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Barnett NP, Sokolovsky AW, Meisel MK, Forkus SR, Jackson KM. A Bluetooth-Based Smartphone App for Detecting Peer Proximity: Protocol for Evaluating Functionality and Validity. JMIR Res Protoc 2024; 13:e50241. [PMID: 38578672 PMCID: PMC11031693 DOI: 10.2196/50241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND While ecological momentary assessment (EMA) is commonly used to study social contexts and social influence in the real world, EMA almost exclusively relies on participant self-report of present circumstances, including the proximity to influential peers. There is the potential for developing a proximity sensing approach that uses small Bluetooth beacons and smartphone-based detection and data collection to collect information about interactions between individuals passively in real time. OBJECTIVE This paper aims to describe the methods for evaluating the functionality and validity of a Bluetooth-based beacon and a smartphone app to identify when ≥2 individuals are physically proximal. METHODS We will recruit 20 participants aged 18 to 29 years with Android smartphones to complete a 3-week study during which beacon detection and self-report data will be collected using a smartphone app (MEI Research). Using an interviewer-administered social network interview, participants will identify up to 3 peers of the same age who are influential on health behavior (alcohol use in this study). These peers will be asked to carry a Bluetooth beacon (Kontakt asset tag) for the duration of the study; each beacon has a unique ID that, when detected, will be recorded by the app on the participant's phone. Participants will be prompted to respond to EMA surveys (signal-contingent reports) when a peer beacon encounter meets our criteria and randomly 3 times daily (random reports) and every morning (morning reports) to collect information about the presence of peers. In all reports, the individualized list of peers will be presented to participants, followed by questions about peer and participant behavior, including alcohol use. Data from multiple app data sets, including beacon encounter specifications, notification, and app logs, participant EMA self-reports and postparticipation interviews, and peer surveys, will be used to evaluate project goals. We will examine the functionality of the technology, including the stability of the app (eg, app crashes and issues opening the app), beacon-to-app detection (ie, does the app detect proximal beacons?), and beacon encounter notification when encounter criteria are met. The validity of the technology will be defined as the concordance between passive detection of peers via beacon-to-app communication and the participant's EMA report of peer presence. Disagreement between the beacon and self-report data (ie, false negatives and false positives) will be investigated in multiple ways (ie, to determine if the reason was technology-related or participant compliance-related) using encounter data and information collected from participants and peers. RESULTS Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. CONCLUSIONS This Bluetooth-based technology has important applications and clinical implications for various health behaviors, including the potential for just-in-time adaptive interventions that target high-risk behavior in real time. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50241.
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Affiliation(s)
- Nancy P Barnett
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - Matthew K Meisel
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - Shannon R Forkus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Kristina M Jackson
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
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Monnig MA, Clark SE, Treloar Padovano H, Sokolovsky AW, Goodyear K, Ahluwalia JS, Monti PM. Access to medication for opioid use disorder supported by telemedicine and healthcare coverage: A web-based survey during the COVID-19 pandemic. Addict Behav Rep 2023; 18:100515. [PMID: 37731991 PMCID: PMC10507580 DOI: 10.1016/j.abrep.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
Background and Aims Medications for opioid use disorder (MOUD) are highly effective in improving treatment outcomes and reducing overdose. Concerns about interrupted access to critical MOUD services led to expansion of telemedicine services during the COVID-19 pandemic in the US. The current study tested the hypothesis that telemedicine usage and healthcare coverage would be significantly associated with access to MOUD in the early phase of the COVID-19 pandemic. Design A cross-sectional online survey was administered to a non-probability sample from June 18-July 19, 2020 using the Amazon Mechanical Turk platform. Setting Northeastern United States during the early phase of the COVID-19 pandemic. At the time of the survey, federal regulators had waived the longstanding requirement for in-office visits for MOUD prescription receipt and provided guidance on increasing third-party payer reimbursement rates for telehealth visits in order to mitigate barriers to care associated with COVID-19 safety guidelines. Participants Individuals 18 years or older residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to complete the survey. The analytic sample was participants who reported using opioids not as prescribed by a physician in the past seven days. Measurements Demographics, telemedicine usage, and healthcare coverage were assessed as explanatory variables. The primary outcome was whether participants reported ability to access MOUD in the past four weeks. Findings In this sample of individuals who used illicit opioids in the past week (N = 191), one in two individuals who utilized telehealth or had healthcare coverage were able to access MOUD, whereas only one in five of their respective counterparts who did not have telehealth access or healthcare coverage were able to access these medications. Conclusions Telemedicine and healthcare coverage were associated with greater MOUD access early in the COVID-19 pandemic, when barriers to care were high. Such findings speak to the importance of not only extending but also formalizing temporary policy changes instituted during the pandemic to allow MOUD prescribing via telemedicine.
