Drug use patterns in young adulthood and post-college employment

Cannabis Use During Adolescence and Young Adulthood and Academic Achievement: A Systematic Review and Meta-Analysis

Importance

Cannabis use during adolescence and young adulthood may affect academic achievement; however, the magnitude of association remains unclear.

Objective

To conduct a systematic review evaluating the association between cannabis use and academic performance.

Data Sources

CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, Scopus, and Web of Science from inception to November 10, 2023.

Study Selection

Observational studies examining the association of cannabis use with academic outcomes were selected. The literature search identified 17 622 unique citations.

Data Extraction and Synthesis

Pairs of reviewers independently assessed risk of bias and extracted data. Both random-effects models and fixed-effects models were used for meta-analyses, and the Grading of Recommendations Assessment, Development, and Evaluation approach was applied to evaluate the certainty of evidence for each outcome. Data were analyzed from April 6 to May 25, 2024.

Main Outcomes and Measures

School grades, school dropout, school absenteeism, grade retention, high school completion, university enrollment, postsecondary degree attainment, and unemployment.

Results

Sixty-three studies including 438 329 individuals proved eligible for analysis. Moderate-certainty evidence showed cannabis use during adolescence and young adulthood was probably associated with lower school grades (odds ratio [OR], 0.61 [95% CI, 0.52-0.71] for grade B and above); less likelihood of high school completion (OR, 0.50 [95% CI, 0.33-0.76]), university enrollment (OR, 0.72 [95% CI, 0.60-0.87]), and postsecondary degree attainment (OR, 0.69 [95% CI, 0.62-0.77]); and increased school dropout rate (OR, 2.19 [95% CI, 1.73-2.78]) and school absenteeism (OR, 2.31 [95% CI, 1.76-3.03]). Absolute risk effects ranged from 7% to 14%. Low-certainty evidence suggested that cannabis use may be associated with increased unemployment (OR, 1.50 [95% CI, 1.15-1.96]), with an absolute risk increase of 9%. Subgroup analyses with moderate credibility showed worse academic outcomes for frequent cannabis users and for students who began cannabis use earlier.

Conclusions and Relevance

Cannabis use during adolescence and young adulthood was probably associated with increases in school absenteeism and dropout; reduced likelihood of obtaining high academic grades, graduating high school, enrolling in university, and postsecondary degree attainment; and perhaps increased unemployment. Further research is needed to identify interventions and policies that mitigate upstream and downstream factors associated with early cannabis exposure.

A suicide prevention initiative across a multi-campus university before and during the COVID-19 pandemic

Increasing rates of depression, anxiety, substance use, and suicidal thoughts and behaviors among college students were exacerbated by the COVID-19 pandemic. This report describes how components of the Johns Hopkins Suicide Prevention Awareness, Response and Coordination (JH-SPARC) Project aligned with a multi-faceted strategy for suicide prevention. Key programs included suicide screening, gatekeeper trainings, and the use of third-party mental health services. Regarding suicide screening outcomes, staff sent 36,148 individual emails inviting students and trainees to participate in stress and depression screening. This approach garnered 2,634 responses and connected 130 students to care, 66 of whom (50.8%) indicated suicidal thoughts, plans, or behaviors. We estimate this screening cost $2.97 per student. Important lessons included the reliance on virtual platforms and the need to coordinate efforts across multiple campuses. Our manuscript provides an example of a transferable strategy for suicide prevention on college campuses in the pandemic era.

The influence of diet quality on health-related quality of life in undergraduates

Objective: Explore the relationship between fruit and vegetable (FV) intake and health-related quality of life (HRQOL) in undergraduates. Participants: Undergraduates (N = 655). Methods: Using the Centers for Disease Control's Healthy Days Core Module and National Cancer Institute's (NCI) FV screener, differences in HRQOL between students who had consumed above the sample's average FV intake and their counterparts were evaluated. Multiple regression analyses assessed behaviors that predicted HRQOL. Results: Differences existed between HRQOL of students who consumed above average FV (M = 2.2 1.3) and peers, F(9,602) = 509, p < 0.001, Wilk's Δ = 0.116, partial n2 = 0.884. Predictors explained 30.0% of the variance in days per month feeling healthy (r2 = 0.29, F(4, 549) = 58.6, p < 0.001): perceived stress (β = 0.46, p < 0.001), body mass index (BMI) (β = 0.11, p < 0.01), FV intake (β = 0.16, p < 0.001), and sleep duration (β = 0.08, p < 0.05). Conclusions: FV intake and modifiable behaviors influenced HRQOL, suggesting that multifaceted interventions could improve HRQOL in this population.

Associations of active-duty mental health trajectories with post-military adjustment: Results from the STARRS Longitudinal Study

BACKGROUND

Many servicemembers experience difficulties transitioning from military to civilian life. We examined whether changes in mental health observed during active duty were associated with indices of post-military adjustment.

METHODS

Survey data from the multi-wave Army STARRS Pre/Post Deployment Study (PPDS; conducted 2012-2014) were linked to follow-up data from wave 1 of the STARRS Longitudinal Study (STARRS-LS1; conducted 2016-2018). Empirical Bayes estimates of intercepts and slopes of posttraumatic stress, problematic anger, and depressive symptoms during the PPDS were extracted from mixed-effects growth models and evaluated as predictors of life stress among 1080 participants who had separated or retired from the Army at STARRS-LS1; and of job satisfaction among 586 veterans who were employed at STARRS-LS1.

RESULTS

Higher average levels and larger increases in posttraumatic stress, anger, and depression over the deployment period were each associated with increased stress and (in the case of anger and depression) reduced job satisfaction. Posttraumatic stress and anger slopes were associated with overall stress (b = 5.60, p < 0.01 and b = 15.64, p = 0.04, respectively) and relationship stress (b = 5.50, p = 0.01 and b = 22.86, p = 0.01, respectively) beyond the average levels of those symptoms.

LIMITATIONS

Some transition-related difficulties may have resolved before outcome assessment; some measures were not previously validated.

CONCLUSIONS

Larger increases in posttraumatic stress and anger over a deployment period were associated with increased stress after leaving the Army, even after controlling for average symptom levels during the same period. Monitoring changes in mental health during active duty may help identify personnel who need additional support to facilitate the military-to-civilian transition.

Alcohol and marijuana use predicting next-day absenteeism and engagement at school and work: A daily study of young adults

This study examined effects of alcohol and marijuana use on next-day absenteeism and engagement at work and school among young adults (18-25 years old) who reported past-month alcohol use and simultaneous alcohol and marijuana use. Participants completed twice daily surveys for five, 14-day bursts. The analytic sample was 409 [64 % were enrolled in university (N = 263) and 95 % were employed (N = 387) in at least one burst]. Daily measures included: any alcohol or marijuana use, quantity of alcohol or marijuana use (i.e., number of drinks, number of hours high), attendance at work or school, and engagement (i.e., attentiveness, productivity) at school or work. Multilevel models examined between- and within-person associations between alcohol and marijuana use and next-day absenteeism and engagement at school or work. Between-persons, the proportion of days of alcohol use days was positively associated with next-day absence from school, consuming more drinks was positively associated with next-day absence from work, and the proportion of days of marijuana use was positively associated with next-day engagement at work. At the daily-level, when individuals consumed any alcohol and when they consumed more drinks than average, they reported lower next-day engagement during school and work. When individuals used marijuana and when they were high for more hours than average, they reported lower next-day engagement during school. Findings suggest alcohol and marijuana use consequences include next-day absence and decrements in next-day engagement at school and work, which could be included in interventions aimed at ameliorating harmful impacts of substance use among young adults.

