The use of tobacco and cannabis at an international music festival

Psychosocial interventions and strategies to support young people at mass gathering events: a scoping review

OBJECTIVES

To improve health and safety outcomes at mass gathering events (MGEs) for young attendees, it is essential to understand the psychosocial factors that may influence behaviour so that the implementation of support strategies before, during and after MGEs can be developed to enhance outcomes. This review identifies the psychosocial outcomes that may occur at MGEs, including social connection, substance use, risky behaviours and psychological distress and examines what interventions have been implemented to target these outcomes.

STUDY DESIGN

Scoping review.

METHODS

This study examined MGE psychosocial interventions with predominantly youth attendees was conducted using the Preferred Reporting Items of Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Papers were collected from the databases CINAHL, MEDLINE, Embase and PsycINFO. Titles and abstracts were scanned for relevance, followed by a full-text screening. Information relevant to the research question was extracted from papers meeting the inclusion criteria.

RESULTS

Twenty-six papers met the inclusion criteria. The psychosocial factors that were most studied included social influence, social interactions and psychological stressors, which lead to behaviours such as excessive alcohol consumption, drug taking, risky casual sex and risk taking amongst psychological factors of young attendees. Effective interventions implemented before or during MGEs, such as alcohol-free zones, antidrinking campaigns, psychoeducation and disapproval from parents with regard to drinking alcohol, showed promise in reducing harms.

CONCLUSION

Psychosocial interventions have the potential to reduce harms and enhance well-being for young people attending MGEs. This review has identified gaps and opportunities in the current literature with regard to psychosocial interventions and strategies to support young people at MGEs and makes recommendations to support the development and refinement of evidence-based interventions aimed at young MGE attendees.

Illicit Drug Use and Associated Problems in the Nightlife Scene: A Potential Setting for Prevention

Illicit drug use is prevalent in the nightlife scene, especially at electronic dance music (EDM) events. The aim of the present study was to investigate illicit drug use patterns and consequences of drug use among frequent visitors of EDM events. Young adults (18-34 years old) who had visited at least six EDM events in Sweden during the past year participated in a web-based survey on drug use patterns and its consequences. Fifty-nine percent of participants had used illicit drugs during the past year, most often cannabis followed by ecstasy, cocaine, and amphetamine. Nightlife venues were identified as the main setting for the use of central stimulants, while cannabis was mostly used at home. Frequent alcohol and tobacco use was associated with illicit drug use. The most prevalent negative consequences of drug use were related to mental health, such as impairments in mood, sleep, and memory problems, but physical manifestations were also reported, such as palpitations and collapsing. These findings confirm that drug use is prevalent and associated with negative health effects among EDM nightlife attendees. The nightlife scene is a setting with promising potential to reach a high-risk target group with illicit drug use prevention interventions.

Use of Medication at the Roskilde (Denmark) Music Festival 2015 - A Prospective Observational Study of 15,133 Treated Attendees

BACKGROUND

Outdoor music festivals (OMFs) attract large numbers of guests and benefit from the help of large numbers of volunteers. Studies have previously described the injury patterns at OMFs, but no studies have described the use of medication and sales from on-site pharmacies at a large OMF.

METHOD

The usage of medication and prescriptions in the Medical Health Care Organization (MHCO), including sales from the on-site pharmacy, at the Roskilde (Denmark) Festival 2015 were prospectively recorded.

RESULTS

In excess of 130,000 attendees (guests and volunteers) participated in the Roskilde Festival 2015. The number of attendees contacting the MHCO was 15,133, of which 3,723 (25%) had a consultation with a doctor. Of all attendees evaluated by a doctor, 669 attendees received some form of medication in relation to the consultation. The MHCO administered and/or handed out a total of 6,494 units of prescription and over-the-counter medication, of which analgesics represented nearly 51%. Asthma was the condition with the highest proportion of attendees requiring pharmaceutical treatment, as 28 out of 48 (58%) received medication during the consultation. Sixty-five attendees received both medicine and a prescription. The MHCO handed out 562 prescriptions. In total, 609 prescriptions were redeemed at the on-site pharmacy. Antibiotics represented more than 78% of all redeemed prescriptions at the on-site pharmacy.

