Age of initiation and substance use progression: A multivariate latent growth analysis

Impact of Pre-Adolescent Substance Familiarity on Subsequent Use: Longitudinal Analysis of Risk by Latent Classes in the Adolescent Brain Cognitive Development Sample

BACKGROUND

Predicting substance use in adolescence is a difficult yet important task in developing effective prevention. We aim to extend previous findings on the linear associations between familiarity with (knowledge of) substances in childhood and subsequent substance use in adolescence through a latent class analysis (LCA) to create risk profiles based on substance familiarity.

METHOD

Using the ABCD Study® sample, we conducted an LCA using 18 binary substance familiarity variables (n = 11,694 substance-naïve youth). Complementary analyses investigated the relationship between LCA groups and (1) longitudinal use, (2) use initiation, and (3) early use.

RESULTS

The optimal LCA resulted in a four-class solution: Naïve, Common, Uncommon, and Rare, with each group increasing in both the number and rarity of known substances. Analysis 1 revealed an increased risk in use over time among both the Uncommon and Rare groups (ORs = 2.08 and 5.55, respectively, p's < 0.001) compared to the Common group. Analysis 2 observed a decreased risk for initiation between the Naïve and Common groups (OR = 0.61, p = 0.009); however, the Uncommon and Rare groups were at an increased risk compared to the Common group (ORs = 2.08 and 3.42, respectively, p's < 0.001). Analysis 3 found an increased risk of early use between the Common and Uncommon groups (OR = 1.92, p < 0.001) with a similar trend between the Common and Rare groups (OR = 1.90, p = 0.06).

CONCLUSION

These results highlight distinct risk profiles for adolescent substance use based on substance familiarity in middle childhood. Current work could be applied as an early screening tool for clinicians to identify those at risk for adolescent substance use.

A Cross-Cultural Comparison of Negative Alcohol-Related Consequences in the United States and Sweden: Measurement Invariance of the Rutgers Alcohol Problem Index

Commensurate measures of alcohol-related consequences across countries and cultures are critical for addressing the global burden of hazardous alcohol use. The Rutgers Alcohol Problem Index (RAPI), developed and validated in the United States, is a popular measure of alcohol problems. This study examined measurement invariance of the RAPI across samples of U.S. and Swedish high school seniors. Latent mean differences in alcohol problems across countries and differences in associations between alcohol problems with alcohol use and protective behavioral strategies (PBS) were also examined. The RAPI was scalar invariant. Swedish students reported fewer problems than U.S. students (latent mean difference = -0.19, p = .047). In both samples, the RAPI was positively correlated with alcohol use frequency and quantity (ps < .001), and negatively correlated with PBS use (ps < .05). Overall, the RAPI demonstrated measurement invariance, and we found evidence for its validity across samples of U.S. and Swedish high school seniors.

Disentangling heterogeneity in substance use disorder: Insights from genome-wide polygenic scores

Substance use disorder (SUD) is a global health problem with a significant impact on individuals and society. The presentation of SUD is diverse, involving various substances, ages at onset, comorbid conditions, and disease trajectories. Current treatments for SUD struggle to address this heterogeneity, resulting in high relapse rates. SUD often co-occurs with other psychiatric and mental health-related conditions that contribute to the heterogeneity of the disorder and predispose to adverse disease trajectories. Family and genetic studies highlight the role of genetic and environmental factors in the course of SUD, and point to a shared genetic liability between SUDs and comorbid psychopathology. In this study, we aimed to disentangle SUD heterogeneity using a deeply phenotyped SUD cohort and polygenic scores (PGSs) for psychiatric disorders and related traits. We explored associations between PGSs and various SUD-related phenotypes, as well as PGS-environment interactions using information on lifetime emotional, physical, and/or sexual abuse. Our results identify clusters of individuals who exhibit differences in their phenotypic profile and reveal different patterns of associations between SUD-related phenotypes and the genetic liability for mental health-related traits, which may help explain part of the heterogeneity observed in SUD. In our SUD sample, we found associations linking the genetic liability for attention-deficit hyperactivity disorder (ADHD) with lower educational attainment, the genetic liability for post-traumatic stress disorder (PTSD) with higher rates of unemployment, the genetic liability for educational attainment with lower rates of criminal records and unemployment, and the genetic liability for well-being with lower rates of outpatient treatments and fewer problems related to family and social relationships. We also found evidence of PGS-environment interactions showing that genetic liability for suicide attempts worsened the psychiatric status in SUD individuals with a history of emotional physical and/or sexual abuse. Collectively, these data contribute to a better understanding of the role of genetic liability for mental health-related conditions and adverse life experiences in SUD heterogeneity.

Characterization of the Neurochemical and Behavioral Effects of the Phenethylamine 2-Cl-4,5-MDMA in Adolescent and Adult Male Rats

BACKGROUND

The proliferation of novel psychoactive substances (NPS) in the drug market raises concerns about uncertainty on their pharmacological profile and the health hazard linked to their use. Within the category of synthetic stimulant NPS, the phenethylamine 2-Cl-4,5-methylenedioxymethamphetamine (2-Cl-4,5-MDMA) has been linked to severe intoxication requiring hospitalization. Thereby, the characterization of its pharmacological profile is urgently warranted.

METHODS

By in vivo brain microdialysis in adolescent and adult male rats we investigated the effects of 2-Cl-4,5-MDMA on dopamine (DA) and serotonin (5-HT) neurotransmission in two brain areas critical for the motivational and rewarding properties of drugs, the nucleus accumbens (NAc) shell and the medial prefrontal cortex (mPFC). Moreover, we evaluated the locomotor and stereotyped activity induced by 2-Cl-4,5-MDMA and the emission of 50-kHz ultrasonic vocalizations (USVs) to characterize its affective properties.

RESULTS

2-Cl-4,5-MDMA increased dialysate DA and 5-HT in a dose-, brain area-, and age-dependent manner. Notably, 2-Cl-4,5-MDMA more markedly increased dialysate DA in the NAc shell and mPFC of adult than adolescent rats, while the opposite was observed on dialysate 5-HT in the NAc shell, with adolescent rats being more responsive. Furthermore, 2-Cl-4,5-MDMA stimulated locomotion and stereotyped activity in both adolescent and adult rats, although to a greater extent in adolescents. Finally, 2-Cl-4,5-MDMA did not stimulate the emission of 50-kHz USVs.

CONCLUSIONS

This is the first pharmacological characterization of 2-Cl-4,5-MDMA demonstrating that its neurochemical and behavioral effects may differ between adolescence and adulthood. These preclinical data could help understanding the central effects of 2-Cl-4,5-MDMA by increasing awareness on possible health damage in users.

The prevalence of cannabis use disorder in attention-deficit hyperactivity disorder: A clinical epidemiological meta-analysis

Studies have shown that individuals with attention-deficit hyperactivity disorder (ADHD) pose an increased risk for developing substance use disorders. Increased cannabis product accessibility and recent legislative changes have led to increased cannabis consumption, thereby increasing the risk of cannabis use disorder (CUD). The present meta-analysis explored the lifetime and current prevalence of CUD in ADHD. A systematic review was conducted using the following databases: PubMed, PsycINFO and Web of Science. A total of 14 articles were included and used to estimate the aggregate lifetime and current prevalence of CUD in ADHD alongside risk ratios comparing increased risk of CUD in ADHD versus control samples. Mixed and random-effects models indicated that lifetime and current prevalence rates of CUD in ADHD populations were 26.9% and 19.2%, respectively (although prediction intervals ranged from 12.4% to 48.8% and 5.5%-39.1%, respectively). Analysis of the risk ratios indicated that those with ADHD were at 2.85- and 2.91-times greater risk of a lifetime or current diagnosis of CUD, respectively, than those in the general population. Our findings support the need for additional research on the prevalence of CUD in those with ADHD, as well as the inclusion of CUD screening in the treatment of ADHD.

Neuroanatomical variability associated with early substance use initiation: Results from the ABCD Study

The extent to which neuroanatomical variability associated with substance involvement reflects pre-existing risk and/or consequences of substance exposure remains poorly understood. In the Adolescent Brain Cognitive DevelopmentSM (ABCD®) Study, we identify associations between global and regional differences in brain structure and early substance use initiation (i.e., occurring <15 years of age; nsanalytic=6,556-9,804), with evidence that associations precede initiation. Neurodevelopmental variability in brain structure may confer risk for substance involvement.