Unemployment and Substance Use: An Updated Review of Studies from North America and Europe

Since the industrial revolution, the relationship between unemployment and psychiatric disorders has been a subject of high interest. Currently, regarding the correlation between unemployment and substance-use disorders (SUDs), only older, often isolated and fragmented research results are available in the literature. This review was based on an extensive literature search of the European and North American literature in most relevant databases for "unemployment" and "substance use" related to "drugs", "alcohol", "nicotine", and "tobacco" between November 2022 and January 2023, according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) guidelines. A total of 59,117 papers were identified, of which only 33 articles were identified as relevant to the research objective. The literature showed significantly higher prevalence rates of SUDs involving divergent psychotropic substances among unemployed people. Unemployment was found to be a risk factor for SUD, and vice versa. However, the correlation between unemployment and relapses or smoking cessation was inconsistent. In addition, there appeared to be a mild effect of business cycles on SUD. The results showed significant multifaceted correlations between unemployment and SUD, indicating that prevention and early intervention are required to prevent harmful psychosocial consequences, such as social disintegration and severe psychiatric disorders.

Digital screening and brief intervention for illicit drug misuse in college students: A mixed methods, pilot, cluster, randomized trial from India

BACKGROUND

Adolescence and early adulthood are vulnerable periods for substance use-related disorders later in life. The use of internet-enabled interventions can be useful, especially in low-resource settings.

AIMS

To examine the feasibility, acceptability, and preliminary effectiveness of single-session digital screening and brief intervention (d-SBI) for illicit drug misuse in college students and explore barriers and facilitators of d-SBI.

METHODS

Design: Mixed-methods, pilot cluster randomized trial.

SETTING

Four conveniently selected colleges were randomized into intervention and control groups.

PARTICIPANTS

219 students were screened, and 37 fulfilled eligibility. Twenty-four completed follow-ups. In-depth interviews were done with ten students. Intervention and Comparator: Following a digital screening, Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) based brief intervention was provided in the d-SBI group. The control group received brief education.

MEASUREMENTS

Acceptability was assessed by direct questions and usage statistics. ASSIST scores of groups were assessed at baseline and 3 months. Inductive coding of the interview transcript was done.

RESULTS

More than 50 % of participants found d-SBI user-friendly, appropriate, and useful. Eighty percent of users, who logged in, completed screening. Per-protocol analysis showed a reduction in cannabis-ASSIST score over 3 months. The mean ASSIST score for other drugs combined did not differ significantly between groups. The difference in risk transition (moderate to low) was not significant. Qualitative analysis revealed three overarching themes- recruitment, engagement, and behavior change.

CONCLUSIONS

Digital SBI for drug misuse is feasible among college students. d-SBI might be effective in reducing cannabis use.

Alcohol Abuse Associated with Accumulated Periods of Precarious Employment: A Four-Year Follow-Up Study of a Young Population in Korea

This study aims to explore how precarious employment among young age groups affects alcohol-use disorders. Using samples from Youth Panel 2007, a longitudinal and annual follow-up survey, the association between alcohol-use disorder assessed with CAGE and the accumulated years of precarious employment was assessed with logistic regression analysis. During the 4-year follow-up period, precarious employment for 2–4 years (OR 2.08, 95% CI 1.02–4.24) showed a significantly increased risk of alcohol-use disorder compared with the full-time permanent sustained group. Among young male adults, precarious employment for 2–4 years (OR 2.57, 95% CI 1.07–6.14) also showed a significantly increased risk of alcohol-use disorder, while it was not significant in women (OR 1.51, 95% CI 0.43–5.31). Although the prevalence of alcohol-use disorders was highest in groups with precarious employment for 2–4 years among female young adults, no significant association between alcohol-use disorders and precarious employment was found. This study suggests that the longer the precarious employment, the higher the risk of alcohol-dependence disorder, and showed that the tendency was stronger in males. In addition, because people engaged in precarious employment are vulnerable to alcohol-use disorders, policy programs focusing on them are needed.

The influence of childhood and early adult adversities on substance use behaviours in racial/ethnically diverse young adult women: a latent class analysis

Childhood and adult adversities occur more frequently among women and persons of colour, possibly influencing racial/ethnic disparities in substance use behaviours. This study investigates how childhood and adult adversities cluster together by race/ethnicity and how these clusters predict binge drinking, tobacco, e-cigarette, and marijuana use. Latent class analysis (LCA) was used in a combined sample from the 2015 to 2018 Minnesota College Student Health Survey to identify clusters of childhood and adult adversities among Asian, Black, Latina, and White women aged 18-25. Each substance use outcome was regressed on each adversity cluster across each race/ethnicity group. Across all racial/ethnic groups and substance use outcomes, the high adversity cluster exhibited the greatest risk. Significant racial/ethnic disparities were observed across several substance use behaviours; these were attenuated among women with fewer adversities. The reduced substance use disparities found among those with lower adversities suggest that prevention of adversities may advance health equity.

Thinking about Social Determinants of Health through the Relationality of Work and Drug Use

Public health often frames drug use and addiction as destructive and antithetical to productive citizenship, particularly formal employment. Anthropologists show how drug use emerges in specific institutional, social, and political economic contexts. This attention to context suggests that the relationship between drug use and work may not be as stable as epidemiology models it. There is a multiplicity to the relationality of work and drug use. These results are based on in-depth interviews conducted in 2018 and 2019 with 16 individuals undergoing addiction treatment at a residential facility in northern Arizona. In some cases, drug and alcohol use led to losing work. In other cases, drug and alcohol use made work more possible. The entanglements between work and drug use fluctuated through time. Social determinants of health are relationally brought into being, part of larger assemblages, and dynamic.

Treatments, Perceived Stigma, and Employment Outcomes among Substance Abusers in China

Employment is a vital component of a substance abuser's recovery, but little is known about how stigma affects employment for substance abusers receiving treatment. The current study investigates the effects of stigma and treatment on employment in the Chinese context. Using a sample of substance abusers (N = 3.978), multiple logistics regressions with moderation effects were employed. The findings show that treatments positively reduce confirmative experiences of anticipated stigma, and promote employment only when respondents do not perceive stigma. The findings highlight the impact of perceived stigma on limiting substance abusers' chances of being employed, implying that eliminating stigma is the foundation for recovery. Possible strategies that can be explored for reducing stigma are discussed.

Adolescent cannabis experimentation and unemployment in young to mid-adulthood: Results from the French TEMPO Cohort study

BACKGROUND

France accounts for one of the highest levels of recreational cannabis use, with almost 40% of youth aged 17 reporting having experimented with cannabis. We investigated the impact of early cannabis experimentation (defined as first-time use ≤ 16 years) on future probability of unemployment in young to mid-adulthood using a longitudinal, community sample over the span of 9 years.