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Affiliation(s)
- Mollie A. Monnig
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, USA
| | - Samantha E. Clark
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, USA
| | - Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, USA
| | - Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jasjit S. Ahluwalia
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, USA
| | - Peter M. Monti
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, USA
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Muzumdar N, Jackson KM, Buckman JF, Spaeth AM, Sokolovsky AW, Pawlak AP, White HR. Dose-dependent Relationships of Same-day and Typical Substance Use to Sleep Duration in College Cannabis and Alcohol Users: A Multilevel Modeling Approach Using Daily Diary Data. Cannabis 2023; 6:49-63. [PMID: 38035172 PMCID: PMC10683747 DOI: 10.26828/cannabis/2023/000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
This study characterized how quantities of cannabis and alcohol use affect sleep. Single-day and typical cannabis and alcohol use patterns were considered to assess acute-chronic use interactions. Linear and non-linear associations assessed dose-dependence. College students (n=337; 52% female) provided 11,417 days of data, with up to five time points per day. Daily self-reported sleep duration, cannabis use quantity, and alcohol use quantity were subjected to linear mixed modeling to capture linear and curvilinear associations between single-day and typical use on same-night and typical sleep. Sleep duration (difference between bedtime and waketime) was the outcome. Quantity of cannabis used each day andtypical quantity used across all days were predictors in the cannabis models. Parallel single-day and typical alcohol variables were predictors in the alcohol models. Follow-up analyses excluded days with alcohol-cannabis co-use. Main effects of single-day and typical cannabis quantity on sleep duration were observed when all cannabis-use days were modeled. Higher than typical doses of single-day and typical cannabis were associated with longer sleep durations, but only to a point; at the highest doses, cannabis shortened sleep. A main effect of single-day alcohol quantity and two interactions (single-day use with both linear and curvilinear typical use) on sleep duration were observed when all alcohol-use days were modeled. Greater alcohol consumption on a given day led to shorter same-night sleep, but typically heavier drinkers required higher doses than typically lighter drinkers to experience these adverse effects. Follow-up models suggested alcohol co-use may contribute to the purported sleep-promoting effects of cannabis.
