Age of Onset, Current Use of Alcohol, Tobacco or Marijuana and Current Polysubstance Use Among Male and Female Mexican Students

The moderating role of sex in the relationship between cannabis use treatment admission profile and treatment processes and outcomes: A gender perspective

BACKGROUND

Gender-specific interventions are crucial in addressing substance use disorders -particularly cannabis use disorder - as they allow for tailored therapeutic approaches and increase the likelihood of successful outcomes. However, differences in therapeutic processes and outcomes between males and females are often not observed, making the prognosis and development of such interventions more difficult.

OBJECTIVE

This study aimed to examine the moderating role of sex in the relationship between treatment admission profile characterized by indicators of cannabis use and sociodemographic sources of gender inequality (e.g., employment status) and adherence and outcome at discharge.

METHOD

A multicentric retrospective observational study was conducted with a sample of 3,814 outpatients diagnosed with cannabis use disorder. Electronic health records were used for data analysis.

RESULTS

The interaction between sex and the number of children, as well as pre-treatment cannabis use, predicted lower treatment adherence, particularly among females. Additionally, the interaction between sex and the number of children predicted outcomes at discharge, with females showing a higher likelihood of dropout compared to males.

DISCUSSION AND CONCLUSION

Enhanced comprehensive treatment with intensified contingency management programs should be prioritized for females (especially those with children) who have consumed cannabis in the month before treatment. Adopting a treatment policy framework incorporating sex/gender-sensitive therapist training and evaluative measures is essential for optimizing treatment outcomes for all patients.

Effect of age of tobacco initiation and number of failed quit attempts on maintenance of tobacco abstinence

BACKGROUND

The decision to make a quit attempt is the first step toward the tobacco cessation process. It is well established in the literature that if someone does not take tobacco till the age of 21 years then his chances of remaining tobacco-free for life are higher than his counterparts who start tobacco at early developmental ages.

METHODOLOGY AND TOOLS

The present study was conducted among 400 university undergraduate students. A cross-sectional survey design was used, multi-stage sampling was done, and four colleges were selected via random sampling. The motivation to quit tobacco, tobacco craving, and maintenance of tobacco abstinence was assessed via contemplation ladder, tobacco craving questionnaire Short Form, and smoking abstinence questionnaire. To validate subjective data, a urine cotinine test was performed.

RESULTS

The age of tobacco initiation significantly impacts intentions to quit tobacco and tobacco craving levels. The number of unsuccessful quit attempts was also significantly associated with the maintenance of tobacco abstinence. The failed quit attempts play a vital role in altering tobacco cravings and make the withdrawals more complicated to handle for recent tobacco quitters.

Investigating the associations of age of initiation and other psychosocial factors of singular alcohol, tobacco and marijuana usage on polysubstance use: analysis of a population-based survey in Jamaica

OBJECTIVES

This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances.

DESIGN

A secondary data analysis.

SETTING

Used the Jamaica National Drug Prevalence Survey 2016 dataset.

PARTICIPANTS

Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old.

OUTCOME MEASURES

Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use.

RESULTS

Approximately 58%-66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p<0.001). Respondents who did not believe that smoking tobacco sometimes (p=0.049), and smoking marijuana sometimes and often was harmful, had increased odds of concurrent polysubstance use (p=0.047 and p<0.001, respectively). Respondents who indicated access to marijuana as easy were significantly more likely to report past month concurrent polysubstance use compared with those who reported access as difficult (p=0.002). Participants who indicated that friends or family members get drunk and take illegal drugs were associated with 1.722 and 1.864 increased odds of reporting past month concurrent polysubstance use (p=0.004 and p=0.017, respectively).

CONCLUSIONS

Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members' drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.