Sociodemographic differences in use of nicotine, cannabis, and non-nicotine E-cigarette devices

BACKGROUND

Sociodemographic differences in e-cigarette use have been documented; however, disparities in use of specific e-cigarette types with various ingredients have yet to be thoroughly investigated. This study examines ever- and past-30-day-use of nicotine, cannabis, and non-nicotine e-cigarette device types by sex, sexual orientation, race/ethnicity, and financial comfort.

METHODS

Data were drawn from a 2021 national cross-sectional survey of adolescents, young adults, and adults (N = 6131, ages 13-40 years old). Participants reported ever and past-30-day-use of (1) disposable nicotine e-cigarettes, (2) pod/cartridge-based nicotine e-cigarettes, (3) "other" nicotine e-cigarettes, (4) non-nicotine e-cigarettes, (5) e-cigarettes with THC, and (6) e-cigarettes with CBD. We constructed summary tables for each e-cigarette device type in which percentages of ever and past-30-day-use were calculated by birth year category and sociodemographic variables: (a) sex, (b) sexual orientation, (c) race/ethnicity, and (d) financial comfort.

RESULTS

Females born between 1996 and 2008 reported higher rates of past-30-day disposable e-cigarette use relative to males (females 26.4%; males 22.4%). Compared to their heterosexual counterparts, LGBTQ+ participants reported higher overall rates of past-30-day-use for disposable (LGBTQ+ 27.9%; Heterosexual 23.8%), THC (LGBTQ+ 30.8%; Heterosexual 24.1%), and CBD e-cigarettes (LGBTQ+ 20.0%; Heterosexual 16.9%). Hispanic/Latino participants generally reported higher rates of past-30-day-use across device types relative to those identifying as Black or White non-Hispanic, particularly disposable nicotine e-cigarettes.

CONCLUSIONS

Findings highlight sociodemographic disparities in e-cigarette use, though differences varied based on e-cigarette device type and participant birth year category. Tailored preventive efforts may be necessary to mitigate e-cigarette use among populations at highest risk.

Anxiety as a predictor of the age of initiation of tobacco and cannabis use in adolescents and young adults

BACKGROUND

Previous research has shown important links between anxiety and the use of tobacco and cannabis. However, it remains unclear whether anxiety leads youth to start using tobacco and cannabis at an earlier age.

METHODS

Data were drawn from Texas Adolescent Tobacco and Marketing Surveillance System for the years 2019-2021(Waves 9-14). Participants were in 10th-grade, 12th-grade, and two years post-high school at baseline. The outcomes were the age of first use of cigarettes, e-cigarettes, and cannabis. Interval-censoring Cox proportional hazards models were fit to examine the differences in the estimated age of initiation of tobacco and cannabis use by anxiety.

RESULTS

Among the 10th-grade cohort, participants with anxiety had an increased risk of an earlier age of cigarette [AHR = 2.29(1.63-3.23)], e-cigarette [AHR = 1.53(1.17-2.00)], and cannabis [AHR = 1.59(1.23-2.05)] initiation. Among the 12th-grade cohort, participants with anxiety had an increased risk of an earlier age of cigarette [AHR = 1.52(1.21-1.90), e-cigarette [1.25(1.01-1.60)] and cannabis [AHR = 1.35(1.09-1.67] initiation. Among the post-high school cohort, the only significant association found was for cannabis initiation [AHR = 1.33(1.11-1.58). Between ages 18-to-19 years in the 10th-grade cohort, and between ages 20-21 years in the 12th-grade cohort, cumulative incidence of each of the three outcomes initiation doubled among anxious youth.

CONCLUSIONS

This study's findings show that anxiety symptoms can increase the risk of substance use initiation at an earlier age, especially among the youngest adolescent cohort (∼15-to-16-year-olds). These findings highlight the importance of early screening and treatment of anxiety symptoms as a preventive measure to delay or prevent the onset of substance use initiation.

Can drug policies modify cannabis use starting choice? Insights from criminalisation in Italy

A key question in the ongoing drug policy debate is whether legalising cannabis leads to an increase in cannabis use. In Europe although no country has yet moved to legalisation, many have decriminalised personal possession. However, some jurisdictions are still discussing increased sanctions or have further strengthened penalties for the possession of illicit substances in order to deter widespread cannabis use. This is the case in Italy, where a law introduced in 2006 and repealed in 2014 de facto criminalised personal drug possession, and a potential increase in penalties is currently being debated as a policy option. Despite the intense public debate surrounding the legal status of cannabis, limited empirical research has been conducted in Europe to assess the population-level effects of drug policy reforms, mainly due to data availability constraints. In this study, we analyse the effect of criminalisation on the age of onset of cannabis use using an unique dataset that combines seven waves (2001-2017) of the nationally representative Italian Population Survey on Alcohol and other Drugs with relevant socio-economic data. The final dataset comprises 77,650 observations. Leveraging the rare opportunity to examine the effects of a policy that remained in force for a limited period, our empirical investigation employs a Complementary Log-Log model to analyse the starting rate, that is, the transition rate from non-use to use. To do so, we use self-reported data on the age of first cannabis use. Our results suggest that the implementation of stricter punishments has a significant effect in reducing the likelihood of early cannabis use initiation. The observed impact of criminalisation is limited in younger ages and diminished as adulthood approaches. This paper also discusses other considerations related to the social costs of criminalisation, which should also be taken into account in the ongoing policy debate.

Feasibility and acceptability of a peer provider delivered substance use screening and brief intervention program for youth in Kenya

BACKGROUND

Youth in sub-Saharan Africa are at high risk of substance use yet lack access to substance use interventions. The goal of this project was to evaluate the feasibility and acceptability of a peer-delivered, single-session substance use screening and brief intervention program for youth in Kenya.

METHODS

This was a convergent parallel mixed methods study utilizing both quantitative and qualitative approaches. Two trained peer providers administered the screening and brief intervention program to 100 youth aged 15-24 years. To evaluate the implementation of the intervention, we collected quantitative and qualitative data. Feasibility and acceptability were quantitatively assessed using the Dissemination and Implementation Measures. Fidelity was assessed by rating all 100 audio-recorded sessions using a checklist. To obtain qualitative feedback on the intervention, we conducted five focus group discussions with 25 youths and six semi-structured interviews with two peer providers and four clinic leaders. The semi-structured interviews were guided by the Consolidated Framework for Implementation Research. Quantitative data was analyzed via descriptive statistics using STATA. Qualitative data was analyzed using thematic analysis with NVIVO.

RESULTS

The lifetime prevalence of any substance use was 50%. The mean level of acceptability of the intervention from the perspective of the youth was 3.53 (SD 0.15), meaning that the youth found the intervention to be acceptable "a lot" of the time. Mean levels of implementation outcomes (acceptability, adoption, Acceptability, Appropriateness, Feasibility, Reach/access, Organizational climate, General leadership skills, and Sustainability) as rated by peer providers and clinic staff ranged between 2.61 ("a moderate amount") and 4.0 ("a lot"). In qualitative data, youth reported that the intervention was helpful and useful in enabling them to stop or reduce substance use. The peer providers felt that the intervention was easy to implement, while the clinic leaders felt that available resources were adequate, and that the intervention aligned well with the goals of the clinic.

CONCLUSION

Our findings suggest that the peer-delivered screening and brief intervention program was perceived as acceptable to the youth and feasible to implement.

TRIAL REGISTRATION

NCT04998045 Registration date: 10/08/2021.

Depressive symptoms and the age of initiation of tobacco and marijuana use among adolescents and young adults

BACKGROUND

Studies have demonstrated important associations between depressive symptoms and tobacco and marijuana use. However, to date, it is unknown if depressive symptoms predispose youth to tobacco and marijuana use at earlier ages over time.

METHODS

Data from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) for the years 2019-2021 (Waves 9-14) were used. Eligible samples include individuals who had never used cigarette (n=1776), e-cigarette (n=1353), or marijuana (n=1505) at basline and had complete data on covariates. Interval-censoring survival analysis was used to examine the differences in the estimated age of first use of cigarettes, e-cigarettes, and marijuana by depressive symptoms.