CONCLUSION

The most utilized medications were analgesics and antibiotics. The data indicate a need for on-site prophylaxis using tetanus toxoid in combination with diphtheria toxoid vaccine and an on-site pharmacy. The content of the formulary at a mass-gathering event should be based on: evacuation time by ambulance/helicopter to hospitals with the level of competence needed; types of conditions to be treated on-site; level of competencies of festival medical staff; expected incidence and type of illness and injuries; and treatment of acute, life-threatening illnesses and or injuries.

Changes in Cigarette, E-Cigarette, and Cannabis Use among U.S. College Students Studying Abroad

Background: Study abroad experiences among U.S. college students are risky environments for alcohol use; however little work has examined how studying abroad may affect other substance use. Purpose: This study assesses changes in frequency of cigarette, e-cigarette, and cannabis use among students studying abroad. Methods: We recruited study abroad students from 63 institutions who studied in the 12 most popular destinations; 2,086 students completed surveys before leaving the U.S. and during their last month abroad. Descriptive and multivariate mixed-effects regression analysis compared substance use by location between students and country natives using publicly available data, identified behavioral and demographic predictors of frequency of substance use abroad, and estimated average adjusted prevalence of substance use by location. Results: Students' cigarette smoking increased three-fold while abroad; patterns of use varied significantly by location and mirrored smoking behaviors of native young adults. Rates of e-cigarette use declined while abroad and rates of cannabis use were similar abroad to pre-departure rates. However, cannabis use varied substantially by location and were higher than native peer rates. For all substances, most frequent substance use abroad was reported among males and those with prior histories of single drug and polydrug use. Conclusion: Findings highlight the importance of continued research on drug use abroad among U.S. college students and pave the way for initial prevention and intervention efforts to target drug use abroad, particularly for cigarettes due to the negative health consequences of use and for cannabis given the potential legal ramification of use in non-legalized countries.

Toxic Nightlife Relationships, Substance Abuse, and Mental Health: Is There a Link? A Qualitative Case Study of Two Patients

Introduction and Aims: This article explores the role of toxic close relationships in night life on substance use disorders and mental health conditions. We also contrast the quality and effects of social relationships when doing drugs with those produced by a mental health program that fosters quality relationships between patients. Design and Methods: This qualitative case study was carried out at a mental health day care center of a hospital in Malaga (Spain). The cases of two patients with severe mental disorders and a history of drug addiction were analyzed. Data were collected through in-depth interviews with every patient, semi-structured interviews about each patient with the psychologist of the medical team of the program, and medical documentation. The analysis involved a combination of inductive and deductive approaches. Results: The analysis of the data revealed, on the one hand, the influence of toxic relationships in nightlife, including violent sporadic sexual relationships, in the initiation and persistence of substance use that took part of the mental health disorder in these patients. On the other hand, the findings show that these participants' current involvement in a mental health program, which fosters quality relationships between patients, has brought emotional benefits to both of them. Discussion and Conclusion: This paper points out the relevance of considering quality of social relationships when examining substance use disorders and related mental health problems. Additionally, the findings indicate the importance of fostering quality peer relationships in mental health rehabilitation programs addressed to patients with histories of drug addiction to improve treatment outcome.

Event-Specific Cannabis Use and Cannabis Use Motives

BACKGROUND

Specific events such as Mardi Gras (MG) and St. Patrick's Day (SPD) have been identified as high-risk events for cannabis use. Further, some campuses may have traditions that are associated with more event-specific cannabis use.

OBJECTIVES

Campus A has specific traditions regarding MG whereas Campus B has specific traditions regarding SPD and these campuses are differentially related to event-specific cannabis use (Buckner, Henslee, & Jeffries, 2015 ). Yet, little work has identified individual difference variables related to high-risk cannabis use events.

METHODS

Current cannabis using undergraduates (N = 154) at two campuses completed an online survey of event-specific cannabis use motives, cannabis use, and cannabis-related problems.