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Affiliation(s)
- Neel Muzumdar
- Department of Kinesiology and Health, Rutgers University – New Brunswick
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University – New Brunswick
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Andrea M. Spaeth
- Department of Kinesiology and Health, Rutgers University – New Brunswick
| | | | - Anthony P. Pawlak
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Helene R. White
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
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Sokolovsky AW, Rubenstein D, Gunn RL, White HR, Jackson KM. Associations of daily alcohol, cannabis, combustible tobacco, and e-cigarette use with same-day co-use and poly-use of the other substances. Drug Alcohol Depend 2023; 251:110922. [PMID: 37625332 PMCID: PMC10538395 DOI: 10.1016/j.drugalcdep.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Young adults frequently use alcohol, cannabis, and tobacco together. Given the increased prevalence of e-cigarette use and recreational cannabis use, we investigated daily patterns of alcohol, cannabis, and tobacco use and distinguished combustible tobacco from e-cigarettes. METHODS Young adult college students (N=341) reporting past-month alcohol and cannabis use "at the same time so that their effects overlapped" completed two 28-day bursts of repeated daily surveys. Exposures were day- and person-level use of each substance. Outcomes were (1) same-day co-use of each remaining substance or (2) poly-use of the other substances. RESULTS Daily use of alcohol, cannabis, combustible cigarettes, and e-cigarettes increased the odds of same-day co-use of the other substances (except combustible tobacco with e-cigarettes) and each poly-use outcome. The influence of person-level substance use on daily substance use was less consistent. Only e-cigarette use increased the odds of daily alcohol use. Use of either tobacco product but not alcohol increased the odds of daily cannabis use. Person-level alcohol and cannabis use increased the odds of daily use of either tobacco product but use of one tobacco product was not associated with daily use of the other product. CONCLUSIONS These findings increase our understanding of emerging daily patterns of alcohol, cannabis, and tobacco co-use, and the impact of different tobacco products. Future work is needed to extend this research into non-college samples and people who use tobacco but do not use alcohol and cannabis simultaneously, and examine daily chronologies of multiple substances that could serve as dynamic markers of risk.
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Affiliation(s)
- Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States.
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2400 Pratt Street, Durham, NC 27705, United States
| | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
| | - Helene R White
- Rutgers Center of Alcohol and Substance Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854-8001, United States
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
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Orchowski LM, Malone S, Sokolovsky AW, Pearlman DN, Rizzo C, Zlotnick C, Berkowitz A, Fortson BL. Preventing sexual violence among high school students through norms correction and bystander intervention: A school-based cluster trial of Your Voice Your View. J Community Psychol 2023; 51:2861-2886. [PMID: 37032619 PMCID: PMC10523861 DOI: 10.1002/jcop.23047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 06/19/2023]
Abstract
Risk for sexual violence begins early in the lifespan; thus, interventions are needed to decrease the risk for sexual violence among high school youth. The current study evaluates the Your Voice Your View (YVYV) sexual violence prevention program using a school-based cluster trial among 26 high schools in the Northeastern United States. YVYV, includes: 1) a series of four classroom workshops designed to engage students as allies in violence prevention through bystander intervention skills training, address risks for sexual aggression, and reduce risk for victimization; 2) a Lunch and Learn teacher training workshop; and 3) a 4-week social norms poster campaign based on normative data from the school. Schools were matched based on size and demographics and randomly assigned to the intervention group or a wait-list control group. A sample of 2685 10th grade students enrolled in the research and completed assessments at baseline, 2-month and 6-month follow-up periods. The magnitude of the difference in sexual aggression did not vary by condition at either follow-up period. The magnitude of 6-month differences in experiencing unwanted sexual intercourse varied significantly by condition (IRR = 0.33 [0.14-0.76]), demonstrating a small protective effect favoring intervention schools (Cohen's f2 = 0.012). These findings highlight the promise of multicomponent interventions grounded in bystander intervention skills training, risk reduction, and social norms theory as a promising, comprehensive approach for sexual violence prevention among youth.