Dampened psychobiological responses to stress and substance use in adolescence

Substance use increases throughout adolescence, and earlier substance use may increase risk for poorer health. However, limited research has examined whether stress responses relate to adolescent substance use, especially among adolescents from ethnic minority and high-adversity backgrounds. The present study assessed whether blunted emotional and cortisol responses to stress at age 14 related to substance use by ages 14 and 16, and whether associations varied by poverty status and sex. A sample of 277 Mexican-origin youth (53.19% female; 68.35% below the poverty line) completed a social-evaluative stress task, which was culturally adapted for this population, and provided saliva samples and rated their anger, sadness, and happiness throughout the task. They also reported whether they had ever used alcohol, marijuana, cigarettes, and vaping of nicotine at age 14 and again at age 16. Multilevel models suggested that blunted cortisol reactivity to stress was associated with alcohol use by age 14 and vaping nicotine by age 16 among youth above the poverty line. Also, blunted sadness and happiness reactivity to stress was associated with use of marijuana and alcohol among female adolescents. Blunted stress responses may be a risk factor for substance use among youth above the poverty line and female adolescents.

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.

Exploring the dynamic transitions of polysubstance use patterns among Canadian youth using Latent Markov Models on COMPASS data

Background

Understanding what factors lead to youth polysubstance use (PSU) patterns and how the transitions between use patterns can inform the design and implementation of PSU prevention programs. We explore the dynamics of PSU patterns from a large cohort of Canadian secondary school students using machine learning techniques.

Methods

We employed a multivariate latent Markov model (LMM) on COMPASS data, with a linked sample (N = 8824) of three-annual waves, Wave I (W_I, 2016-17, as baseline), Wave II (W_II, 2017-18), and Wave III (W_III, 2018-19). Substance use indicators, i.e., cigarette, e-cigarette, alcohol and marijuana, were self-reported and were categorized into never/occasional/current use.

Outcomes

Four distinct use patterns were identified: no-use (S1), single-use of alcohol (S2), dual-use of e-cigarettes and alcohol (S3), and multi-use (S4). S1 had the highest prevalence (60.5%) at W_I, however, S3 became the prominent use pattern (32.5%) by W_III. Most students remained in the same subgroup over time, particularly S4 had the highest transition probability (0.87) across the three-wave. With time, those who transitioned typically moved towards a higher use pattern, with the most and least likely transition occurring S2→S3 (0.45) and S3→S2 (<0.01), respectively. Among all covariates being examined, truancy, being measured by the # of classes skipped, significantly affected transition probabilities from any low→high (e.g., OR_S2→S4 = 2.41, 95% CI [2.11, 2.72], p < 0.00001) and high→low (e.g., OR_S3→S1 = 0.38, 95% CI [0.33, 0.44], p < 0.00001) use directions over time. Older students, blacks (vs. whites), and breakfast eaters were less likely to transition from low→high use direction. Students with more weekly allowance, with more friends that smoked, longer sedentary time, and attended attended school unsupportive to resist or quit drug/alcohol were more likely to transition from low→high use direction. Except for truancy, all other covariates had inconsistent effects on the transition probabilities from the high→low use direction.

Interpretation

This is the first study to ascertain the dynamics of use patterns and factors in youth PSU utilizing LMM with population-based longitudinal health surveys, providing evidence in developing programs to prevent youth PSU.

Funding

The Applied Health Sciences scholarship; the Microsoft AI for Good grant; the Canadian Institutes of Health Research, Health Canada, the Canadian Centre on Substance Abuse, the SickKids Foundation, the Ministère de la Santé et des Services sociaux of the province of Québec.

Cultural Protection from Polysubstance Use Among Native American Adolescents and Young Adults

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings.

Predictors of Engagement and Attendance of a Family-Based Prevention Program for Underage Drinking in Mexico