RESULTS

Campus A endorsed more MG-specific social and enhancement motives than Campus B. Campus A reported more socially, enhancement, coping, conformity, and expansion motivated cannabis use on MG than on SPD, whereas Campus B reported more socially and enhancement motivated cannabis use on SPD than on MG. Campus A was indirectly related to more MG-specific cannabis use through MG-specific social and enhancement motives. Conclusions/Importance: Event-specific cannabis motives are differentially related to specific high-risk cannabis use events and may be important therapeutic targets.

Music festival attendees' illicit drug use, knowledge and practices regarding drug content and purity: a cross-sectional survey

BACKGROUND

Drug checking is a harm reduction strategy which allows users to check the content and purity of illicit drugs. Although drug checking has been trialled internationally, with demonstrated value as a harm reduction and health promotion strategy, the use of such services in Australia remains a contentious issue. This study aimed to investigate the proportion and patterns of illicit drug use among young people, their attitudes towards drug checking at festivals and the potential impact of drug checking on intended drug use behaviour.

METHODS

The survey was conducted at a major Australian music festival in 2016. Data was collected from a sample of festival attendees (n = 642) aged between 18 and 30 years. A descriptive analysis of the data was performed.

RESULTS

Nearly three-quarters (73.4%) of participants reported that they had used illicit drugs in the past 12 months, most commonly cannabis (63.9%) and ecstasy (59.8%). A large proportion of participants believed 'somewhat' or 'a lot' that drug checking services could help users seek help to reduce harm (86.5%) and that drug checking services should be combined with harm reduction advice (84.9%). However, two thirds of the participants agreed 'somewhat' or 'a lot' that drug sellers may use this service as a quality control mechanism (68.6%). Approximately half (54.4%) indicated they would be highly likely and a third (32.7%) would be somewhat likely to utilise free drug checking services should they be available at music festivals. When asked whether the results of drug checking would influence their drug use behaviour, participants reported that they would not take substances shown to contain methamphetamine (65.1%), ketamine (57.5%) or para-methoxyamphetamine (PMA) (58.4%).

CONCLUSION

The majority of festival attendees aged 18-30 participating in this study reported a history of illicit drug use and were in favour of the provision of free drug checking at festivals. A considerable proportion reported that the results of drug checking would influence their drug use behaviour. The findings of this study can contribute to the debate regarding whether drug checking services could potentially play a major role in harm reduction and health promotion programming for young people attending festivals.

Is 4/20 an Event-Specific Marijuana Holiday? A Daily Diary Investigation of Marijuana Use and Consequences Among College Students

OBJECTIVE

Given the popular association between April 20 ("4/20") and marijuana, the present study examined marijuana use and consequences on 4/20 compared with other days in order to test whether 4/20 is a high-risk, event-specific marijuana use holiday among college student marijuana users.

METHOD

Fifty-nine college student marijuana users from three different, large U.S. universities located in Virginia, New Mexico, and Colorado completed daily brief surveys (<10 minutes) over a 12-day (April 15-April 26) period assessing prior-day marijuana use (i.e., percentage of users who consumed marijuana, number of unique marijuana use sessions, subjective high/intoxication while under the influence of marijuana, and number of grams of marijuana consumed) and marijuana-related consequences.

RESULTS

Using oneway repeated-measures analyses of variance, we found that (a) 50% of students reported using marijuana on 4/20, which was significantly more than weekdays (28%) and weekend days (37%); (b) students reported a significantly higher number of unique marijuana use sessions on 4/20 (M = 1.47) compared with weekdays (M = 0.91); and (c) students reported a significantly higher number of grams consumed on 4/20 (M = 0.79) compared with weekdays (M = 0.35) and weekend days (M = 0.47).

CONCLUSIONS

Our study provides preliminary support that 4/20 is a day associated with increased marijuana use but provides little evidence for an association with more problematic use.