METHODS

Data were obtained from the French TEMPO Cohort study, set up in 2009 among young adults aged 22-25 years old. Participants who reported information on age of cannabis experimentation and employment status in at least one study wave (2009, 2011, 2015 and 2018) were included in the statistical analyses (N = 1487, 61.2% female).

RESULTS

In A-IPW-adjusted analyses, early cannabis experimenters (≤ 16 years) had 1.71 (95% CI: 1.46-2.02) times higher odds of experiencing unemployment compared to late cannabis experimenters (> 16 years) and 2.40 (95% CI: 2.00 - 2.88) times higher odds of experiencing unemployment compared to non-experimenters. Late cannabis experimenters experienced 1.39 (95% CI: 1.17-1.68) times higher odds of being unemployed compared to non-experimenters, and early cannabis experimenters experienced 3.84 (95%CI: 2.73-5.42) times higher odds of experiencing long-term unemployment (defined as unemployed at least twice) compared to non-experimenters.

CONCLUSIONS

Participants who ever used cannabis, especially at or before the age of 16, had higher odds of experiencing unemployment, even when accounting for many psychological, academic and family characteristics which preceded cannabis initiation.

Assessment of characteristics and exposure to vulnerable factors for drug use among male illicit drug users in Sri Lanka: A multicenter cross-sectional study

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Methodology:

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How marijuana use status affects responses to anti-marijuana messages

Background

The current study examined how cannabis use status impacts cognitive and emotional reactions to public health campaigns about cannabis, and the degree to which these reactions influence message likeability and attitudes about cannabis-related harms.

Methods

In a between-subjects design, 252 subjects recruited via Amazon Mechanical Turk viewed six real-world cannabis education messages: three message themes (cognitive ability, driving, and health harms) from each of two real-world public campaigns. Subjects answered questions measuring their cognitive and emotional reactions to each message as well as message likeability and harm perceptions of cannabis. Analyses examined the mediating effects of message responsiveness on the association between baseline cannabis use (user vs non-user) with indices of liking and harm.

Results

For all three message themes, informativeness ratings mediated the effect of cannabis user status on the outcomes of perceived harmfulness and message likeability. Specifically, cannabis users perceived cannabis as less harmful and reported all messages as less likeable compared to non-users, partly because they perceived the messages to be less informative than non-users. Surprisingly, users found some of the messages to be more pleasant, which was associated with increased perceptions of harm and message liking compared to non-users.

Conclusions

Cannabis education campaigns that take into account differences in emotional and cognitive reactions by use experience, rather than use a "one size fits all" approach, could possibly maximally impact likeability and harm perceptions of these messages.

A Prospective Longitudinal Cohort Study of College Students' Alcohol and Abstinence Displays on Social Media

PURPOSE

The past decade has seen tremendous growth in research focused on understanding college students' alcohol-related social media displays. However, longitudinal studies remain rare. The purpose of this 5-year study was to describe alcohol and abstinence display patterns on Facebook.

METHODS

This prospective longitudinal cohort study recruited incoming 17- to 19-year-old college students from two universities upon entering college. Trained coders evaluated Facebook profiles monthly over five years to identify alcohol and abstinence displays. Alcohol displays were further categorized as general alcohol use or intoxication/problem drinking references. Analyses included multivariate negative binomial regression.

RESULTS

Among 338 participants recruited (mean age = 18.4, SD = .6), 56.1% were female, 74.8% were Caucasian, and 58.8% were from the Midwest college. General alcohol use references were most common in the spring semester of the third year (mean = 3.9 displays; 95% CI: 3.21-4.73), these often included references to a "21 run." Intoxication/problem drinking references were most common in spring semester of the first year (mean = .79 displays, 95% confidence interval: .56-1.10) and second year of college (mean = .77 displays, 95% confidence interval: .54-1.11). There were no gender differences associated with alcohol displays at any time point. Abstinence displays were rare and declined in frequency to a low of four total displays in year 5.

CONCLUSIONS

This 5-year study is the first to document patterns of alcohol and abstinence displays throughout the undergraduate experience. Findings may inform planning targeted interventions by time point, or longitudinal studies of other substances or on different platforms.

Risk for alcohol use/misuse among entering college students: The role of personality and stress

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We examined unique and joint effects of stress and personality on alcohol misuse.

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Factor-level Neuroticism is not uniquely associated with more alcohol misuse.

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Higher Neuroticism—Depression facet scores are associated with more alcohol misuse.

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Neuroticism—Depression moderates the association between stress and alcohol misuse.

Introduction

Excessive alcohol use amongst college students is associated with low grades, poor mental health, and risks to physical safety. Neuroticism, characterized by emotional instability and anxiety, and self-reported stress have both been shown to be strong predictors of alcohol use and misuse, however, previous studies have shown that measures of stress and Neuroticism are frequently confounded. This study tests the hypothesis that personality traits, and Neuroticism in particular, predict alcohol use/misuse in matriculating freshmen above and beyond reported levels of stress.

Methods

Data were collected as part of an IRB-approved longitudinal study, MAPme, examining behavioral health in college. Participants were 303 first-year college students (70% female) with an average age of 18.58 (SD = 0.39). Data were collected during the first eight weeks of the first semester at college.

Results

Overall, domain-level Neuroticism was not associated with alcohol use/misuse above and beyond perceived levels of stress and other Big Five domains (β = 0.14, p = 0.088). Notably, the depression facet of Neuroticism (Neuroticism—Depression), was positively associated with alcohol use/misuse when accounting for the shared effects of stress. Results demonstrated that the Neuroticism—Depression facet moderated the relationship between stress and alcohol use/misuse (β = 0.18, p = 0.020).

Conclusions

The Neuroticism—Depression facet is a better predictor of alcohol use/misuse than the Neuroticism domain, even when accounting for stress and other personality domains.

At low levels of the Depression facet, stress was negatively associated with alcohol use/misuse, but at high levels of the Depression facet, stress was positively associated with alcohol use/misuse. Taken together, our results shed new light into the combined and independent effects of Neuroticism and stress on alcohol use/misuse.

Prison sentencing increases the risk of unemployment among illegal heroin users in Taiwan

BACKGROUND

Previous studies have rarely explored the effect of type of sentencing on employment status among illegal heroin users, therefore, we aims to examine the association of the sentencing types and employment outcomes among illegal heroin users in Taiwan.

METHODS

Participants with illegal heroin use were identified through the national prison register system and deferred prosecution system: 2406 with deferred prosecutions, 4741 with observation and rehabilitation, 15 compulsory rehabilitation and 1958 sentenced to prison in calendar 2011. Logistic regression models were built to estimate the effect of sentencing type on unemployment status at 2 years after release. Stratification analysis was conducted to determine the effect of sentencing type based on the offender's employment status before sentencing.

RESULTS

Illegal heroin users receiving a prison sentence were more than twice as likely to be unemployed 2 years later than those receiving deferred prosecution. The unemployment rate was also higher for those with observation and rehabilitation and compulsory rehabilitation than deferred prosecution in the 2 years following sentencing. Males, older users, without a job before sentencing, divorced or widowed and higher prior drug use criminal records were also higher risk of unemployment. Subgroup analysis by prior employment status revealed that being sentenced to prison, observation and rehabilitation and compulsory rehabilitation affected the subsequent employment status only for those heroin users with a job before sentencing. The strength of associations showed dose-dependent relationship between different sentencing types (sentenced to prison> compulsory rehabilitation> observation and rehabilitation) and employment outcomes.

