Within-person associations of escalated electronic nicotine delivery systems use with cigarette, alcohol, marijuana and drug use behaviors among US young adults

Randomized Controlled Trial of Acceptance and Commitment Therapy for Fatigue Interference With Functioning in Metastatic Breast Cancer

PURPOSE

Fatigue is a highly prevalent and disabling symptom for patients with metastatic breast cancer (MBC). Evidence-based interventions for managing fatigue in advanced cancer populations are lacking. This phase II randomized controlled trial tested the effect of acceptance and commitment therapy (ACT) on fatigue interference with functioning in patients with MBC.

METHODS

Eligible patients were women with stage IV breast cancer who had moderate to severe fatigue interference. Patients completed a baseline assessment that included self-report measures of fatigue interference with activities, mood, and cognition (primary outcome) and sleep interference with functioning, engagement in daily activities, and quality of life (QOL; secondary outcomes). Then patients were randomly assigned to six weekly telephone-delivered sessions of either ACT (n = 116) or education/support (n = 120). Follow-up assessments occurred at 2 weeks, 3 months, and 6 months postintervention (means, 9.69, 20.51, and 33.59 weeks postbaseline, respectively).

RESULTS

Linear mixed model analyses showed that compared with patients in the education/support condition, patients in the ACT condition reported significantly less fatigue interference (P = .018). These results were significant at 2 weeks and 6 months postintervention. ACT's effect on sleep interference was not statistically significant after the Sidak adjustment for multiple comparisons (P = .037). ACT patients showed a steady decline in sleep interference, a trend that was not found for education/support patients. Engagement in daily activities and QOL did not significantly differ between study groups, except for functional QOL (P = .006). Compared with education/support patients, ACT patients showed significantly better functional QOL at 2 weeks and 6 months postintervention.

CONCLUSION

Results suggest that a brief, telephone-delivered ACT intervention can reduce fatigue interference with functioning in patients with MBC.

Longitudinal associations of e-cigarette use with cigarette, marijuana, and other drug use initiation among US adolescents and young adults: Findings from the population assessment of tobacco and health study (Waves 1-6)

INTRODUCTION

Research examining prospective links of e-cigarette use with cigarette, marijuana, and other substance use has been limited largely to 1-2-year follow-up periods and focused on younger adolescents. This study examined longitudinal associations of e-cigarette use with cigarette, marijuana, and other substance use initiation among U.S. adolescents and young adults (AYAs) across an eight-year period.

METHODS

Adolescent (ages 12-17) and young adult (ages 18-25) data from waves 1-6 of the nationally representative Population Assessment of Tobacco and Health study (2013-2021) were used. Discrete time survival models with time-varying weights were employed to examine the risk of cigarette, marijuana, and other drug use initiation over an eight-year follow-up period among AYAs with no lifetime use of e-cigarettes/other tobacco, lifetime but no past 30-day use of e-cigarettes/other tobacco, past 30-day e-cigarettes only, other tobacco use only, or past 30-day e-cigarette/other tobacco use. We compare our time-varying weighting approach to a traditional time-invariant/complete case weighting approach.

RESULTS

Across six follow-up waves, all three past 30-day nicotine/tobacco use groups, including e-cigarettes only, had greater risk for cigarette, marijuana, and other drug use initiation relative to those not using nicotine/tobacco. The three past 30-day nicotine/tobacco use groups did not differ from each other in risk for marijuana use initiation. Associations were smaller in magnitude for young adults compared to adolescents, but significant for both age groups.

CONCLUSIONS

Substance use initiation risks persist beyond 1-2 years for U.S. AYAs using e-cigarettes. Prevention strategies to reduce AYA e-cigarette use are needed to reduce cancer-related risk.

Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products

Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis

INTRODUCTION

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied.

METHODS

Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education).

RESULTS

Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes.

CONCLUSIONS

Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

Association of electronic nicotine delivery system (ENDS) and cigarette solo and dual use with alcohol-related consequences among US adults

INTRODUCTION

Research reports a robust association between combustible cigarette use and alcohol use frequency and severity. Extension to the emerging landscape of electronic nicotine delivery system (ENDS) use is needed to inform prevention and treatment strategies.

METHOD

We evaluated data from the 2020 National Survey on Drug Use and Health (NSDUH). Respondents included adults reporting cigarettes or ENDS solo or dual use. Multivariable logistic regression models evaluated associations with alcohol use disorder (AUD) and alcohol-related risky behavior (i.e., heavy drinking, binge alcohol use, and driving after drinking) compared to never use controls and respondents with a history, but not current, use of cigarettes or ENDS.

RESULTS

Multivariable models showed greater odds of AUD for respondents with dual ENDS and cigarette use (AOR = 10.2), ENDS use (AOR = 6.27), cigarette use (AOR = 4.45), and a history, but not ongoing, use (AOR = 2.60) relative to respondents with no use history. Similarly, respondents with dual use (AOR = 3.94), ENDS use (AOR = 2.41), and cigarette use (AOR = 1.71) had greater odds of AUD relative to those with a history of, but not ongoing, use. The association between dual use and AUD was greater for adults ages 21-25 (AOR = 16.2) than for adults over 25 (AOR = 7.82). Cigarette and ENDS solo and dual-use were similarly associated with greater odds of alcohol-related risky behavior relative to control groups.

CONCLUSION

These findings demonstrate that nicotine use and dual use may be associated with indicators of problematic drinking. These results offer insight into emerging licit polysubstance profiles and call for mechanistic research to inform prevention and intervention efforts.