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Affiliation(s)
- Lindsay M. Orchowski
- Department of Psychiatry and Human Behavior, Rhode Island
Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode
Island, USA
| | - Sandra Malone
- Day One of Rhode Island, Providence, Rhode Island,
USA
| | - Alexander W. Sokolovsky
- School of Public Health, Centers for Alcohol and Addiction
Studies, Brown University, Providence, Rhode Island, USA
| | - Deborah N. Pearlman
- Department of Epidemiology, School of Public Health, Brown
University, Providence, Rhode Island, USA
| | - Christie Rizzo
- Department of Applied Psychology, Northeastern University,
Boston, Massachusetts, USA
| | - Caron Zlotnick
- Department of Psychiatry and Mental Health, Women and
Infants Hospital, University of CapeTown, CapeTown, South Africa
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan Berkowitz
- Independent Research and Practitioner, Mount Shasta,
California, USA
| | - Beverly L. Fortson
- Division of Violence Prevention, National Center for Injury
Prevention and Control, Centers for Disease Control and Prevention, Atlanta,
Georgia, USA
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Cioe PA, Sokolovsky AW, Brewer JA, Kahler CW. App-Delivered Mindfulness Training to Reduce Anxiety in People with HIV Who Smoke: A One-Armed Feasibility Trial. Int J Environ Res Public Health 2023; 20:4826. [PMID: 36981734 PMCID: PMC10048883 DOI: 10.3390/ijerph20064826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION People with HIV (PWH) who smoke have reported that managing anxiety is a barrier to making a quit attempt and maintaining abstinence post-quit. This study examined the feasibility and acceptability of an app-based mindfulness intervention, Unwinding Anxiety, to reduce anxiety prior to a quit attempt in PWH who were not planning to quit in the next 30 days. METHODS Sixteen PWH (mean age 51.5 [SD = 13.2]; mean cigarettes per day 11.4 [SD = 5.4]) were enrolled and followed for eight weeks. A smartphone-based app with 30 modules designed to reduce anxiety was introduced at baseline; participants were encouraged to complete one module daily for four weeks. Symptoms of anxiety and readiness to quit smoking were measured at baseline and weeks 4 and 8. The mean number of modules completed, session attendance, and number of study completers were examined. Generalized estimating equations (GEE) were used to examine changes in self-reported anxiety and readiness to quit at baseline, week 4, and week 8. A brief qualitative interview was conducted at week 4 to explore the acceptability of the app. RESULTS Feasibility was high, with 93% of participants completing the study. The mean number of study sessions completed was 2.7 (SD = 0.59), and the mean number of modules completed was 16.0 (SD 16.8). Anxiety was high at baseline (M = 14.4, SD = 3.9), but lower at week 4 (b = -5.5; CI: [-9.4, -1.7]; p = 0.004) and week 8 (b = -5.1; CI: [-8.8, -1.3]; p = 0.008), and stable between weeks 4 and 8 (b = 0.48; CI: [-2.0, 3.0]; p = 0.706). Readiness to quit significantly increased from baseline M = 5.5 (SD = 1.6) to week 4 (b = 0.56; CI: [0.20, 0.91]; p = 0.002) but was not significantly different from baseline at week 8 (b = 0.34; CI: [-0.30, 1.0]; p = 0.30). Ad-hoc moderation analyses found that anxiety had a small significantly positive association with readiness to quit at baseline (main effect: b = 0.10; SE = 0.03; p < 0.001) and significantly attenuated the increase in readiness to quit observed at week 4 (anxiety by week 4 interaction: b = -0.08; SE = 0.03; p = 0.009). CONCLUSIONS App-based mindfulness training appears to be feasible and acceptable for PWH who smoke and report baseline anxiety. At week 4, anxiety was reduced and readiness to quit was increased, perhaps a key time point for a smoking cessation attempt.
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Affiliation(s)
- Patricia A. Cioe
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02903, USA; (A.W.S.); (J.A.B.); (C.W.K.)