CONCLUSIONS

Illegal heroin users who receive a prison sentence have a much higher risk of unemployment than those who receive deferred prosecution after controlling potential confounders, especially those who had a job before sentencing. The implication is the stronger freedom of punishment, the higher risk of unemployment outcomes. Our study support that illegal heroin user is legally regarded as a patient before being regarded as a criminal, so giving priority to quit addition rather than imprisonment.

Health and socioeconomic circumstances over three generations as predictors of youth unemployment trajectories

BACKGROUND

Youth unemployment is a critical life event, which may trigger other labour market-related disadvantages and detrimental health implications. To better understand the processes causing unemployment, we study how socioeconomic circumstances of successive generations and familial and health factors in adolescence predict youth unemployment trajectories between ages 16 and 28 in Finland from 2000 to 2009.

METHODS

We used survey data from 1979 to 1997 on 12- to 18-year-old Finns (n = 43 238) linked with 1970-2009 registry-based data of their grandparents, parents and themselves. Growth mixture modelling and multivariate logistic regression analyses were used.

RESULTS

Three latent youth unemployment trajectories emerged; low (46%), decreasing (38%) and high (16%) risk groups. Of adolescent factors, low school achievement was the most important predictor of youth unemployment followed by smoking, stress symptoms and poor self-rated health. Grandparents' education predicted their grandchildren's unemployment but the effects of other grandparental socioeconomic circumstances mediated through parents' socioeconomic status (SES). Parents' low SES and education, and long-term unemployment increased the risk of the child's unemployment. Youth unemployment was related to low education at the age of 29.

CONCLUSION

Grandparents' education, family socioeconomic circumstances and adolescents' health and school achievement predict the developmental trajectory of youth unemployment. Youth unemployment is also related to low education in early adulthood. Our findings suggest that the health selection of unemployment works already in adolescence.

A Digital Substance-Use Harm Reduction Intervention for Students in Higher Education (MyUSE): Protocol for Project Development

BACKGROUND

Digital interventions have been identified as a possible tool for reducing the harm caused by illicit drug use among students attending higher education (ie, college students). However, the success of interventions in this area has been hampered by a lack of user involvement and behavior change theory in their design. The My Understanding of Substance use Experiences (MyUSE) project combines a rigorous user-centered design (UCD) methodology and a robust behavioral change framework to develop a digitally delivered harm reduction intervention for illicit drug use among students in higher education.

OBJECTIVE

This project aims to design and develop a digital intervention that targets drug use-related harm among students in higher education.

METHODS

The MyUSE project will take place over 3 phases. The first phase was exploratory in nature, involving 3 systematic reviews, a large survey, and student workshops to gather a comprehensive evidence base to guide the project. The second phase is the development stage of the project, involving the use of the Behavior Change Wheel theoretical framework to determine the behavior change techniques of the intervention and the use of the UCD methodology to guide the development of the digital intervention. The third phase is the evaluation stage, whereby the intervention will undergo a 5-stage evaluation process to comprehensively evaluate its impacts.

RESULTS

The exploratory phase 1 of the MyUSE project was completed in December 2018. Phase 2 is currently underway, and phase 3 is due to begin in September 2020.

CONCLUSIONS

Higher education institutions (HEIs) are ideally placed to intervene and support students in the area of illicit drug use but are constrained by limited resources. Current digital interventions in this area are sparse and have several weaknesses. The MyUSE project combines a UCD approach with a robust behavior change framework to develop a digitally delivered intervention that is economically viable, effective in changing behavior, usable and acceptable to students, and able to sustain long-term implementation in HEIs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17829.

Economic Effects of Adolescent to Adult Patterns of Cannabis Use: Full-Time Employment and Employment Stability

Research has yet to examine stability in employment as a function of cannabis use once an individual transitions into full-time work. Using data from the Rochester Youth Development Study, trajectories of cannabis use spanning ages 14 to 30 were identified among a sample of predominantly minorities (>80%; 68% African American). After hard-classifying individuals by patterns of cannabis use, probabilities of full-time employment and conditional probabilities of full-time employment were calculated and compared across patterns of use. Abstention or rare cannabis use was associated with a higher likelihood of full-time employment compared with other cannabis use patterns. Full-time employment stability was high for each pattern of cannabis use (>89%) and differences decreased with age and prior periods of employment. The results indicate that patterns of cannabis use spanning adolescence to adulthood have limited impact on the ability to retain full-time employment once employed and are interpreted in light of growing legalization of cannabis use.

Illicit drug use among students of a university in Southern Brazil

OBJECTIVE

To describe drug consumption and the co-occurrence use of more than one illegal drug as well as associated factors in freshmen at a public university in Southern Brazil.

METHODS

Cross-sectional study with census of students entering undergraduate courses in 2017. A total of 1,788 university students answered questions about illicit drug use. For analysis, ordinal logistic regression was used.

RESULTS

Marijuana was the most consumed drug (lifetime: 42.1%; 30-day use: 22.7%), followed by hallucinogens (lifetime: 13.1%, 30-day use: 2.8%). Rates for lifetime use of 0, 1 and 2 or more drugs were 56.2%, 23.3% and 20.4%, respectively, and were associated with men (OR = 2.2; 95%CI:1.4–3.5), being at least 23 years old (OR = 2.7; 95%CI: 1.4–5.1), under 18 years old first experimentation with drugs (OR = 2.3; 95%CI: 1.3–3.9) and living with friends (OR = 2.0; 95%CI: 1.2–3.4). Rates for 30-day use of 0, 1 and 2 or more drugs were 76.8%; 18.1% and 5.1%, respectively, and were associated with being single, separated or widowed (OR = 3.2; 95%CI: 1.4–7.0), lower socioeconomic classes (OR = 0.3; 95%CI: 0.1–1.1; p = 0.001), under 18 years old first experimentation with drugs (OR = 1.8; 95%CI: 1.1–2.9) and living with friends (OR = 1.8 95%CI: 1.2–2.8).

CONCLUSION

Results indicate that students are at greater risk of illicit drug-related health problems. Thus, a better understanding of this consumption should be pursued, as well as the development of a prevention plan.

Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort

BACKGROUND

This study examined associations of sexual orientation and gender identity with prevalence of substance use disorders (SUDs) and co-occurring multiple SUDs in the past 12-months during young adulthood in a United States longitudinal cohort.

METHODS

Questionnaires self-administered in 2010 and 2015 assessed probable past 12-month nicotine dependence, alcohol abuse and dependence, and drug abuse and dependence among 12,428 participants of an ongoing cohort study when they were ages 20-35 years. Binary or multinomial logistic regressions using generalized estimating equations were used to estimate differences by sexual orientation and gender identity in the odds of SUDs and multiple SUDs, stratified by sex assigned at birth.