RESULTS

10th-grade cohort participants with depressive symptoms had increased risk of earlier age of first use of cigarette [AHR=1.45; 95% CI=1.02-2.04)], e-cigarette [AHR=1.65(1.27-2.15)], and marijuana [AHR=1.56(1.20-2.01)]. 12th-grade cohort participants with depressive symptoms had increased risk of earlier age of first use of cigarette [AHR=1.41(1.11-1.82), e-cigarette [AHR=1.35(1.10-1.87)] and marijuana [AHR=1.25(1.01-1.55)]. However, among the two-year post-high school cohort, depressive symptoms predicted the age of first use of marijuana only [AHR=1.34(1.13-1.60)]. Between ages 18-to-20 years, the estimated cumulative incidence of initiation almost doubled for all three products among depressive participants in 10th and 12th-grade cohorts.

CONCLUSIONS

Among 10th-grade, 12th-grade, and 2-year post-HS students, those with depressive symptoms initiate tobacco and marijuana use at earlier ages than peers without depressive symptoms. Early screening and management of depressive symptoms among adolescents and young adults may be a promising target for preventing or delaying the age of first use of substance use.

Neurocognitive predictors of addiction-related outcomes: A systematic review of longitudinal studies

It is well-established that addiction is typically associated with a distinct pattern of neurocognitive functioning with a consensus that it is typified by impaired top-down executive control and aberrant risk-reward processing. Despite a consensus that neurocognition plays an important role in characterizing and maintaining addictive disorders, there is a lack of systematic, bottom-up synthesis of quantitative evidence showing that neurocognition predicts addictive behaviors, and which neurocognitive constructs have the best predictive validity. This systematic review aimed to assess whether cognitive control and risk-reward processes as defined by the Research Domain Criteria (RDoC) predict the development and maintenance of addictive behaviors specifically, consumption, severity, and relapse. The findings from this review expose the substantial lack of evidence for neurocognition predicting addiction outcomes. However, there is evidence that suggests reward-related neurocognitive processes may be important for the detection of early risk for addiction, as well as a potentially viable target for designing novel, more effective interventions.

Socio-demographic profile and clinical co-morbidities of cannabis users attending a tertiary care hospital in India: A retrospective case record study

Context

Cannabis use has been the most commonly used illicit psychoactive substance in India. Increasing use of cannabis has been associated with an increased risk of co-morbid psychotic spectrum disorders with worse outcomes. This risk increases with increased use in a dose-dependent manner. A very complex association exists between cannabis use and mental illness hence it is essential to understand the relationship between the two to facilitate better care and management.

Aim

The present study was conducted to assess the socio-demographic profile and psychiatric co-morbidities of cannabis users attending a tertiary mental health establishment in Goa.

Materials and Methods

A retrospective case record study was carried out among self-reported cannabis users attending services at a tertiary mental health establishment from June 2021 to June 2022. Data regarding cannabis use, clinical profile, and socio-demographic profile of the individuals was obtained and analyzed using appropriate statistical tests.

Results

One hundred and sixty-four cannabis users were evaluated which consisted of 140 males and 24 females, the mean age being 28 years with a standard deviation of 7.68. Ganja was the most commonly used form smoked as joints. The median age of initiation was 18 with females starting at a later age than males. Later initiation was associated with using lower quantities. Concurrent alcohol and nicotine use was present in 90% of the cases. The most commonly associated diagnosis was substance-induced psychosis.

Conclusions

Cannabis use in individuals with mental illness is more common in males and an early age of initiation was linked to earlier age of onset of psychiatric illness.

Substance use and sleep health in young adults: Implications for integrated treatment and harm reduction

In their systematic review and meta-analysis, Meneo and colleagues document distinct substance-sleep effects reported by young adults (ages 18-30) across multidimensional sleep health and different substances used in the naturalistic environment, including alarming rates of self-medication for sleep aid. Key innovations of Meneo et al.'s review include (a) a multidimensional approach to defining sleep health and (b) robust inclusion of various substances commonly used in young adults. Although future research will be essential to clarifying transdiagnostic risk mechanisms, interplay of co-used substances, and the role of expectancies in risk processes, the developing literature reviewed herein may inform much-needed clinical recommendations. This work by Meneo et al should prompt an emphasis on approaching young adult substance use and self-medication through a harm reduction lens, highlighting recommendations for integrated behavioral sleep treatment tailored to stage of change using motivational interviewing.

Medical cannabis identity and public health paternalism

Objectives

State-dependent and variable lists of medical conditions granting access to medical cannabis in the United States may be an example of public health paternalism. While purporting to ensure that medical use is clearly defined, the variability of approved conditions has created an atmosphere of ambiguity and medical precarity. The purpose of this study is to examine the relationship between "state" and "self" medical cannabis user identities and the ways non-medical users understand their cannabis consumption.

Study design

This is a mixed methods study consisting of semi-structured interviews and survey data.

Methods

In Phase 1, we examined the relationship between self and state-sanctioned cannabis identity, drawing on the 2022 New Frontier Data Consumer Survey of current cannabis consumers (N = 4682). In Phase 2, we conducted eight semi-structured interviews with a separate sample of adults who use cannabis regularly but do not consider themselves "medical consumers".

Results

Self-reported cannabis identity was significantly related to the adoption of a cannabis consumer identity. Those who self-identified as solely medical or recreational consumers were more likely to reject the identity of "cannabis consumer" than those who identified as both. Self-medical identity was overshadowed by use for "wellness" among interviewees. Most interviewees, despite not identifying as medical users, report therapeutic benefit. Their identity as a cannabis consumer, is tied to the definition of "medical cannabis patient" where they live as well as the fluctuating role of cannabis related to their well-being across their lifespan.

Conclusions

The designation of medical vs. nonmedical use of cannabis varies from state to state, which is not the case for other medicine. This highly variable designation may be paternalistic in nature as governments attempt to differentiate between "legitimate" and "illegitimate" use in the context of federal cannabis prohibition. As a result, lines between medical use and wellness are blurred, which impacts consumer self-identity.

Associations Between Cannabis Use, Polygenic Liability for Schizophrenia, and Cannabis-related Experiences in a Sample of Cannabis Users

BACKGROUND AND HYPOTHESIS

Risk for cannabis use and schizophrenia is influenced in part by genetic factors, and there is evidence that genetic risk for schizophrenia is associated with subclinical psychotic-like experiences (PLEs). Few studies to date have examined whether genetic risk for schizophrenia is associated with cannabis-related PLEs.

STUDY DESIGN

We tested whether measures of cannabis involvement and polygenic risk scores (PRS) for schizophrenia were associated with self-reported cannabis-related experiences in a sample ascertained for alcohol use disorders (AUDs), the Collaborative Study on the Genetics of Alcoholism (COGA). We analyzed 4832 subjects (3128 of European ancestry and 1704 of African ancestry; 42% female; 74% meeting lifetime criteria for an AUD).

STUDY RESULTS

Cannabis use disorder (CUD) was prevalent in this analytic sample (70%), with 40% classified as mild, 25% as moderate, and 35% as severe. Polygenic risk for schizophrenia was positively associated with cannabis-related paranoia, feeling depressed or anhedonia, social withdrawal, and cognitive difficulties, even when controlling for duration of daily cannabis use, CUD, and age at first cannabis use. The schizophrenia PRS was most robustly associated with cannabis-related cognitive difficulties (β = 0.22, SE = 0.04, P = 5.2e-7). In an independent replication sample (N = 1446), associations between the schizophrenia PRS and cannabis-related experiences were in the expected direction and not statistically different in magnitude from those in the COGA sample.

CONCLUSIONS

Among individuals who regularly use cannabis, genetic liability for schizophrenia-even in those without clinical features-may increase the likelihood of reporting unusual experiences related to cannabis use.