Underage drinking represents a major global health problem. Given the crisis that underage drinking represents, Tomando Buenas Decisiones, a family-based prevention program, was adapted and piloted in Mexico based on the existing Guiding Good Choices program. Although family-based interventions in the USA are promising for preventing underage drinking, little is known about how adapted versions of these interventions may work in low-middle income countries, such as in Latin America. The present study examined whether baseline individual, familial, and cultural factors predict participants' engagement and attendance in an adapted program for preventing underage drinking in Zacatecas, Mexico. The study was conducted with a sample of 178 parents who participated in the adapted program and were employed at local private companies. Latent growth curve modeling was used to analyze (a) change in engagement, (b) predictors of engagement, and (c) predictors of attendance. Results indicated that perceived engagement evidenced a significant linear increase throughout the intervention. Participants' familism values, such as perceived family as referents and family support, at baseline predicted both initial levels of and change in engagement. Perceived familial obligation also predicted change in engagement. Attendance was negatively predicted by male gender, by perceived stress, and by perceived familial obligations among women only. Poor family management, and perceived familial obligations among men, positively predicted attendance. Our findings have important implications for the conceptualization of engagement and attendance in family-based preventive interventions for underage drinking among Hispanics. Researchers interested in implementing interventions in Latin America can use these findings to better comprehend how and for whom adapted family-based preventive interventions work.

Associations between Longitudinal Patterns of Substance Use and Anxiety and Depression Symptoms among a Sample of Canadian Secondary School Students

The objective of this study is to examine the longitudinal associations between latent classes of substance use and anxiety and depression scores among youth who use substances. This study uses data from three waves (Wave 1: 2017/18, Wave 2: 2018/19, and Wave 3: 2019/20) of the COMPASS study. Students in grades 9 and 10 who reported substance use at baseline (n = 738) report their substance use (alcohol, cannabis, cigarettes, and e-cigarettes) and anxiety and depression symptoms at each wave. A Repeated Measures Latent Class Analysis (RMLCA) is used to determine substance use classes, and mixed models are used to examine the associations between substance use classes and anxiety and depression. We identify three classes of substance use: (1) occasional alcohol and e-cigarette use, (2) escalating poly-substance use, and (3) consistent poly-substance use. After controlling for relevant covariates, consistent poly-substance use is associated with depression (Female OR: 1.24 [95%CI: 0.46, 2.02]; Male OR 1.13 [95%CI: 0.38, 1.87]) but not anxiety. Escalating poly-substance use is associated with depression among males (OR 0.72 [95%CI: 0.10, 1.33]). These findings should be taken into consideration when creating prevention programming and treatment strategies for adolescents. Substance use programming should be comprehensive, consider multiple substances, and be cognizant of symptoms of mental illness, particularly depression.

Changes in cannabis, tobacco, and alcohol use among sexually active female adolescents and young adults over a twelve-year period ending in 2019

BACKGROUND

The United States has experienced an increasing divergence in cannabis, tobacco, and alcohol use among adolescents and young adults (AYA). We assessed the changes in cannabis, tobacco and alcohol use in an inner-city population of predominantly minority AYA females attending a large adolescent-specific health center in New York City.

METHODS

This was a longitudinal study of AYA women recruited and followed over a twelve-year period between 2007 and 2019. Lifetime and past 30-day use were assessed by self-administered questionnaire every six months. In addition, we assessed associations with race, ethnicity, sexual behaviors, receipt of social services, living situation at home (e.g., with or without parents), and use of other drugs.

RESULTS

Participants included 1549 AYA females aged 13-21 at baseline, 95% of whom were youth of color. Use of cannabis increased significantly over the twelve-year period, with frequent cannabis use (≥20 times in 30-days) increasing almost 18% per year (OR = 1.18; 95%CI:1.13-1.23). In contrast, past 30-day tobacco use declined over the same period (OR = 0.86; 95%CI:0.83-0.89). Past 30-day cannabis use was more likely among African Americans (OR = 1.33; 95%CI:1.08-1.63), women who had sex with both men and women compared to with men only (OR = 1.44; 95%CI:1.18-1.75), recent users of tobacco (OR = 2.20; 95%CI:1.92-2.52) and alcohol (OR = 2.84; 95%CI:2.52-3.20), and ever users of other drugs (OR = 1.69; 95%CI:1.44-1.99), independent of age, time and living situation.

CONCLUSIONS

Increasing rates of cannabis use and the association with concurrent tobacco and alcohol use in AYA females underscore the need to screen for unhealthy cannabis use, in addition to tobacco and alcohol, especially among inner-city AYA.