RESULTS

Compared with completely heterosexuals (CH), sexual minority (SM; i.e., mostly heterosexual, bisexual, lesbian/gay) participants were generally more likely to have a SUD, including multiple SUDs. Among participants assigned female at birth, adjusted odds ratios (AORs) for SUDs comparing SMs to CHs ranged from 1.61 to 6.97 (ps<.05); among participants assigned male at birth, AORs ranged from 1.30 to 3.08, and were statistically significant for 62% of the estimates. Apart from elevated alcohol dependence among gender minority participants assigned male at birth compared with cisgender males (AOR: 2.30; p < .05), gender identity was not associated with prevalence of SUDs.

CONCLUSIONS

Sexual and gender minority (SGM) young adults disproportionately evidence SUDs, as well as co-occurring multiple SUDs. Findings related to gender identity and bisexuals assigned male at birth should be interpreted with caution due to small sample sizes. SUD prevention and treatment efforts should focus on SGM young adults.

Predictors of Post-Treatment Employment for Individuals with Substance Use Disorders

This study examined the influence of gender, post-treatment issue severities, and treatment participation rate on the post-treatment employment status of consumers with substance use disorders. The study analyzed the archival data of 100 unemployed and underemployed participants from a substance abuse intensive outpatient program. We found significant differences in the characteristics of gender, severity of alcohol use, drug use, psychiatric issues, and treatment participation rate. Female gender and low treatment participation rates negatively predicted employment. This study increased understanding about the interplay of alcohol, drug, and psychiatric influences on post-treatment employment status.

A systematic review of the effectiveness of digital interventions for illicit substance misuse harm reduction in third-level students

Background

Illicit substance misuse is a growing public health problem, with misuse peaking among 18–25 year-olds, and attendance at third-level education identified as a risk factor. Illicit substance misuse has the potential to harm mental and physical health, social relationships, and impact on academic achievements and future career prospects. Digital interventions have been identified as a vehicle for reaching large student populations and circumventing the limited capacity of student health services for delivering face-to-face interventions. Digital interventions have been developed in the area of alcohol and tobacco harm reduction, reporting some effectiveness, but the evidence for the effectiveness of digital interventions targeting illicit substance misuse is lacking. This review aims to systematically identify and critically appraise studies examining the effectiveness of digital interventions for illicit substance misuse harm reduction in third-level students.

Methods

We systematically searched ten databases in April 2018 using keywords and database specific terms under the pillars of “mHealth,” “substance misuse,” and “student.” To be eligible for inclusion, papers had to present a measure of illicit substance misuse harm reduction. Included articles were critically appraised and included in the qualitative synthesis regardless of quality.

Results

A total of eight studies were included in the qualitative synthesis. Studies reported harm reduction in terms of substance misuse or initiation, as consequences or problems associated with substance misuse, or as correction of perceived social norms. Overall, five out of the eight studies reported at least one positive outcome for harm reduction. The critical appraisal indicated that the study quality was generally weak, predominantly due to a lack of blinding of study participants, and the use of self-reported substance misuse measures. However, results suggest that digital interventions may produce a modest reduction in harm from illicit substance misuse.

Conclusions

The results of this review are positive, and support the need for further high-quality research in this area, particularly given the success of digital interventions for alcohol and tobacco harm reduction. However, very few studies focused solely on illicit substances, and those that did targeted only marijuana. This suggests the need for further research on the effectiveness of this type of intervention for other illicit substances.

Trial registration

This review is registered on PROSPERO, ID number: CRD42018097203.

Perceived Effectiveness of Anti-Marijuana Messages in Adult Users and Nonusers: An Examination of Responses to Messages About Marijuana's Effects on Cognitive Performance, Driving, and Health

OBJECTIVE

Marijuana use is associated with negative cognitive and health outcomes and risky driving. Given the rapidly changing policies regarding legal recreational and medicinal marijuana use, it is important to examine what types of marijuana prevention messages may be effective in minimizing such outcomes. This study examined cognitive and affective responses to anti-marijuana public health messages in a sample of adult marijuana users and nonusers to determine the correlates of perceived message effectiveness.

METHOD

Participants (N = 203; mean age = 37.7 years) were adult marijuana users and nonusers recruited via Amazon Mechanical Turk (August 2017). After completing self-report measures of marijuana use, they viewed six anti-marijuana messages presented in a random order, addressing marijuana's effects in each of three topic areas: cognitive performance, driving, and adverse health outcomes (e.g., two messages per topic). Participants completed assessments of cognitive and affective perceptions after viewing each message. For each message topic, a linear regression model was used to determine which cognitive and affective perceptions were most predictive of perceived message effectiveness.

RESULTS

For all message topics, nonusers perceived the messages as more effective than did users (p < .001). In the majority of analyses, greater message effectiveness was associated with increased perceived harm of marijuana and increased liking of the message. For driving and health messages, greater message effectiveness was also significantly correlated with lower pleasant affect.

CONCLUSIONS

The findings suggest that audience perceptions may be uniquely predictive of message effectiveness, depending on the topic.

Substance Use Among College Students

U.S. college campuses have witnessed a national increase of cannabis, stimulant, and illicit drug use among students over the past decade. Substance use among college students is associated with numerous negative outcomes including lower academic performance, a higher probability of unemployment after graduation, and an increased risk of committing and experiencing sexual assault. Several risk factors for substance use are specific to this population, including an affiliation with Greek life, perception of high academic pressure, and peer pressure. Students with problematic substance use also face unique challenges in planning treatment, including aspects of confidentiality, financial constraints, and potential university oversight and involvement. This article highlights the prevalence of substance use on college campuses and describes some of the specific challenges and approaches to treatment in this population, including screening tests and interventions for specific substances used on college campuses and evidence-based substance use programming for college students.

'Higher education' - substance use among Berlin college students

Berlin is internationally known for its intense nightlife associated with high rates of psychoactive substance use. Previous studies conducted in other cities indicated college students as a group at high risk for substance (mis-)use that was associated with individual psychological and cognitive impairments as well as lower academic performance. The aim of this study was to provide detailed data about the substance use patterns of Berlin college students. In addition, major protective and risk factors were analysed. An online questionnaire assessing sociodemographic data and various relevant aspects of both legal and illegal substance use such as consumption pattern and frequency as well as risk-taking behaviour was developed and distributed among colleges in Berlin. A sample of 9351 participants from 17 different colleges in Berlin completed the questionnaire. The study revealed high lifetime (69.3%), past year (45.9%) and past month (28.3%) prevalence of illicit substance use in the sample. Daily tobacco-smoking, a mental disorder diagnosis, a positive screening for problematic consumption (Cage-AID), bisexual orientation and living in open relationship were main factors positively associated with the prevalence and the extent of illicit substance use. Students in Berlin appear to show higher rates of illicit substance use than was previously reported for age-matched individuals in the general German population and college students in other cities. Thus, they are a relevant target group for early prevention and intervention concerning substance use and abuse.

High Socioeconomic Status Predicts Substance Use and Alcohol Consumption in U.S. Undergraduates

BACKGROUND

In health sociology, the prevailing consensus is that socioeconomic status (SES) lowers illness risk. This model neglects the fact that unhealthful consumption patterns may covary with affluence. The current study examines consumption of drugs and alcohol among affluent U.S. college students.