Environmental Factors Associated with Psychotropic Drug Use in Brazilian Nightclubs

The purpose of this study was to identify environmental factors associated with patterns of psychotropic drug use in nightclubs. Mixed methods were used to investigate psychotropic drugs consumption among patrons of 31 nightclubs in São Paulo, Brazil. A total of 1822 patrons at the entrance and exit of the venues and 30 staff members of the nightclubs were interviewed. The observational data were collected through 307 h of observational research using a structured guide to register environmental measures. Psychotropic drug use in nightclubs was classified into three categories (1: no drugs; 2: legal drugs [e.g., alcohol and tobacco]; or 3: illicit drugs regardless of alcohol and tobacco use). Illicit drugs used were self-reported by patrons, and alcohol use was measured using a breathalyzer. The data were analyzed in clusters using correlated multinomial logistic regression models. The following environmental variables were associated with illicit drug use in nightclubs: all-you-can-drink service (adjusted odds ratio (aOR) = 11.84, 95%CI [4.06;34.57]) and light effects, such as laser and "disco lights" (aOR = 24.49, 95%CI [8.48;70.77]). The number of bouncers per capita × 100 and the presence of two or more dance floors were inversely associated with the use of illicit drugs (aOR = 0.26, 95%CI [0.11;0.65], and aOR = 0.13, 95%CI [0.06;0.29], respectively). Legal drug use was associated with all-you-can-drink service (aOR = 2.17, 95%CI [1.43;5.04]), the presence of two or more dance floors (aOR = 2.06, 95%CI [1.40;3.05]), and the number of bouncers per capita × 100 (aOR = 1.39, 95%CI [1.22;1.59]). These findings suggest that this is a multivariate phenomenon that would require an integrated approach involving the venue owners, staff members, patrons, local governments, and law enforcement agencies.

Event-specific cannabis use and use-related impairment: the relationship to campus traditions

OBJECTIVE

Despite high rates of college cannabis use, little work has identified high-risk cannabis use events. For instance, Mardi Gras (MG) and St. Patrick's Day (SPD) are characterized by more college drinking, yet it is unknown whether they are also related to greater cannabis use. Further, some campuses may have traditions that emphasize substance use during these events, whereas other campuses may not. Such campus differences may affect whether students use cannabis during specific events. The present study tested whether MG and SPD were related to more cannabis use at two campuses with different traditions regarding MG and SPD. Further, given that Campus A has specific traditions regarding MG whereas Campus B has specific traditions regarding SPD, cross-campus differences in event-specific use were examined.

METHOD

Current cannabis-using undergraduates (N = 154) at two campuses completed an online survey of event-specific cannabis use and event-specific cannabis-related problems.

RESULTS

Participants used more cannabis during MG and SPD than during a typical weekday, typical day on which the holiday fell, and a holiday unrelated to cannabis use (Presidents' Day). Among those who engaged in event-specific use, MG and SPD cannabis use was greater than typical weekend use. Campus differences were observed. For example, Campus A reported more cannabis-related problems during MG than SPD, whereas Campus B reported more problems during SPD than MG.

CONCLUSIONS

Specific holidays were associated with more cannabis use and use-related problems. Observed between-campus differences indicate that campus traditions may affect event-specific cannabis use and use-related problems.

Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence?

Mass gatherings are characterized by the concentration of people temporally and spatially, and may lead to the emergence of infectious diseases due to enhanced transmission between attendees. This is well-demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review was to present the available evidence on outbreaks associated with a variety of pathogens, or also the lack thereof, as assessed by thorough surveillance at any mass gatherings with the exception of those in Saudi Arabia. A systematic search for relevant articles in the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixty-eight studies were identified. Although outbreaks have not been reported frequently in or after mass gatherings outside the Hajj and Umrah pilgrimages, they have sometimes occurred at Muslim, Christian, and Hindu religious events, at sports events, and at large-scale open air festivals. In this review it was found that the most common outbreaks at these mass gatherings involved vaccine preventable diseases, mainly measles and influenza, but also mumps and hepatitis A. Meningococcal disease has rarely been recorded. Additionally it was found that the transmission of various communicable diseases that may not be prevented by vaccination has been recorded in association with mass gatherings. These were mainly gastrointestinal infections, caused by a variety of pathogens. It was also noted that some outbreaks occurring at mass gatherings have resulted in the international spread of communicable diseases.

Smoking mull: a grounded theory model on the dynamics of combined tobacco and cannabis use among adult men

ISSUE ADDRESSED

Australians' use of cannabis has been increasing. Over a third of Australians (35.4%) have used cannabis at some time in their lives and 10.3% are recent users. Almost two-thirds of cannabis users combine cannabis with tobacco. The aim of this study was to understand the process of mulling - smoking tobacco and cannabis together - using a grounded theory approach.