Current Status of Korean Alcohol Drinking in Accordance with the Korean Alcohol Guidelines for Moderate Drinking Based on Facial Flushing

Since each person has a different ability to break down alcohol, it is inappropriate to apply a uniform standard to everyone when evaluating drinking status. In Korea, there has been a guideline for moderate drinking based not only on sex and age but Koreans' alcohol metabolism capabilities that can be predicted by presence of facial flushing response. So far, there have been no studies that have investigated drinking habits of Koreans in accordance with the guideline. This study tried to identify the current drinking status of Koreans according to the guideline. As a result, it was confirmed that about 1/3 of the total population was accompanied by facial flushing when drinking alcohol, and it was found that different drinking habits were shown even in the same age and gender groups according to the presence of facial flushing. It is difficult to accurately evaluate drinking habits because facial flushing has not yet been investigated in some large data or various medical examinations. In the future, it is necessary to ensure that the presence of facial flushing can be confirmed at the medical treatment or examination site so that accurate drinking habit evaluation and prevention and resolution of drinking problems can be achieved.

The intersection of neighborhood and race in urban adolescent health risk behaviors

AIMS

Racial variability in associations of neighborhood socioeconomic disadvantage and neighborhood disorder with adolescent health risk behaviors remains under-researched, which this study examined over 1 year among racially diverse adolescents.

METHODS

High school students (N = 345; 18% Asian, 44% Black, 16% Multiracial, 22% White) completed surveys assessing neighborhood socioeconomic disadvantage and neighborhood disorder, and health risk behaviors (lifetime alcohol, cannabis, and cigarette use, number of sexual partners) at baseline (Year 1) and 1-year follow-up (Year 2).

RESULTS

Asian, Black, and Multiracial adolescents were more likely to endorse health risk behaviors in Year 2 compared to White adolescents living in similarly disadvantaged neighborhoods at Year 1. Associations of neighborhood disorder with health risk behavior did not differ by race.

CONCLUSION

Neighborhood socioeconomic disadvantage (but not neighborhood disorder) may predispose Asian, Black, and Multiracial adolescents to health risk behaviors. Findings may inform interventions to address racial disparities in adolescent health risk behaviors.

Measuring white matter microstructure in 1,457 cannabis users and 1,441 controls: A systematic review of diffusion-weighted MRI studies

INTRODUCTION

Cannabis is the most widely used regulated substance by youth and adults. Cannabis use has been associated with psychosocial problems, which have been partly ascribed to neurobiological changes. Emerging evidence to date from diffusion-MRI studies shows that cannabis users compared to controls show poorer integrity of white matter fibre tracts, which structurally connect distinct brain regions to facilitate neural communication. However, the most recent evidence from diffusion-MRI studies thus far has yet to be integrated. Therefore, it is unclear if white matter differences in cannabis users are evident consistently in selected locations, in specific diffusion-MRI metrics, and whether these differences in metrics are associated with cannabis exposure levels.

METHODS

We systematically reviewed the results from diffusion-MRI imaging studies that compared white matter differences between cannabis users and controls. We also examined the associations between cannabis exposure and other behavioral variables due to changes in white matter. Our review was pre-registered in PROSPERO (ID: 258250; https://www.crd.york.ac.uk/prospero/).

RESULTS

We identified 30 diffusion-MRI studies including 1,457 cannabis users and 1,441 controls aged 16-to-45 years. All but 6 studies reported group differences in white matter integrity. The most consistent differences between cannabis users and controls were lower fractional anisotropy within the arcuate/superior longitudinal fasciculus (7 studies), and lower fractional anisotropy of the corpus callosum (6 studies) as well as higher mean diffusivity and trace (4 studies). Differences in fractional anisotropy were associated with cannabis use onset (4 studies), especially in the corpus callosum (3 studies).

DISCUSSION

The mechanisms underscoring white matter differences are unclear, and they may include effects of cannabis use onset during youth, neurotoxic effects or neuro adaptations from regular exposure to tetrahydrocannabinol (THC), which exerts its effects by binding to brain receptors, or a neurobiological vulnerability predating the onset of cannabis use. Future multimodal neuroimaging studies, including recently developed advanced diffusion-MRI metrics, can be used to track cannabis users over time and to define with precision when and which region of the brain the white matter changes commence in youth cannabis users, and whether cessation of use recovers white matter differences.

SYSTEMATIC REVIEW REGISTRATION

www.crd.york.ac.uk/prospero/, identifier: 258250.

New Frontiers in Prevention Research Models: Commentary on the Special Issue

Models considered in the current special issue represent valuable additions to the statistical toolbox of prevention researchers for many types of research questions and designs. Their appropriate use, however, depends on critical evaluation relative to previously existing techniques. This evaluation includes (a.) model choice involving "right-sizing" of the model relative to the amount and quality of data at hand, (b.) examination of the external validity of identified associations relative to observed or latent subgroups, (c.) confirmation of the reasonableness of the functional form assumed by the model, and (d.) identification of influential or outlying observations which unduly affect model fit or parameter estimates. Models in this issue allow for testing of new types of hypotheses in prevention research, and can constitute counterarguments to existing statistical practice. These models may, however, in turn be the object of critical examination of counterarguments a reasonable skeptic may offer.

Dampened autonomic nervous system responses to stress and substance use in adolescence

We investigated whether parasympathetic and sympathetic nervous system (SNS) responses to social-evaluative threat at age 14 were related to the number of substances used between ages 14 and 16 among Mexican-origin adolescents (N = 243; 70.4% had never used substances by 14). Participants completed the Trier Social Stress Test, while cardiac measures of parasympathetic and SNS activity were measured continuously using respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP), respectively. Participants reported whether they had ever used alcohol, marijuana, and cigarettes, and had ever vaped nicotine in their lifetime at ages 14 and 16. Multilevel models were used to test associations between RSA and PEP responses at age 14 and substance use at 16. Among youth who had not used substances by 14, dampened RSA and PEP responses, and profiles of greater coinhibition and lower reciprocal SNS activation between RSA and PEP, at age 14 were associated with using substances by 16. Among youth who used by 14, exaggerated PEP responses were associated with using more substances by age 16. Taken together, dampened autonomic responses to social-evaluative threat predicted initiation of substance use over two years, and difficulties with coordination of physiological responses may confer risk for substance use in adolescence.

The trajectories and associations of insomnia symptoms with addictive behaviours in adolescents: A two-year longitudinal study

Insomnia displays heterogeneous trajectories across adolescence, which may induce addictive behaviours, including internet gaming disorder and substance use. This study aimed to investigate the latent trajectory classes of insomnia symptoms over 2 years and to examine the associations between insomnia trajectories and these addictive behaviours. Participants were 910 adolescents from six middle schools in Shanghai, China (52.7% males; mean age = 13.17 years). The three-wave survey measured insomnia symptoms, internet gaming disorder, substance use, depressive symptoms, and sociodemographic characteristics from 7th to 9th grade. Latent class growth modelling was performed to identify the latent trajectory classes of insomnia symptoms. Then multivariable logistic regressions were conducted within the best-fitting latent class growth model to examine the associations of insomnia trajectories with internet gaming disorder and substance use. Two latent trajectory classes of insomnia symptoms were recognised: the non-insomnia group (71.8%) and the insomnia group (28.2%). In the multivariable analysis controlling for baseline demographic variables and depressive symptoms, the insomnia group had a higher risk of developing internet gaming disorder (OR = 2.203 [95% CI: 1.258-3.858]) and substance use (OR = 2.215 [95% CI: 1.324-3.705]) compared with the non-insomnia group. These findings add to a growing body of research on heterogeneous trajectories of insomnia symptoms during adolescence, suggesting that intervention strategies are needed to target the characteristics or developmental patterns of different insomnia subgroups. The ultimate goal is to mitigate the impact of insomnia symptoms on adolescent addictive behaviours.

Recreational cannabis legalization has had limited effects on a wide range of adult psychiatric and psychosocial outcomes

BACKGROUND

The causal impacts of recreational cannabis legalization are not well understood due to the number of potential confounds. We sought to quantify possible causal effects of recreational cannabis legalization on substance use, substance use disorder, and psychosocial functioning, and whether vulnerable individuals are more susceptible to the effects of cannabis legalization than others.

METHODS

We used a longitudinal, co-twin control design in 4043 twins (N = 240 pairs discordant on residence), first assessed in adolescence and now age 24-49, currently residing in states with different cannabis policies (40% resided in a recreationally legal state). We tested the effect of legalization on outcomes of interest and whether legalization interacts with established vulnerability factors (age, sex, or externalizing psychopathology).