OBJECTIVES

The article tests the hypothesis that undergraduate students from high-SES households have higher rates and levels of drug and alcohol consumption than their peers.

METHODS

The study used self-report data from 18,611 18- to 24-year-old undergraduates across 23 public and private U.S. institutions from the Healthy Minds 2016 dataset.

RESULTS

I found that high-SES undergraduates were more likely than peers to use marijuana, choose varied drugs, consume alcohol frequently, and use alcohol and substances to cope with stress. The first three results were robust after controlling for gender, race, residence type, and relationship status. Marital status and race were stronger predictors than SES. Asians and married students were the least likely to use alcohol and drugs. Conclusions/Importance: Findings supported the main hypotheses, and the effects were robust to controls. Consumption of illicit drugs and alcohol may be one hitherto neglected reason for downward mobility among economically privileged college students.

Graduate degree completion: Associations with alcohol and marijuana use before and after enrollment

Research has shown that alcohol and marijuana use are associated with academic performance difficulties, but the relationship to completion of a graduate degree has not been explored. Undergraduate students (n = 1253) were assessed during their first year of college and annually thereafter until age 29. Among the subset of the original sample who enrolled in graduate school (n = 520), measures of alcohol and marijuana use were averaged separately for the time periods before and after graduate school enrollment. Logistic regression models were developed to examine the associations between these variables and graduate degree completion, adjusting for other factors. In general, a minority of the sample were excessive drinkers or frequent marijuana users. The majority of drinkers (70%) drank an average of twice a week or less each year, and 62% of marijuana users used marijuana once a month or less each year. After adjusting for demographic and program characteristics, marijuana use frequency after graduate school enrollment was negatively associated with odds of graduate degree completion. Alcohol use frequency before graduate school enrollment was positively associated with odds of graduate degree completion. Results add to the growing body of literature on marijuana use and decreased academic achievement, but results should be interpreted with caution given the small, but significant, effect sizes found. The positive association between alcohol use frequency and degree completion might be attributed to engagement in the academic environment. Future studies should examine the potential mechanisms through which alcohol and marijuana use are related to the academic achievement of graduate students.

Instagram Participation and Substance Use Among Emerging Adults: The Potential Perils of Peer Belonging

Emerging adults (ages 18-29) have the highest rates of both harmful drinking and participation on social network sites (SNSs) compared to adolescents and older adults. In fact, greater SNS participation has been shown to predict greater alcohol use. Little is known, however, about noncollege samples, substances apart from alcohol, and SNSs other than Facebook. Furthermore, few studies have examined what might moderate any observed influence of SNS participation on substance use. In this study, we used hierarchical linear and negative binomial regression analyses to examine the unique associations between Instagram participation and alcohol as well as marijuana use, controlling statistically for demographic characteristics, peer norms, and social status, in a community sample of emerging adults (N = 194). We also tested whether peer belonging or motives for Instagram participation moderated these relationships. Results showed that Instagram participation was positively related to alcohol use only for those with high levels of peer belonging. The initial negative association between Instagram participation and marijuana use disappeared once peer norms and social status were included. Peer norms were positively related to both alcohol and marijuana use, while peer belonging was positively related to marijuana use. Peer belonging appears to be an important variable in the study of SNSs and substance use among emerging adults. Future work might test the somewhat counterintuitive hypotheses raised by these findings that peer belonging sensitizes individuals to SNS influences on drinking and could be a marker of greater marijuana use.

Consideration of future consequences as a moderator of the willingness-behavior relationship for young adult marijuana use and consequences

The Prototype Willingness Model is a dual-processing (i.e., intentional and socially reactive) health-risk behavior model. The socially reactive path includes behavioral willingness, descriptive normative perceptions, and favorable images of individuals who engage in health-risk behavior (prototype favorability) as important predictors of health behaviors. Individual differences (such as consideration of future consequences) may potentiate the effects of behavioral willingness on health-risk outcomes, such as marijuana use. Given limited research investigating marijuana use and the Prototype Willingness Model, the goals of the current study were: 1) examine consideration of future consequences and Prototype Willingness Model social reaction pathway variables in relation to behavioral willingness to use marijuana longitudinally; and 2) determine if consideration of future consequences moderated the behavioral willingness-marijuana use relation prospectively. Young adults (N = 769) from a larger longitudinal study completed baseline and 3 follow-up assessments (Months 3, 4, 5). Behavioral willingness was positively related to a higher likelihood of use, more days having used marijuana, and more consequences prospectively, over and above baseline use. Consideration of future consequences moderated the association between behavioral willingness and hours high in a typical week. These findings support the willingness-behavior association of the Prototype Willingness Model and preliminarily demonstrate consideration of future consequences' differential impact on behavioral willingness-future marijuana use relation. Intervention and prevention implications are discussed.

A Longitudinal Investigation of Associations Between Marijuana Displays on Facebook and Self-Reported Behaviors Among College Students

PURPOSE

College students frequently display references to substance use, including marijuana, on social media such as Facebook. The significance of displayed marijuana references on social media is unknown. The purpose of this longitudinal cohort study was to evaluate college students' displayed marijuanareferences on Facebook and their association with self-reported marijuana use.

METHODS

First-year students from two U.S. universities were randomly selected from registrar lists for recruitment. Data collection included 4years of monthly Facebook coding, and yearly phone interviews that each assessed lifetime and current marijuana use. We compared frequencies of displayed marijuana references on Facebook between marijuana users and nonusers using two-sample t-tests and Pearson's chi-squared tests. Generalized linear models were used to evaluate the likelihood of displayed marijuana references on Facebook.

RESULTS

A total of 338 participants were recruited, 56.1% were female, 74.8% were Caucasian, and 58.8% were from the Midwest college. Prevalence of displayed marijuana references on Facebook profiles variedfrom 5% to 10% across 4 years. Displayed marijuana references included most "Actions" and "Locations" on the Facebook profile. Marijuana users were more likely to display marijuana references on Facebook compared to nonusers, though Likes were more common among nonusers. Predictors of displayed marijuana references included lifetime and current marijuana use.

CONCLUSIONS

The prevalence of displayed marijuana references on Facebook was consistent but uncommon; marijuana references included both information sharing and personal experiences. Marijuana users were more likely to display marijuana references, suggesting these displays could be leveraged for intervention efforts.

Frequent Drug Use and Negative Employment Outcomes among the Criminally Active

BACKGROUND

Employment is a central component of economic independence and is widely viewed as an essential element of social control. Whether frequent drug use reduces the likelihood of employment or obstructs hours worked, wages, and job commitment is therefore an important question about which there remains uncertainty.

METHODS

We improve on shortcomings of prior research through a monthly within-person analysis of a population at high-risk of both drug use and poor employment outcomes. We present multilevel models of the 18 months spent on the street preceding the arrest that led to incarceration in minimum/medium security facilities in Ohio from a random sample of 250 adult male inmates interviewed during the outset of a prison spell.

RESULTS

The analysis reveals consistently strong, negative effects of frequent drug use on employment, hours worked, and wages in the month following frequent drug use, including marijuana, cocaine, heroin, and prescription opioids. As well, frequent drug use (with the exception of marijuana) undermines job commitment during the months that participants are employed.