Relationships between age at first substance use and persistence of cannabis use and cannabis use disorder

Background

From a secondary prevention perspective, it is useful to know who is at greatest risk of progressing from substance initiation to riskier patterns of future use. Therefore, the aim of this study was to determine relationships between age at first use of alcohol, tobacco and cannabis and patterns of cannabis use, frequency of use and whether age of substance use onset is related to having a cannabis use disorder (CUD).

Methods

We analysed data from Ireland’s 2010/11 and 2014/15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported lifetime cannabis use. Multinomial, linear and binary logistic regression analyses were used to determine relationships between age of substance use onset and patterns of cannabis use, frequency of use and having a CUD.

Results

When compared to former users, the odds of being a current cannabis user were found to be reduced by 11% (OR = 0.89; 95% CI: 0.83, 0.95) and 4% (OR = 0.96; 95% CI: 0.92, 1.00) for each year of delayed alcohol and cannabis use onset, respectively. Among current users, significant inverse linear relationships were noted, with increasing age of first use of tobacco (β = − 0.547; P < .001) and cannabis (β = − 0.634; P < .001) being associated with a decreased frequency of cannabis use within the last 30 days. The odds of having a CUD were found to be reduced by 14% (OR = 0.86; 95% CI: 0.78, 0.94) and 11% (OR = 0.89; 95% CI: 0.82, 0.98) for each year of delayed tobacco and cannabis use onset respectively in analyses which examined survey participants aged 15–34 years.

Conclusions

Among people who report past cannabis use, it is those with a more precocious pattern of early use of substances, including alcohol, and especially tobacco and cannabis, who are more likely to report ongoing, heavy and problematic cannabis use. Secondary prevention initiatives should prioritise people with a pattern of very early onset substance use.

Characteristics associated with marijuana use in Latinx college students

While marijuana use rates are significantly high within college students, less is known about use patterns and correlates in Latinx groups. This study assessed the relationships between ever use and frequency of use of marijuana, polysubstance use, expectancies, motives, and mental illness symptoms among Latinx college students (n = 345). Results indicated more frequent marijuana use was positively associated with: enjoyment, celebration, social anxiety, low risk, sleep and availability and was negatively associated with: experimentation, boredom, altered perception, and anxiety. Other dual use with tobacco expectancies were also observed. These constructs should be explored prospectively and inform prevention and intervention efforts.

Prevalence and correlates of youth poly-substance use in the COMPASS study

BACKGROUND AND AIMS

Youth poly-substance use, associated with long-term negative health and social outcomes, is of increasing concern following the rise of e-cigarette vaping and cannabis legalization in Canada. This work aimed to investigate current evidence on correlates of this behaviour to inform effective prevention and harm reduction programming.

DESIGN

Cross-sectional sample taking part in a cohort study.

SETTING

Canadian high schools (AB, BC, ON, QC) PARTICIPANTS: 74,501 Canadian high school students who completed the COMPASS student questionnaire in 2018/2019.

MEASUREMENTS

Self-report data on use of five substances (alcohol, cigarettes, e-cigarettes, cannabis, and opioids) alongside demographic factors, social and school support, and mental health-related measures.

RESULTS

Of the 39% of youth who reported current substance use, 53% reported using two or more. E-cigarette vaping was most prevalent (28%) and most often combined with other substances. Feeling supported by friends and having no problem with seeking help at school were associated with higher levels of poly-substance use. Family support, school connectedness, and school support to resist drugs decreased the risk of substance co-use.

CONCLUSIONS

The evidence presented here suggests that interventions for youth poly-substance use should rely on joint efforts between parents, schools, and communities to focus on structural factors rather than problematizing the individual.

Exploring the relationship between age at first drink, low-risk drinking knowledge and drinks counting: six rounds of a country-wide survey in Australia

OBJECTIVE

Although a reasonable volume of research has been conducted around health impacts of age at first drink of alcohol on adverse health outcomes, the effects of age at first drink of alcohol on knowledge of low-risk drinking and drinks counting habits were rarely researched. The objective of this study is to examine the associations between age at first full serve of alcohol, knowledge of low-risk drinking and frequency of drinks counting.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data of six rounds of the National Drug Strategy Household Survey, conducted during the period 2001-2016, were analysed. Multivariable log-binomial regression models were used to explore the associations.