RESULTS

In the co-twin control design accounting for earlier cannabis frequency and alcohol use disorder (AUD) symptoms respectively, the twin living in a recreational state used cannabis on average more often (βw = 0.11, p = 1.3 × 10-3), and had fewer AUD symptoms (βw = -0.11, p = 6.7 × 10-3) than their co-twin living in an non-recreational state. Cannabis legalization was associated with no other adverse outcome in the co-twin design, including cannabis use disorder. No risk factor significantly interacted with legalization status to predict any outcome.

CONCLUSIONS

Recreational legalization was associated with increased cannabis use and decreased AUD symptoms but was not associated with other maladaptations. These effects were maintained within twin pairs discordant for residence. Moreover, vulnerabilities to cannabis use were not exacerbated by the legal cannabis environment. Future research may investigate causal links between cannabis consumption and outcomes.

Substance Initiation Tendency Scale (SITS): Validity and Reliability Study

Background: The purpose of the present study was to make a new contribution to the literature by developing a scale to detect the substance initiation tendencies of young people and adolescents and to create a leading tool for preventive policies to be implemented against substance use. Method: An 8-item and 2-factor measurement tool called the "Substance Initiation Tendency Scale" was created. The data obtained from 470 students studying in 5 high schools in the Genç County of Bingöl, Turkey, were subjected to reliability and validity tests. In this context, Explanatory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), item analysis, and halving methods were used along with the SPSS 24 and AMOS 24 data analysis programs. Results: It was found that the Kaiser-Meyer Olkin (KMO) value was "excellent" with .909 and the Bartlett Sphericity Test was significant, and the scale, which could explain 57.332% of the total variance, had the feature of distinguishing what was intended to be measured. The values obtained from the Confirmatory Factor Analysis showed a "good fit". Conclusion: It was understood that the obtained data were sufficient to confirm the construct's validity.

Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study

BACKGROUND

Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population.

OBJECTIVES

This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns.

DESIGN

Anonymous, online cross-sectional survey.

METHODS

Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS.

RESULTS

The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns.

CONCLUSION

Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.

Does abstaining from alcohol in high school moderate intervention effects for college students? Implications for tiered intervention strategies

Brief motivational intervention (BMI) and personalized feedback intervention (PFI) are individual-focused brief alcohol intervention approaches that have been proven efficacious for reducing alcohol use among college students and young adults. Although the efficacy of these two intervention approaches has been well established, little is known about the factors that may modify their effects on alcohol outcomes. In particular, high school drinking may be a risk factor for continued and heightened use of alcohol in college, and thus may influence the outcomes of BMI and PFI. The purpose of this study was to investigate whether high school drinking was associated with different intervention outcomes among students who received PFI compared to those who received BMI. We conducted moderation analyses examining 348 mandated students (60.1% male; 73.3% White; and 61.5% first-year student) who were randomly assigned to either a BMI or a PFI and whose alcohol consumption was assessed at 4-month and 15-month follow-ups. Results from marginalized zero-inflated Poisson models showed that high school drinking moderated the effects of PFI and BMI at the 4-month follow-up but not at the 15-month follow-up. Specifically, students who reported no drinking in their senior year of high school consumed a 49% higher mean number of drinks after receiving BMI than PFI at the 4-month follow-up. The results suggest that alcohol consumption in high school may be informative when screening and allocating students to appropriate alcohol interventions to meet their different needs.

Trajectories of adolescent poly-substance use and their long-term social and economic outcomes for males from low-income backgrounds

Substance abuse is a significant public health concern that disproportionately burdens males and low-income communities. This study examined (1) longitudinal profiles of male adolescent poly-substance use and (2) their association with social and economic participation across early adulthood. Drawing on a cohort of males (n = 890) from low-income neighborhoods, we used group-based multi-trajectory modeling to identify profiles of poly-substance use (alcohol, tobacco, cannabis, illicit drugs) from age 13-17 years. Regression models were used to link substance use profiles to high school graduation, criminal convictions, personal and household earnings, welfare receipt and partnership from age 19-37 years, obtained from administrative records. Child IQ, family adversity and behavioral problems were adjusted for. Four poly-substance use profiles were identified: abstinent (n = 128, 14.4%), late-onset (n = 412, 46.5%), mid-onset (n = 249, 28.1%), and early-onset (n = 98, 11.1%). Relative to the late-onset (reference) group, participants in the early-onset profile were 3.0 times (95%CI = 1.68-5.53) more likely to have left school without a diploma, 2.7 times (95% CI = 1.56-4.68) more likely to have a criminal conviction by age 24 years, earned 10,185 USD less (95% CI =  - 15,225- - 5144) per year at age 33-37 years and had 15,790 USD lower (95% CI =  - 23,378- - 8218) household income at age 33-37 years, a 1.3 times (95%CI = 1.15-1.57) higher incidence of annual welfare receipt and a 24% (95% CI = 5-40) lower incidence of marriage/cohabitation from age 18-35 years. We show that adolescent-onset poly-substance use by age 13 is associated with poor social and economic outcomes. Delaying the onset of substance use and reducing exposure to additional substance classes has potential for high societal cost savings.

Transitions in risk-behavior profiles among first-year college students

ObjectiveThe current study utilized a longitudinal person-centered approach (latent transition analysis [LTA]) to assess transitions into and out of risk-behavior profiles during the transition into and throughout the first year of college. Participants: Participants included 579 first-year college students (Mage = 18.13, SD = .94) from a large mid-Atlantic university. Methods: Participants completed surveys at five points throughout their freshman year. Results: LTA suggested that most individuals either abstained from engaging in risk behaviors or transitioned toward profiles of less risk over time. A smaller portion of individuals either began and ended the year in the same risk profile or transitioned into profiles of greater risk. Conclusions: The findings highlight the importance of utilizing person-centered analyses to examine change in multiple health-risk behaviors.

Patterns of Violence Exposure and Substance Use among Child Welfare Involved Youth

Emerging research suggests an association between exposure to violence, specifically indirect forms, and substance use among youth involved in the child welfare (CW) system. However, this has only been recently and tentatively explored. This study examined the associations among various forms of indirect violence exposure and substance use among subgroups of youth involved in the CW system. The analytic sample consisted of participants (aged 11 years or older) in the baseline year of the second National Survey of Child and Adolescent Well-Being (2008-2012), including youth and their caregivers. Latent class analysis was used to examine associations among distinct forms of indirect violence exposure and substance use and the potential identification of unique at-risk groups. Models for the overall sample suggested two classes of at-risk youth, with the higher-risk class having higher probabilities of alcohol, marijuana, and hard drug use, which coincided with higher probabilities of exposure to arrests, stealing, drug deals, and weapon use. However, stratified models suggested unique results for youth aged 13-14 and 15-17, suggesting that the confluence of these risks appears to differ developmentally. Prevention and intervention services for CW-involved youth should assess and address violence exposure types among youth as a potential opportunity to mitigate substance use and subsequent high-risk behavior.

Geographical variation and correlates of substance use among married men in Ethiopia: spatial and multilevel analysis from Ethiopian Demographic and Health Survey 2016

OBJECTIVE

The use of substances has become one of the world's most serious public health and socioeconomic issues. Most nations in sub-Saharan Africa, including Ethiopia, are undergoing significant economic transitions, creating a favourable environment for socially destructive substance use. This study aimed to determine the geographical variation, prevalence and correlates of substance use among ever-married men in Ethiopia.

DESIGN

A community-based cross-sectional survey was undertaken from 18 January 2016 to 27 June 2016.

DATA SOURCE

Data were used from the 2016 Ethiopian Demographic and Health Survey (EDHS).

DATA EXTRACTION AND ANALYSIS

Data from the 2016 EDHS was used, and a total of 7793 ever-married men were involved in the analysis. The spatial autocorrelation statistic (Global Moran's I) was used to determine whether substance use was dispersed, clustered or randomly distributed. A multilevel logistic regression model was used to identify the correlates with substance use, and statistical significance was declared at p<0.05 and 95% CI.

RESULTS

Of all ever-married men, 72.5% (95% CI 71.5% to 73.4%) were currently using at least one of the three substances (alcohol, cigarettes and chat). The highest hotspot areas of substance use were observed in Ahmara and Tigray regions. The age (adjusted OR, AOR 1.80; 95% CI 1.32 to 2.45), educational status (AOR 0.64; 95% CI 0.51 to 0.82), occupation (AOR 1.36; 95% CI 1.05 to 1.76), watching television (AOR 1.50; 95% CI 1.25 to 1.81) and living in the city (AOR 2.25; 95% CI to 1.36 to 3.74) were individual and community-level correlates found to have a statistically significant association with substance use.