METHODS

Twenty-one in-depth semistructured interviews were conducted with men aged 25-34 and living on the North Coast of New South Wales. Interviews explored participants' smoking practices, histories and cessation attempts.

RESULTS

A model describing mulling behaviour and the dynamics of smoking cannabis and tobacco was developed. It provides an explanatory framework that demonstrates the flexibility in smoking practices, including substance substitution - participants changed the type of cannabis they smoked, the amount of tobacco they mixed with it and the devices they used to smoke according to the situations they were in and the effects sought.

CONCLUSION

Understanding these dynamic smoking practices and the importance of situations and effects, as well as the specific role of tobacco in mulling, may allow health workers to design more relevant and appropriate interventions. SO WHAT? Combining tobacco with cannabis is the most common way of smoking cannabis in Australia. However, tobacco cessation programmes rarely address cannabis use. Further research to develop evidence-based approaches for mull use would improve cessation outcomes.

An exploratory prospective study of young people's drinking during a holiday

Background

Heavy drinking and drug use is increasingly recognised as a problem in relation to holidays at nightlife resorts. However, studies conducted on the subject to date have relied on retrospective accounts of drinking, and little is known about the course of drinking, consequences and experiences during such holidays.

Methods

A prospective study was carried out in Sunny Beach, Bulgaria, of 112 Danish tourists aged 16 to 25 years, 68% of whom were male. Participants completed questionnaires within one day of arrival at the resort, and subsequently on days 3 and 5 of the holiday.

Results

The response rate was adequate, with 81% providing complete data on all three occasions, and 93% providing complete data on at least two of the three occasions. During the holiday, participants cut down on their drinking significantly. Men drank more than women. The group of people with whom individuals travelled had a significant influence on their drinking. We also analysed predictors of several adverse outcomes. Individuals who travelled for the purpose of socialising drank more, whereas those who travelled to participate in sports activities drank less.

Conclusion

The study demonstrates the efficaciousness of prospective surveys as a methodology for onsite monitoring of substance use and other behaviours of young people during holidays. The study showed that young people drink like the members of the group they are with, but experience the consequences of drinking independently.

Illicit drug use in the flemish nightlife scene between 2003 and 2009

AIMS

Given the importance of party people as innovators and early adaptors in the diffusion of substance use, and given the lack of longitudinal scope in studies of the nightlife scene, we explored changes in illicit drug use among young people participating in the nightlife scene in Flanders.

METHODS

A survey among party people selected at dance events, rock festivals and clubs was held in the summer of 2003 and repeated in 2005, 2007 and 2009. In total, 2,812 respondents filled in a questionnaire on the use of cannabis, ecstasy, cocaine, amphetamines, GHB and ketamine.

RESULTS

The results of the multiple logistic regression analyses show that in the group of frequent pub visitors, the predicting probability of cannabis use increased over time, while the gap in drug use between dance music lovers and non-lovers of dance music narrowed. For cocaine use during the last year, an increase was found related to the housing situation (alone or with parents) of respondents. While the odds of using ecstasy decreased over the years, the odds of using GHB increased.

CONCLUSION

We can conclude that monitoring emerging trends, which can be quickly observed in the nightlife scene, provides meaningful information for anticipating possible trends.

Drug use and nightlife: more than just dance music

Background

Research over the last decade has focused almost exclusively on the association between electronic music and MDMA (3,4-Methylenedioxymethamphetamine or "ecstasy") or other stimulant drug use in clubs. Less attention has been given to other nightlife venues and music preferences, such as rock music or southern/funky music. This study aims to examine a broader spectrum of nightlife, beyond dance music. It looks at whether certain factors influence the frequency of illegal drug and alcohol use: the frequency of going to certain nightlife venues in the previous month (such as, pubs, clubs or goa parties); listening to rock music, dance music or southern and funky music; or sampling venues (such as, clubs, dance events or rock festivals). The question of how these nightlife variables influence the use of popular drugs like alcohol, MDMA, cannabis, cocaine and amphetamines is addressed.