CONCLUSIONS

The consequences of frequent drug use for future employment are consistently negative within this criminal justice sample. Results suggest that lower levels of drug use may improve the success of postrelease employment programs. In a context of increasing concern over rising opioid and heroin, but also cocaine and marijuana abuse, the findings suggest a renewed focus on and perhaps expansion of evidence-based drug treatment among populations embedded within the criminal justice system, particularly if employment constrains criminal behavior.

Addictive behaviors and psychological distress among adolescents and emerging adults: A mediating role of peer group identification

Objective

Research suggests the sense of belonging to primary groups functions as an important social resource for youth well-being, but it can be compromised among those dealing with addiction. The current study examined how adolescents' and emerging adults' identification with a primary peer group consisting of friends, mediates the relationship between addictive behaviors and psychological distress.

Method

The study utilized demographically balanced survey data on 1200 Finnish participants aged 15 to 25 (mean age 21.29, 50% female). Measures were included for psychological distress, excessive drinking, excessive drug use, excessive gambling, excessive Internet use, and peer group identification.

Results

All forms of addictive behaviors had a significant direct relationship with higher psychological distress. Excessive drug use, gambling and Internet use were associated with a weaker identification with a peer group, which predicted higher psychological distress. Contrary to the above findings, excessive drinking was linked to stronger peer group identification, mediating psychological distress downwards.

Conclusions

These findings support past research and provide a mediation model explanation onto how weaker social relations add to negative well-being consequences in different addictive behaviors, thus underlining the importance of expanding our understanding of social group outcomes among young individuals.

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Data from a demographically balanced sample (N = 1200) of Finnish youths aged 15 to 25.

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Four different types of addictive behaviors were associated with higher psychological distress.

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Psychological distress was significantly mediated by social identification to a primary peer group.

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The mediating role of social identification varied among different addictions.

When the party continues: Impulsivity and the effect of employment on young adults' post-college alcohol use

BACKGROUND

The transition from college to work is both an exciting and potentially high risk time for young adults. As students transition from academic settings to full-time employment, they must navigate new social demands, work demands, and adjust their drinking behaviors accordingly. Research has shown that there are both protective factors and risk factors associated with starting a new job when it comes to alcohol use, and individual differences can moderate these factors.

METHOD

1361 students were recruited from 4 geographically diverse universities and followed 1month pre- and 1month post-graduation. Drinking frequency, quantity, consequences, and impulsivity were assessed.

RESULTS

Full-time employment was related to increased drinking quantity but not related to changes in other drinking outcomes. However, impulsivity moderated the relationship between employment and drinking. For those reporting higher levels of impulsivity at baseline, full-time employment was associated with an increase in drinking variables (quantity and frequency), whereas drinking was unaffected by full-time employment status among those reporting lower levels of impulsivity. Implications for future research are discussed.

A latent class analysis of poly-marijuana use among young adults

INTRODUCTION

With more states legalizing marijuana use, the marijuana industry has grown, introducing a variety of marijuana products. Our study explores the use of multiple marijuana products (poly-marijuana use) and the characteristics associated with this behavior.

METHODS

Past-month marijuana users aged 18-34years were surveyed online via an existing online panel (n=2444). Participants answered questions about past-month use of three types of marijuana (plant-based, concentrates, edibles), marijuana use patterns, and driving after use. Latent class analysis was used to identify subgroups of marijuana users.

RESULTS

Four classes of marijuana users were identified: Light plant users, who used only plant-based products infrequently and were unlikely to drive after use (32%); Heavy plant users, who used mainly plant-based products frequently, multiple times per day, and were likely to drive after use (37%); Plant and concentrates users, who used plant-based products heavily and concentrates at least infrequently, used multiple times per day, and were likely to drive after use (20%); Light plant and edibles users, who used both products infrequently and were unlikely to drive after use (10%). Those in legal marijuana states were more likely to belong to the poly-marijuana groups.

DISCUSSION

Our findings reflect the increase in popularity of new marijuana products in legal states and suggest that heavy user groups, including concentrates users, are associated with driving after use. As various forms of marijuana use increases, monitoring and surveillance of the use of multiple types of marijuana will be important for determining potential varying impacts on physiological and social consequences.

Risk factors for gambling and substance use among recent college students

BACKGROUND

While it is well known that substance use and gambling overlap, the degree to which this overlap can be explained by shared risk factors has not been fully explored. This study aimed to identify common and unique risk factors for gambling and substance use among young adults.

METHODS

Young adults (n=1,019) in a longitudinal study since college entry were interviewed annually. Past-year frequency of seven gambling activities was assessed once (Year 5). Structural equation models evaluated suspected risk factors in two models, one for gambling with substance use as an intermediary variable, and one for substance use with gambling as the intermediary variable.

RESULTS

Sixty percent gambled; 6% gambled weekly or more. Examination of the two structural models supported the existence of significant paths (a) from two of the five substance use variables (alcohol, drugs) to gambling frequency, and (b) from gambling frequency to all five substance use variables. Every risk factor associated with gambling was also associated with one or more substance use variables. Risk factors common to gambling and substance use were sex, race/ethnicity, extracurricular involvement (fraternity/sorority, athletics), impulsive sensation-seeking, and behavioral dysregulation. Risk factors unique to substance use were conduct problems, anxiety, and parent's history of alcohol and mental health problems.

CONCLUSIONS

Gambling and substance use are interrelated, but with incomplete overlap in their respective risk factors. Results underscore the need for longitudinal research to elucidate their distinct etiologies.

Gender and race/ethnic differences in the persistence of alcohol, drug, and poly-substance use disorders

AIMS

To examine gender and racial/ethnic differences in the effect of substance use disorder (SUD) type on SUD persistence.

METHODS

Data were provided by 1025 women and 1835 men from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender and race/ethnicity (Non-Hispanic White, Black, Hispanic) moderate the effects of DSM-IV defined past-12 month SUD type (alcohol, drug, poly-substance) on SUD persistence at 3-year follow-up, controlling for covariates. Using gender-stratified weighted binary logistic regression, we examined predictors of SUD persistence, tested an SUD type by race/ethnicity interaction term, and calculated and conducted Bonferroni corrected pairwise comparisons of predicted probabilities.

RESULTS

SUD persistence rates at 3-year follow-up differed for SUD type by gender by race/ethnicity sub-group, and ranged from 31% to 81%. SUD persistence rates were consistently higher among poly-substance users; patterns were mixed in relation to gender and race/ethnicity. Among women, alcohol disordered Hispanics were less likely to persist than Whites. Among men, drug disordered Hispanics were less likely to persist than Whites. Also, Black men with an alcohol or drug use disorder were less likely to persist than Whites, but Black men with a poly-substance use disorder were more likely to persist than Hispanics.

CONCLUSIONS

The effect of SUD type on SUD persistence varies by race/ethnicity, and the nature of these relationships is different by gender. Such knowledge could inform tailoring of SUD screening and treatment programs, potentially increasing their impact.

Prevalence and incidence of drug use among college students: an 8-year longitudinal analysis

BACKGROUND

Drug use among college students is associated with adverse academic and health outcomes and risks to personal safety.