CONCLUSION

In this study, nearly three-fourths of married men used one of the three substances. Given these findings, it is critical to reducing the problem by improving modifiable individual-level variables such as educational status and reducing substance advertising.

Examining protective factors for substance use problems and self-harm behavior during adolescence: A longitudinal co-twin control study

Sports participation, physical activity, and friendship quality are theorized to have protective effects on the developmental emergence of substance use and self-harm behavior in adolescence, but existing research has been mixed. This ambiguity could reflect, in part, the potential for confounding of observed associations by genetic and environmental factors, which previous research has been unable to rigorously rule out. We used data from the prospective, population-based Child and Adolescent Twin Study in Sweden (n = 18,234 born 1994-2001) and applied a co-twin control design to account for potential genetic and environmental confounding of sports participation, physical activity, and friendship quality (assessed at age 15) as presumed protective factors for adolescent substance use and self-harm behavior (assessed at age 18). While confidence intervals widened to include the null in numerous co-twin control analyses adjusting for childhood psychopathology, parent-reported sports participation and twin-reported positive friendship quality were associated with increased odds of alcohol problems and nicotine use. However, parent-reported sports participation, twin-reported physical activity, and twin-reported friendship quality were associated with decreased odds of self-harm behavior. The findings provide a more nuanced understanding of the risks and benefits of putative protective factors for risky behaviors that emerge during adolescence.

The joint development of externalizing and internalizing behaviors in black and Hispanic youth and the link to late adolescent substance use

There is a need to understand how the joint development of externalizing and internalizing behaviors is related to substance use, particularly among historically understudied and often disadvantaged populations. Latent class models were used to estimate patterns of externalizing behaviors and internalizing behaviors in the form of depressive and anxious symptoms from age 6 to 14 among 390 Black and Hispanic youth. Then, growth curve models of substance use between the ages of 15 and 19 were estimated as a function of joint latent class membership. Only elevated levels of externalizing behaviors were associated with higher levels of substance use through age 18. Internalizing behaviors appeared to serve as a protective factor among those with moderate displays of externalizing behavior only. Additionally, growth in substance use from ages 15 to 19 was slower among those who displayed the highest level of externalizing behaviors, and internalizing behaviors appeared to moderate growth (and serve as protective factor) among those who displayed moderate levels of externalizing behaviors. The findings underscore the importance of pattern profiles based on observations of the joint development of problem behaviors to assess risk for substance use, particularly in understudied populations where risk/protective factors may operate in a unique manner.

Trajectories of Substance Use and Well-being in Early and Middle Adolescence Shaped by Social Connectedness

Increasing substance use and decreasing well-being are typical in adolescence, yet how social contexts shape disparate development during this time is less well-understood. A latent growth class analysis was conducted that identified groups of early (N = 706; Age_m  = 12.20) and middle (N = 666; Age_m  = 14.38) adolescents distinguished by rates of substance use and well-being over three years. In both cohorts, the largest group reported low substance use and high well-being, with a smaller group exhibiting maladaptive trajectories for both substance use and well-being. Two additional groups were identified during middle adolescence characterized by either low well-being or high substance use. Family connectedness was a protective factor, while high peer connectedness was a risk factor for substance-use groups and low peer connectedness for languishing.

Associations of childhood sociability and responsibility with cannabis use trajectories during adolescence: results from a prospective population-based birth cohort study

This study aims to identify distinct trajectories of cannabis use during adolescence and examine whether Sociability (ability to relate to others) and Responsibility (ability to integrate a community setting) during childhood are associated with these trajectories, accounting for individual and familial confounders. Population-based cohort study (1998-2019): 1511 children from the Quebec Longitudinal Study of Child Development were followed between ages 5 months and 19 years. We identified developmental trajectories of adolescent cannabis use (assessed biyearly between ages 12 and 19 years) using a group-based trajectory model. We performed multinomial regression analyses to estimate the association between childhood Sociability and Responsibility assessed yearly between ages 6 and 12 years, and cannabis use trajectories. At 19 years, 62.8% (807/1286) of adolescents had used cannabis at least once in their lifetime, 44.2% had used at least once in the past 12 months (504/1140), and 6.8% were reporting daily use (77/1140). We identified three cannabis use trajectories: nonusers (n = 577, 38.2%), late users (n = 690, 45.7%; mean age of initiation: 16.2 ± 1.6), and early users (n = 244, 16.2%; mean age of initiation: 14.1 ± 1.3). Compared with Nonusers, children with low Sociability had a lower risk for late (OR, 0.43; 95 CI 0.27; 0.68) and early (OR, 0.22; 95 CI 0.12; 0.41) cannabis use. Children with low Responsibility were at higher risk of being Early users (OR, 2.23; 95 CI 1.13; 4.37) but not Late users (OR, 1.20; 95 CI 0.71; 2.03). Understanding the multiple dimensions of social skills and their association with cannabis use trajectories may help improve the effectiveness of evidence-based prevention strategies.

Retail cannabis environment and adolescent use: The role of advertising and retailers near home and school

Youth cannabis use is influenced by overlapping environmental contexts. We examined the associations between proximity to cannabis retailers and seeing cannabis advertisements and cannabis use behaviors in Oregon, a state with adult cannabis legalization. We used 2017 anonymous survey data from 24,154 Oregon 8th and 11th grade students. After adjustments for student and school district characteristics, advertising for 8th graders and presence of a retailer within a mile from school for 11th graders were associated with cannabis use and perceived harm. Additional policy efforts may further reduce youth exposure to cannabis.

Developmental and etiological patterns of substance use from adolescence to middle age: A longitudinal twin study

BACKGROUND

The common liability to addiction framework suggests the tendency to use substances is largely a general heritable liability, but little is known about how expression of liability varies across development. We evaluated average developmental trajectories and covariation underlying commonly used substances using a genetically informative prospective design spanning three decades.

METHODS

Using a sample of 3762 twins across seven waves of assessment spanning ages 14-40, we modeled these relationships using two complementary approaches: piecewise latent growth and common factor modeling on four measures of alcohol, tobacco, and marijuana use RESULTS: Average use increased across adolescence and either stabilized (alcohol frequency) or declined (all others) in adulthood. Trajectories were heritable (~.35-.75), and genetically correlated with one another (~.40-.80). The random intercepts, centered at age 16, exhibited shared environmental correlations across substances. We found moderate to large phenotypic (rp~.3-.9) and genetic correlations (rg~.3-1) among the longitudinally varying common factors loading on use of each substance at each age. The factor loadings declined with age, reflecting waning influence of common etiology in substance use.

CONCLUSIONS

Trajectories of substance use were strongly correlated with each other and influenced primarily by genetic and non-shared environment. A heritable common factor accounted for co-occurring substance use from mid-adolescence to mid-adulthood, and greater substance specificity emerged with maturation. These results extend and reinforce prior work examining consumption and problem use, providing new evidence over a broad age range showing that substance use behaviors are influenced by a more general liability in adolescence and specificity increases across development.

Adolescents' Frequency of Alcohol Use and Problems from Alcohol Abuse: Integrating Dating Partners with Parent and Peer Influences

Despite the centrality of dating relationships for teens, it is unclear whether the influence of romantic partners' alcohol use on adolescents' under-age drinking is distinct from the influence of peers and parents. To address this gap, this study used longitudinal data from a population-based sample of 825 adolescents (49% male, 51% female), ages 12 to 19. Adolescents completed a survey using laptops for privacy, and a parent completed a survey separately. Ordinary least squares and logistic regression models assessed alcohol use frequency and alcohol problems and included dating partners' drinking, adolescents' prior drinking, peers' drinking, parents' substance use, parental monitoring, and sociodemographic background characteristics. Alcohol use frequency and alcohol problems were influenced by dating partners' alcohol use and dating partners' influence was stronger on older adolescents and male adolescents. The study results are useful for public health messaging and prevention efforts by demonstrating the influence of parents, peers, and dating partners on teens' alcohol use.