Methods

The study sample consisted of 775 visitors of dance events, clubs and rock festivals in Belgium. Study participants answered a survey on patterns of going out, music preferences and drug use. Odds ratios were used to determine whether the odds of being an illegal substance user are higher for certain nightlife-related variables. Furthermore, five separate ordinal regression analyses were used to investigate drug use in relation to music preference, venues visited during the last month and sampling venue.

Results

Respondents who used illegal drugs were 2.5 times more likely to report that they prefer dance music. Goa party visitors were nearly 5 times more likely to use illegal drugs. For those who reported visiting clubs, the odds of using illegal drugs were nearly 2 times higher. Having gone to a pub in the last month was associated with both more frequent alcohol use and more frequent illegal substance use. People who reported liking rock music and attendees of rock festivals used drugs less frequently.

Conclusions

It was concluded that a more extended recreational environment, beyond dance clubs, is associated with frequent drug use. This stresses the importance of targeted prevention in various recreational venues tailored to the specific needs of the setting and its visitors.

Self-efficacy, affectivity and smoking behavior in adolescence

BACKGROUND

Research on health-related behaviors confirms the contribution of self-efficacy and affective factors to the initiation and continuation of smoking behavior. The aim was to assess the degree to which affectivity contributes to the association between self-efficacy and smoking behavior in adolescence.

METHODS

A sample of 501 elementary school students (mean age 14.7 ± 0.9 years, 48.5% males) from the Slovak and Czech Republics filled out the Self-Efficacy Scale, the Positive and Negative Affect Schedule and answered questions about smoking behavior.

RESULTS

Logistic regression showed that social self-efficacy increased the likelihood of smoking behavior but only after adding positive and negative affectivity to the model. Adjustment for age and gender as covariates did not change these findings.

CONCLUSION

Results show the need to prepare programs aimed at enhancing appropriate social self-efficacy and especially improving skills to resist the pressures emerging from peers. Adolescents should also learn to handle their negative emotions differently, instead of through smoking behavior.

Cannabis use patterns and their association with DSM-IV cannabis dependence and gender

AIMS

To investigate the gender differences in the patterns of cannabis use (CU), namely frequency, times of day, social context and methods and in their association with DSM-IV cannabis dependence.

METHODS

A sample of 3,904 students from German universities was recruited via an internet survey. Logistic regressions and associated areas under the ROC curve (AUC) were calculated among current cannabis users (at least once a month, n = 843).

RESULTS

CU using a water pipe was more often reported by males (50 vs. 34.6%). Usual CU 'before going to sleep at night' was more often reported by females (47.3 vs. 35.7%). Most CU patterns showed a similar association with DSM-IV cannabis dependence in both genders. The association of CU 'with strangers' was stronger in females (AUC 0.68 vs. AUC 0.56). Slightly different multiple models were found (females AUC 0.86, males AUC 0.77).

CONCLUSIONS

There are considerable gender differences in the CU patterns and, thus, in the way CU functions. In the association of CU patterns with cannabis dependence, the similarities are rather great. Examining the CU patterns might make a considerable contribution to the better detection of high-risk population segments for prevention and early intervention in both genders.

Actions speak louder than words: an experiment on the impact of peers discouraging young adult smoking

This study investigates whether antismoking peer pressure and/or nonsmoking peers are protective factors and decrease young adults' likelihood to smoke. An experiment was conducted among 59 daily-smoking young adults aged 16-24 years. The experiment consisted of four conditions. During the session, the confederate and participant sat in a camper van and had to do a 30-min joint music task. The participants' smoking behavior was observed during this task. The results of Poisson log-linear analysis, controlling for participants' carbon monoxide level and gender, showed that young adults smoked fewer cigarettes in the presence of a nonsmoking model pressuring the young adult not to smoke compared to a heavy-smoking model not using any pressure. At the same time, the results of Fisher's exact test indicated that the total number of cigarettes smoked did not differ significantly for nonsmoking peers verbally pressuring the young adult not to smoke compared to nonsmoking peers not verbally pressuring the young adult. Our findings indicate that the protective effect of peer influence merely lies in that the peer does not smoke. Therefore, antismoking programs and policy should focus specifically on reducing exposure to smoking peers.