OBJECTIVES

This study utilized data from a longitudinal study to estimate annual prevalence, cumulative lifetime prevalence, and incidence of ten types of drug use during the eight years after college entry and the average age of onset of each drug used.

METHODS

Participants (N = 1,253; 52% female) were young adults who were originally enrolled as first-time, first-year students at a university in the mid-Atlantic US. Annual personal interviews gathered data about the use of seven illicit drugs and three prescription drugs used nonmedically. Annual follow-up rates ranged from 76 to 91%.

RESULTS

Marijuana was the most commonly used drug in every year of the study, with the highest annual prevalence estimates in Year 3 (47%_wt). In Year 8, when the modal age of participants was 25, 29%_wt used marijuana during the past year. Nonmedical use of prescription drugs was more prevalent during college than in the later years of the study. Although the prevalence of cocaine and ecstasy use was low (cumulative prevalence estimates of 17%_wt and 13%_wt, respectively), incidence for these drugs was particularly high in the later years of the study.

CONCLUSION

Drug use is prevalent among college students, and drug use persists among young adults, even after many have graduated college. More attention should be directed at identifying and intervening with students at risk for drug use to mitigate possible academic, health, and safety consequences.

Drinking, Cigarette Smoking, and Employment Among American College Freshmen at a Four-Year University

BACKGROUND

For American college students, alcohol and cigarette use are important health concerns, and employment concurrent with school attendance is on the rise. Given the lifelong importance of employment and substance use trajectories begun in college, parsing out the relationship between the two is meaningful.

OBJECTIVES

This study's purpose is to determine whether employment during college is associated with substance use.

METHODS

Cross-sectional associations between employment (work hours, earnings) and substance use (drinking frequency, drinking quantity, smoking frequency) were estimated using partial proportional odds models in a sample of N = 1457 freshmen attending a large, public 4-year university in 2011, after accounting for demographics, personality, social environment, and parental influences.

RESULTS

Working 10 more hours and earning $50 more per week as a freshman had modest positive associations with higher smoking frequency and with moderate drinking frequency and quantity prior to adjustment. After adjustment, work hours remained modestly associated with moderate drinking frequency and quantity. No adjusted associations were found among employment measures and smoking or between weekly earnings and drinking frequency. Different relationships emerged for moderate versus heavy alcohol use frequency and quantity.

CONCLUSIONS

Both employment and substance use are commonplace among college freshmen. After extensive controls for potential confounders, the relationship between the two appears modest. Employment may yet play a role in college student substance use, but work hours and earnings are likely only small parts of a larger web of influences on drinking and smoking.

Main mental disorders in crack-cocaine users treated at Psychosocial Care Centers for Alcohol and Drugs in the city of Recife, Brazil

Abstract Introduction: Brazil's Northeast region has the highest crack-cocaine consumption in the country. Crack-cocaine has more intense effects than cocaine powder and can cause greater chemical dependence. Psychosocial Care Centers for Alcohol and Drugs (CAPSad) are public health services that provide treatment for drug dependence. It is common for drug users, and particularly crack-cocaine users, to develop mental disorders. Objective: To evaluate the most common mental disorders in crack-cocaine dependents in treatment at CAPSad in the city of Recife, Brazil. Methods: The research database "Between rocks and shots: user profiles, consumption strategies, and social impact of crack cocaine" (CEP/CCS/UFPE no. 206/11) was consulted to establish the areas of crack cocaine consumption in the city of Recife. Results: There were 885 patients in treatment for crack-cocaine use, with a mean age of 29.8±9.4 years. The mean duration of drug use was 6.1±4.6 years. Most of the patients were males (80.3%), had left school at some point between the 1st and 9th grades (45.6%), were unemployed and/or seeking employment (52%) and used drugs daily (56.4%). Cocaine chemical dependence was more significant when correlated with use of crack-cocaine and other drugs such as medications and hallucinogens (p = 0.01). Conclusions: Data from this study showed strong associations between crack-cocaine uses and development of mental disorders, particularly when abuse of multiple substances occurs. Based on these data, there is a clear need for coordination of related public policies for support and social reintegration to provide these people with comprehensive care.

Patterns of the co-use of alcohol, marijuana, and emerging tobacco products in a national sample of young adults

BACKGROUND

Emerging tobacco product use is on the rise in young adults and has been linked to alcohol and marijuana use. Little is known about which patterns of alcohol, marijuana, and emerging tobacco product co-use are most popular in this age group.

OBJECTIVES

This study examined the prevalence of a broad spectrum of marijuana, alcohol, and tobacco co-use patterns across a variety of tobacco products in a national sample of young adults.

METHODS

Data were analyzed from a sub-set of 18-24 year olds (unweighted n = 3,940) from five waves of the Truth Initiative Young Adult Cohort, a national sample of 18-34 year olds. A user-generated statistical program in R was used to assess all possible patterns of past 30-day use of alcohol, marijuana, cigarettes, cigars, e-cigarettes, little cigars/cigarillos, hookah, and other tobacco (pipe, chew, dip, snus, dissolvables).

RESULTS

No past 30-day use of any substance emerged as the most popular pattern across all years (42%), followed by exclusive past 30-day alcohol use (31%), and past 30-day alcohol use with cigarettes (5%) or marijuana (4%). The popularity of exclusive marijuana use increased over time, but only 1% reported exclusive marijuana use without the combination of either alcohol or a tobacco product. E-cigarette use only emerged in combination with alcohol and was the least popular pattern of co-use relative to other patterns.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Patterns stress the importance of alcohol among young people. Successful substance use prevention should focus on alcohol's co-use with a variety of substances of abuse, rather than focus on a single behavior. (Am J Addict 2016;25:634-640).

Persistent cannabis dependence and alcohol dependence represent risks for midlife economic and social problems: A longitudinal cohort study

With the increasing legalization of cannabis, understanding the consequences of cannabis use is particularly timely. We examined the association between cannabis use and dependence, prospectively assessed between ages 18-38, and economic and social problems at age 38. We studied participants in the Dunedin Longitudinal Study, a cohort (n=1,037) followed from birth to age 38. Study members with regular cannabis use and persistent dependence experienced downward socioeconomic mobility, more financial difficulties, workplace problems, and relationship conflict in early midlife. Cannabis dependence was not linked to traffic-related convictions. Associations were not explained by socioeconomic adversity, childhood psychopathology, achievement orientation, or family structure; cannabis-related criminal convictions; early onset of cannabis dependence; or comorbid substance dependence. Cannabis dependence was associated with more financial difficulties than alcohol dependence; no difference was found in risks for other economic or social problems. Cannabis dependence is not associated with fewer harmful economic and social problems than alcohol dependence.

Why young people's substance use matters for global health

During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen. This Series paper considers the potential effects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the offspring of young people who use substances. We sourced consistent support for causal relations between substance use and outcomes and evidence of biological plausibility from different but complementary research designs. Many adverse health and social outcomes have been associated with different types of substance use. The major challenge lies in deciding which are causal. Furthermore, qualitatively different harms are associated with different substances, differences in life stage when these harms occur, and the quality of evidence for different substances and health outcomes varies substantially. The preponderance of evidence comes from a few high-income countries, thus whether the same social and health outcomes would occur in other countries and cultures is unclear. Nonetheless, the number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.