pattern was observed, whereby comorbidity was lowest in non-users, moderate in single product users (conventional or e-cigarette), and highest in dual users. These findings: (1) raise question of whether emotionally-healthier ('lower-risk') adolescents who are not interested in conventional cigarettes are being attracted to e-cigarettes; (2) indicate that research, intervention, and policy dedicated to adolescent tobacco-psychiatric comorbidity should distinguish conventional cigarette, e-cigarette, and dual use.

A score for measuring health risk perception in environmental surveys

BACKGROUND

In environmental surveys, risk perception may be a source of bias when information on health outcomes is reported using questionnaires. Using the data from a survey carried out in the largest chipboard industrial district in Italy (Viadana, Mantova), we devised a score of health risk perception and described its determinants in an adult population.

METHODS

In 2006, 3697 parents of children were administered a questionnaire that included ratings on 7 environmental issues. Items dimensionality was studied by factor analysis. After testing equidistance across response options by homogeneity analysis, a risk perception score was devised by summing up item ratings.

RESULTS

Factor analysis identified one latent factor, which we interpreted as health risk perception, that explained 65.4% of the variance of five items retained after scaling. The scale (range 0-10, mean ± SD 9.3 ± 1.9) had a good internal consistency (Cronbach's alpha 0.87). Most subjects (80.6%) expressed maximum risk perception (score = 10). Italian mothers showed significantly higher risk perception than foreign fathers. Risk perception was higher for parents of young children, and for older parents with a higher education, than for their counterparts. Actual distance to major roads was not associated with the score, while self-reported intense traffic and frequent air refreshing at home predicted higher risk perception.

CONCLUSIONS

When investigating health effects of environmental hazards using questionnaires, care should be taken to reduce the possibility of awareness bias at the stage of study planning and data analysis. Including appropriate items in study questionnaires can be useful to derive a measure of health risk perception, which can help to identify confounding of association estimates by risk perception.

Properties of the Cannabis Abuse Screening Test (CAST) in the general population

This paper explores the DSM-IV latent structure of cannabis users (especially its invariance towards gender and age) and assesses the psychometric properties of the Cannabis Abuse Screening Test (CAST) by confrontation with the theoretical diagnoses [dependence and cannabis use disorders (CUD)] and the latent class structure of the DSM-IV. The random sample comprised 550 French cannabis smokers aged 15-62 years interviewed by telephone. DSM-IV diagnoses were assessed with the Munich Composite International Diagnostic Interview. Internal structures of both instruments were assessed using factor analysis and latent class analysis. Optimal CAST cutoffs were determined by sensitivity, specificity and area under the receiver operating curve (AUC). CAST and DSM-IV were unidimensional (Cronbach's α = 0.742 and 0.752, respectively), although a two-factor solution showed a better fit for the CAST. CAST cutoffs for screening CUD and dependence were three (AUC = 0.851) and five (AUC = 0.868), respectively. DSM-IV latent class structure varied only marginally in age and gender. Three classes of cannabis smokers were determined, ordered along a continuum of symptoms: non-symptomatic (61.1%), moderate (32.9%) and severe (6.0%). CAST cutoff scores for screening moderate/severe and severe were, respectively, three (AUC = 0.869) and eight (AUC = 0.952). Results are compared to those obtained in previous CAST studies and discussed in line with the DSM-5.

Severity of khat dependence among adult khat chewers: the moderating influence of gender and age

ETHNOPHARMACOLOGICAL RELEVANCE

The escalating use of khat (Catha edulis) in East Africa and Arabia is a major concern for public health. Yet little is known about the impact of khat on behavior. There has been no study in the region to assess the extent to which dependence syndrome is associated with khat use in this population.

AIM OF THE STUDY

To examine psychometric properties of the Severity of Dependence Scale-Khat (SDS-khat), gender differences in patterns of khat use and dependence, and the extent to which age moderated the link between gender and khat dependence.

MATERIALS AND METHODS

Two-hundred and seventy khat chewers recruited in two Yemeni cities completed face-to-face interviews asking about demographics and patterns of khat use. Validity of SDS-khat was examined by the principle component analysis and reliability of the scale was tested by Cronbach׳s alpha. A series of chi-square tests and analysis of variances (ANOVAs) were conducted to examine gender differences in khat use variables.

RESULTS

The results indicated that the mean age of khat chewers was 30.52 years (95% CI: 29.34, 31.70) and 52% of them were males. The SDS-khat was found to have two factors with moderate reliability. This pattern was consistent when the analysis was conducted in the entire sample and in each gender. Male khat chewers reported more symptoms related to khat dependence than female chewers. A significant gender by age interaction in SDS-khat levels (p=0.013) revealed a positive association between age and khat dependence in women only.

CONCLUSION

These results provide initial support for the use of SDS-khat in the assessment of khat dependence in Yemen. Gender differences in khat use patterns and dependence observed in this study call the need for more studies carefully examining the role of gender in khat research.

Predicting cannabis abuse screening test (CAST) scores: a recursive partitioning analysis using survey data from Czech Republic, Italy, the Netherlands and Sweden

Introduction

Cannabis is Europe's most commonly used illicit drug. Some users do not develop dependence or other problems, whereas others do. Many factors are associated with the occurrence of cannabis-related disorders. This makes it difficult to identify key risk factors and markers to profile at-risk cannabis users using traditional hypothesis-driven approaches. Therefore, the use of a data-mining technique called binary recursive partitioning is demonstrated in this study by creating a classification tree to profile at-risk users.

Methods

59 variables on cannabis use and drug market experiences were extracted from an internet-based survey dataset collected in four European countries (Czech Republic, Italy, Netherlands and Sweden), n = 2617. These 59 potential predictors of problematic cannabis use were used to partition individual respondents into subgroups with low and high risk of having a cannabis use disorder, based on their responses on the Cannabis Abuse Screening Test. Both a generic model for the four countries combined and four country-specific models were constructed.

Results

Of the 59 variables included in the first analysis step, only three variables were required to construct a generic partitioning model to classify high risk cannabis users with 65–73% accuracy. Based on the generic model for the four countries combined, the highest risk for cannabis use disorder is seen in participants reporting a cannabis use on more than 200 days in the last 12 months. In comparison to the generic model, the country-specific models led to modest, non-significant improvements in classification accuracy, with an exception for Italy (p = 0.01).

Conclusion

Using recursive partitioning, it is feasible to construct classification trees based on only a few variables with acceptable performance to classify cannabis users into groups with low or high risk of meeting criteria for cannabis use disorder. The number of cannabis use days in the last 12 months is the most relevant variable. The identified variables may be considered for use in future screeners for cannabis use disorders.