RESULTS

Most people drank the first full serve of alcohol during adolescence, and the age at first full serve of alcohol was consumed increased over time. The levels of knowledge of low-risk drinking and frequency of drinks counting increased with age at first drink of alcohol more steeply during adolescence than in the later period. Participants' age at drinking the first full serve of alcohol was significantly associated with knowledge of low-risk drinking and drinks counting. There was an increasing trend of significant risk ratio between knowledge score and the frequency of drinks counting.

CONCLUSION

It seems conceivable that those who reported drinking the first full serve of alcohol before 16 years of age were indifferent to drinks counting, and they lacked necessary knowledge of standard drink of alcohol or low-risk drinking. Tailored prevention programs are recommended among adolescents to delay age at first drink of alcohol and to enhance their knowledge base on low-risk drinking.

The Dangerous Pattern of Concurrent Use of Alcohol and Cocaine Among Drunk-Drivers of Northeast Italy

Aim

To estimate the prevalence of drug and polydrug use among drunk-drivers during the driving license regranting program, in order to assess the inclusion of toxicological tests on hair and urine samples in the systematic methodology in this category of subjects.

Short summary

A total of 2160 drunk-drivers were tested for alcohol and drugs during driving license regranting. Thirty-one subjects showed alcohol use, 212 illicit drug use and, among these, 131 were polydrug users. Nineteen different patterns of drug and polydrug use were found. Cocaine was detected in 165 subjects.

Methods

The study was performed on 2160 drunk-drivers examined at Legal Medicine and Toxicology Unit of the University of Padova, in a 3-year-period (2014-2017). The positivity for one or more illicit drugs in hair or urine samples was confirmed by LC/MS and GC/MS methods. Chi-square test, Fischer's exact test and Cochran-Armitage Trend test were used to study the correlation between general characteristics of the examined sample and the presence of drug/polydrug use.

Results

Thirty-one subjects showed alcohol use, 212 illicit drug use and, among these, 131 were polydrug users. Nineteen different patterns of drug and polydrug use were found. Cocaine was detected in 165 subjects in whom 122 showed a concurrent use of alcohol and cocaine, identified through the detection of cocaethylene in hair samples. No significant association and/or trends between drug/polydrug use and the general characteristics of the sample were detected.

Conclusions

The results show that drug and polydrug use among drunk-drivers should be subjected to toxicological as well as alcohological monitoring, especially in the regranting procedure. The implementation of this procedure could improve the knowledge of dimensions of the issue, providing a powerful means for the reduction of phenomenon of driving under the influence of alcohol and drugs.

Marihuana y drogas ilícitas en jóvenes mexicanos: Factores de riesgo y protección asociados a la edad de inicio del consumo

Objetivo: Determinar factores de riesgo y protección asociados a la edad de inicio del consumo de mariguana y drogas ilícitas en jóvenes mexicanos. Método: Se analizaron datos de 40,366 jóvenes participantes de la Encuesta de Cohesión Social para la Prevención de la Violencia y la Delincuencia (ECOPRED). Las variables asociadas con la edad de inicio del consumo de mariguana y otras drogas ilícitas fueron determinadas mediante dos modelos de riesgos proporcionales. Resultados: La edad mediana de inicio en consumo de drogas ilícitas osciló entre los 15 y 18 años, mientras que en consumo de marihuana fue de 17 años. En ambos modelos, tener un par consumidor de marihuana fue el factor más fuertemente asociado al inicio de consumo. Discusión: La edad de inicio de consumo revelada en el presente estudio resultó similar a aquella propuesta en investigaciones previas. A pesar de las diferencias de factores en cada modelo, tener un par consumidor de marihuana y el consumo previo de tabaco (variable moderadora) resultaron los factores más fuertemente asociados en ambos modelos.