Early life stress and substance use disorders: The critical role of adolescent substance use

Early life stress (ELS) is a well-established risk factor for many psychiatric and medical disorders, including substance use disorders (SUDs). The relationship between ELS and SUDs is complex and there are likely multiple pathways from ELS to adverse substance use outcomes. The association between ELS and substance use emerges in adolescence. Adolescence is a critical period in development during which substance exposure markedly increases risk for SUDs. Therefore, this review focuses on the literature supporting the hypothesis that ELS increases risk for the development of SUDs through its influence on adolescent substance use. We discuss studies substantiating the role of ELS in adolescent substance use and explore how internalizing and externalizing psychopathology may be antecedents of substance use in adolescence. We examine clinical work suggesting ELS sculpts the Hypothalamic-Pituitary-Adrenal (HPA) Axis and developing brain-particularly subcortical brain regions that underlie stress response, mesocorticolimbic brain systems associated with reward sensitivity, and prefrontal regions that underlie executive control-in a way that increases risk for adolescent substance use and SUDs. We further explore how substance use during adolescence alters structure and function of these same systems, and how brain changes following ELS and adolescent substance use may independently, additively, or interactively contribute to risk for addiction. We conclude by discussing how the current literature can inform interventions aimed at reducing risk for SUDs in individuals with a history of ELS.

Trends in cannabis-related attitudes and behaviors among cannabis-using adolescent and young adult outpatients following medical cannabis legalization in Massachusetts

Background: Among youth already using cannabis, legalization of medical cannabis may influence cannabis-related attitudes and behaviors, including increasing access through use of someone else's medical cannabis (diversion). Objective: To examine cannabis-related attitudes and behaviors (including diverted cannabis use) in cannabis-using youth in the four years following medical cannabis legalization. Additionally, we investigated characteristics of youth who used vs. did not use diverted medical cannabis. Methods: Data were collected in Boston from 2013 (when medical cannabis legislation took effect in Massachusetts) through 2016 (when recreational cannabis use became legal in Massachusetts). Cannabis-using youth (age 13-24) presenting to an outpatient adolescent substance use treatment program (ASUTP) or recruited for an adolescent medicine clinic study (AMCS) completed a confidential survey on demographic characteristics and cannabis use behaviors and attitudes. We used multiple logistic regression to analyze changes in attitudes and behaviors over three years versus the reference year (2013), controlling for demographics. We used chi-square to compare characteristics of youth reporting use of diverted medical cannabis versus those not. Results: The sample included 273 cannabis-using youth (ASUTP n = 203, AMCS n = 70; 2013 n = 67, 2014 n = 67, 2015 n = 77, 2016 n = 62). Mean ± SD age was 18.2 ± 2.5 years, 32% were female, 58% were White non-Hispanic, and 70% had college-graduate parents. In 2013, most youth reported that cannabis was easy to obtain (97.9%), and that occasional cannabis use had "no" or "slight" risk of harm (89.4%), with little change across years. In 2016, 44% of youth reported using someone else's medical cannabis, versus 15% in 2013 (aOR 4.66, 95% CI 1.81, 11.95). Youth using diverted medical cannabis had higher likelihood of reporting riding with a driver, or driving themselves, after cannabis use (both p < .01). Conclusion: Among at-risk youth in Massachusetts, use of diverted medical cannabis increased after medical cannabis legalization, and those using diverted medical cannabis reported higher risk for cannabis-related traffic injury.

Ethical concerns relating to genetic risk scores for suicide

Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.

Peri-adolescent exposure to (meth)amphetamine in animal models

Experimentation with psychoactive drugs is often initiated in the peri-adolescent period, but knowledge of differences in the outcomes of peri-adolescent- vs adult-initiated exposure is incomplete. We consider the existing animal research in this area for (meth)amphetamines. Established for a number of phenotypes, is lower sensitivity of peri-adolescents than adults to acute effects of (meth)amphetamines, including neurotoxic effects of binge-level exposure. More variable are data for long-term consequences of peri-adolescent exposure on motivational and cognitive traits. Moreover, investigations often exclude an adult-initiated exposure group critical for answering questions about outcomes unique to peri-adolescent initiation. Despite this, it is clear from the animal research that (meth)amphetamine exposure during the peri-adolescent period, whether self- or other-administered, impacts brain motivational circuitry and cognitive function, and alters adult sensitivity to other drugs and natural rewards. Such consequences occurring in humans have the potential to predispose toward unfortunate and potentially disastrous family, social and livelihood outcomes.

A systematic review and meta-analysis of sex differences in cannabis use disorder amongst people with comorbid mental illness

BACKGROUND

While males are more likely diagnosed with cannabis use disorder (CUD), females are more susceptible to developing and maintaining CUD. Yet, for both sexes, CUD is associated with high rates of comorbid mental illness (MI).

OBJECTIVES

To identify and compare sex differences in the prevalence of comorbid CUD amongst individuals with/without MIs.

METHODS

This systematic review generated pooled odds ratios (OR) and 95% confidence intervals (CI) from 37 studies (including clinical trials, cohort, and case-control studies) among individuals with and without MIs, quantifying sex differences in rates of comorbid CUD. A meta-analysis was also completed.

RESULTS

In the CUD-only group, males were twice as likely to have CUD than females (OR = 2.0, CI = 1.9-2.1). Among MIs, males were more likely than females to have CUD comorbid with schizophrenia (OR ~2.6, CI = 2.5-2.7) and other psychotic, mood, and substance use disorders (1> OR <2.2, CI = 0.7-2.6). The reverse association (females > males) was observed for anxiety disorders and antisocial personality disorder (OR = 0.8, CI = 0.7-1.0). Among females, MIs increased the likelihood of having CUD, except for psychotic disorders and depression. A meta-analysis was inconclusive due to high heterogeneity across studies. Thus, comparisons across MI groups were not possible.

CONCLUSION

While males are more likely to be diagnosed with CUD, there are important sex differences in the prevalence of CUD across MI diagnoses that should be taken into account when approaching CUD prevention and determining treatment efficacy.

Alcohol-related cognitions: Implications for concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse among young adults

INTRODUCTION

This study examined the associations between alcohol-related cognitions within the social reaction pathway of the Prototype Willingness Model and concurrent (use of two or more substances within a specified time period) use of 1) alcohol and marijuana and 2) alcohol and prescription stimulant misuse.

METHODS

A convenience sample of 1,062 emerging adults in the U.S. (18-20 years old; 54.5% female) who reported past 3-month alcohol use completed a baseline survey as part of a larger randomized controlled trial.

RESULTS

Results indicate that controlling for age, biological sex, race, ethnicity, and college enrollment, perceived descriptive norms and willingness to drink were associated with past 3-month concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse. However, alcohol prototype similarity and alcohol-related perceived vulnerability were not associated with either concurrent use outcome examined.

DISCUSSION

These findings suggest that alcohol-related perceived descriptive norms and willingness to drink are associated with concurrent substance use among young adults. Thus, it is possible that existing efficacious alcohol interventions that target descriptive norms and willingness to drink may have the added benefit of also reducing concurrent substance cognitions and ultimately use.

Alcohol, cannabis, and tobacco polysubstance use: A latent profile analysis of age of onset

BACKGROUND

Despite understanding the long-term risks associated with early substance use, less is known about the specific patterns of the age of onset (AO) across multiple substances and whether these patterns of early exposure are linked to substance use later in young adulthood. Consequently, the present study sought to (1) identify distinct classes regarding AO for alcohol, cannabis, and tobacco and (2) compare these classes on patterns of individual and simultaneous alcohol, cannabis, and tobacco use, other substance use, and mental health symptoms.

METHODS

Participants were 510 emerging adults (Mage = 21.35; 88.6% men) who reported past-year use of alcohol, cannabis, and tobacco.

RESULTS

Latent profile analysis was used to identify classes based on three indicators: AO for alcohol, cannabis, and tobacco. Results revealed that four classes best fit the data: Earliest AO for Alcohol (19.8%); Latest AO for Substances (6.5%); Late AO for Substances (67.8%); Earliest AO for Cannabis and Tobacco (5.9%). Classes varied on current patterns of individual substance use, co-use of substances, other illicit drug use, and mental health symptomology. The Latest AO of Substances class reported the lowest alcohol use, cannabis use, other illicit drug use, and mental health symptomology than the other classes. The Earliest AO for Alcohol and the Late AO of Substances reported a lower frequency of tobacco compared to the other classes. The Late AO of Substance class reported the highest past-year frequency of simultaneous alcohol and cannabis use.

CONCLUSIONS

The current study contributed to the larger polysubstance literature by identifying profiles that may signify risky patterns of use. Findings may help guide prevention and intervention work with adolescents and young adults.

An International Comparison of a Web-Based Personalized Feedback Intervention for Alcohol use During the Transition out of High School in the United States and Sweden

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

Resting state functional connectivity in the default mode network: Relationships between cannabis use, gender, and cognition in adolescents and young adults

INTRODUCTION

Cannabis is the most commonly used illicit substance in the United States, and nearly 1 in 4 young adults are current cannabis users. Chronic cannabis use is associated with changes in resting state functional connectivity (RSFC) in the default mode network (DMN) in adolescents and young adults; results are somewhat inconsistent across studies, potentially due to methodological differences. The aims of the present study were to examine potential differences in DMN RSFC between cannabis users and controls, and to examine, as an exploratory analysis, if gender moderated any findings. We further examined whether differences in RSFC related to differences in performance on selected neuropsychological measures.

MATERIALS AND METHODS

Seventy-seven 16-26-year-old participants underwent an MRI scan (including resting state scan), neuropsychological battery, toxicology screening, and drug use interview. Differences in DMN connectivity were examined between groups (cannabis vs. control) and with an exploratory group by gender interaction, using a left posterior cingulate cortex (PCC) seed-based analysis conducted in AFNI.

RESULTS

Cannabis users demonstrated weaker connectivity than controls between the left PCC and various DMN nodes, and the right Rolandic operculum/Heschl's gyrus. Cannabis users demonstrated stronger connectivity between the left PCC and the cerebellum and left supramarginal gyrus. The group by gender interaction was not significantly associated with connectivity differences. Stronger left PCC-cerebellum connectivity was associated with poorer performance on cognitive measures in cannabis users. In controls, intra-DMN connectivity was positively correlated with performance on a speeded selective/sustained attention measure.

DISCUSSION

Consistent with our hypotheses and other studies, cannabis users demonstrated weaker connectivity between the left PCC and DMN nodes. Chronic THC exposure may alter GABA and glutamate concentrations, which may alter brain communication. Future studies should be conducted with a larger sample size and examine gender differences and the mechanism by which these differences may arise.

Piloting of the Just Say Know prevention program: a psychoeducational approach to translating the neuroscience of addiction to youth

BACKGROUND

Substance use during adolescence can have a number of negative consequences and interfere with normal brain development. Given limited time and resources, brief group- and school-based prevention programs are an efficient strategy for educating youth about the effects of substance use on health outcomes.

OBJECTIVES

To determine if a science-based, interactive substance prevention program could improve student knowledge and influence students' attitudes toward future substance use behaviors.

METHODS

The Just Say Know program was given to 1,594 middle and high school students. The facilitator engaged students in an interactive, hour-long session covering brain basics and effects of substance use. Students completed an eight-item pre- and post-knowledge-based test to measure learning outcomes along with feedback questions about youths' attitudes toward substance use and the program.

RESULTS

After the program, 94% of students reported that it provided helpful information; 92% reported it may influence their approach to substance use, with 76% specifying that they would delay or cut back on substance use. Knowledge-based test performance increased by 78%, with high schoolers displaying significantly higher scores than middle schoolers, but both showing similar improvements in scores. Students who reported higher levels of friends' substance use had smaller improvements from pre- to posttest.

CONCLUSION

Results suggest Just Say Know, a scientifically-based prevention program, is effective in increasing adolescents' program based-knowledge, has the potential to affect youths' attitudes toward substance use, and is well-received. These findings provide preliminary evidence that a cost-effective, neuroscience-informed group prevention program might reduce or delay adolescents' future substance use.

Latency to cannabis dependence mediates the relationship between age at cannabis use initiation and cannabis use outcomes during treatment in men but not women

BACKGROUND

Time from first cannabis use to cannabis dependence (latency) may be an important prognostic indicator of cannabis-related problems and treatment outcomes. Gender differences in latency have been found; however, research in this general area is limited. As cannabis use increases and perceived risk declines, a better understanding of how these factors interact in predicting treatment outcomes is critical.

METHODS

A secondary data analysis of a randomized, double-blind, placebo-controlled pharmacotherapy trial for cannabis dependence (N = 302) examined the associations between age of cannabis use onset, time to cannabis dependence (latency), and gender on cannabis use during the trial. Mediation analysis tested whether the association between age of onset and cannabis use during the trial was mediated by latency to cannabis dependence differentially for men and women.

RESULTS

Age of use initiation was inversely correlated with latency to dependence prior to treatment [HR(95% CI) = 1.18 (1.06, 1.30); p = .002] and cannabis use during treatment (β=-1.27; SE = 0.37; p < .001). There was a significant mediation effect between age of onset, latency, and cannabis use that varied by gender. Earlier age of onset predicted longer latency, and subsequently, greater cannabis use during the trial in men (21.4% mediated; p < .05), but not women. Other substance use, race, and past psychiatric diagnosis did not predict latency either independently or in interaction models.

CONCLUSION

Findings support existing evidence that early cannabis use onset is associated with worse outcomes and add new knowledge on the differential associations between age of onset, latency to cannabis dependence, and treatment outcomes for men and women.

Legal and social consequences of substance use: Results from a nationwide study in Bangladesh

Substance use is a major public health concern and its consequences can destroy someone's life. This study aimed to explore the legal and social consequences of substance use in Bangladesh. We conducted a nationwide descriptive cross-sectional study among relapse cases of substance use from January to December 2018. We visited 138 drug rehabilitation centers countrywide and were able to recruit 939 relapse cases, from where 28 cases were excluded due to incomplete data. Finally, data from 911 cases were analyzed. The majority (89.3%) of the study participants were 19-45 years old. Most commonly used drugs were amphetamine (76.1%), cannabis (75.0%), alcohol (54.3%), cough sirup (54.2%), heroin (47.0%) and sleeping pills (21.6%). Almost half (49.5%) of the substance users were arrested for drug use and among arrested cases, 52.1% were sent to jail. About 75% of the substance users experienced a lack of family interaction, 70% experienced destroyed family relationships, and 71.4% faced social stigma. Our study also found 60% of the participants were bullied, 50% were deprived or unwilling to have social interactions. Moreover, 13.8% of the participants left home, while 8% got divorced. Our data represented the significant impact of substance use on the legal aspect and social life of individuals. However, with a multi-dimensional treatment, rehabilitation, and social intervention approach, it is not impossible to overcome. Therefore, we believe it is imperative to focus on social awareness and to create a robust platform for health promotion and improve quality of life.

Patterns of substance use among adolescents: A systematic review

PURPOSE

This review characterizes empirically derived patterns of multiple (multi-) substance use among adolescents. A secondary objective was to examine the extent to which mental health symptomatology was included in the empirical analyses examining substance use patterns.

METHODS

Eligible studies included those that used cluster-based approaches, included the assessment of at least two different substances, and were based on study samples with mean ages between 11 and 18 years. 4665 records were screened including 461 studies for full-text screening.

RESULTS

70 studies were included with common clusters being: low use, single or dual substance use, moderate general multi-use, and high multi-use. The most common patterns of single or multi-substance use were: alcohol only, alcohol with cannabis and/or tobacco, and use of alcohol, tobacco, and cannabis with and without other drugs. Lower socioeconomic status, older age, and male gender were consistent predictors of multi-use clusters. Only 37 % of studies compared differences in levels of mental health across clusters with symptoms consistently associated with a greater likelihood of multi-use. Only 29 % of studies included mental health indicators in cluster-based analyses, with over half identifying distinct mental health and substance use clusters. Fit indices in cluster analyses and measurement properties of substance use were heterogeneous and inconsistently reported across studies.

CONCLUSIONS

Distinct patterns of substance use were derived but methodological differences prevented direct comparison and reduced capacity to generalize across studies. There is a need to establish standardized methodological approaches to identify robust patterns of substance use to enhance etiological, prognostic, and intervention research.