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Drohan MM, Stevens AK, Gunn RL, Sokolovsky AW, White HR, Jackson KM. Acute Consequences Associated With Co-use of Alcohol and Cannabis: A Daily Survey Analysis. J Stud Alcohol Drugs 2023; 84:208-213. [PMID: 36971729 PMCID: PMC10171256 DOI: 10.15288/jsad.22-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Co-use of alcohol and cannabis has been associated with more total negative consequences than single-substance use, but results have been mixed depending on whether the single substance was alcohol or cannabis. The present study used within-person analyses to examine whether co-use increased the risk for experiencing specific acute negative consequences. METHOD College students who were co-users of alcohol and cannabis (N = 341; M age = 19.8 years; 51.3% female; 74.8% White) completed 56 days of five daily surveys across two bursts. We used generalized linear mixed effects models to examine the effects of type of substance use day on specific negative consequences, controlling for consumption and covariates. RESULTS Relative to both alcohol-only and co-use days, cannabis-only days were associated with decreased likelihood of experiencing hangover, blackout, nausea/vomiting, injury, rude/aggressive behavior, and unwanted sex. Relative to alcohol-only days, cannabis-only and co-use days were associated with an increased likelihood of driving high/drunk. Finally, there was an increased likelihood of hangovers on alcohol-only days compared with co-use days. CONCLUSIONS Days with different types of substance use differed in specific consequences. Most of the negative co-use consequences investigated here appear to be driven by alcohol consumption rather than cannabis use. The results also indicated that these young adults were more likely to endorse driving under the influence of cannabis than alcohol. Interventions for co-use should target alcohol consumption to reduce negative consequences such as blackout, injury, rude/aggressive behavior, and unwanted sex and highlight the dangers of driving under the influence of cannabis.
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Affiliation(s)
- Megan M. Drohan
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Angela K. Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Helene R. White
- Center of Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
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Monnig MA, Clark SE, Avila JC, Sokolovsky AW, Treloar Padovano H, Goodyear K, Aston ER, Haass-Koffler CL, Tidey JW, Ahluwalia JS, Monti PM. COVID-19-Related Stressors and Clinical Mental Health Symptoms in a Northeast US Sample. Int J Environ Res Public Health 2023; 20:1367. [PMID: 36674123 PMCID: PMC9858791 DOI: 10.3390/ijerph20021367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Research has linked specific COVID-19-related stressors to the mental health burden, yet most previous studies have examined only a limited number of stressors and have paid little attention to their clinical significance. This study tested the hypothesis that individuals who reported greater COVID-19-related stressors would be more likely to have elevated levels of anxiety, posttraumatic stress symptoms, and serious psychological distress. METHODS An online survey was administered to a convenience sample from 18 June to 19 July 2020, in US states that were most affected by COVID-19 infections and deaths at the time. Individuals who were 18 or older and residents of five Northeast US states were eligible to participate (N = 1079). In preregistered analyses, we used logistic regression models to test the associations of COVID-19 stressors with symptoms on the Generalized Anxiety Disorder-7 (GAD-7), Impact of Event Scale-Revised, and K6, adjusting for sociodemographic covariates. RESULTS COVID-19-related stressors (i.e., essential worker status, worry about COVID-19 infection, knowing someone hospitalized by COVID-19, having children under 14 at home, loneliness, barriers to environmental rewards, food insecurity, loss of employment) were associated with meeting thresholds (i.e., positive screening) for anxiety, posttraumatic stress, and/or serious psychological distress. Loneliness and barriers to environmental rewards were associated with all mental health outcomes. LIMITATIONS We used a non-probability sample and cannot assume temporal precedence of stressors with regard to development of mental health symptoms. CONCLUSIONS These findings link specific stressors to the mental health burden of the COVID-19 pandemic.
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Affiliation(s)
- Mollie A. Monnig
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
| | - Samantha E. Clark
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
| | - Jaqueline C. Avila
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
| | - Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
| | - Carolina L. Haass-Koffler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Jasjit S. Ahluwalia
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
| | - Peter M. Monti
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI 02912, USA
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Gunn RL, Sokolovsky AW, Drohan MM, Boyle HK, Stevens AK, White HR, Jackson K. The role of alcohol and cannabis co-use in drinking rate and its impact on consequences. Alcohol Clin Exp Res 2022; 46:2110-2120. [PMID: 36124876 PMCID: PMC9968512 DOI: 10.1111/acer.14946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of alcohol and cannabis co-use on college student drinking and related outcomes is complex. Specific characteristics or patterns of co-use events beyond drinking quantity may be important to the experience of consequences. The present study used repeated daily surveys to examine the association between co-use (versus use of alcohol only) and drinking rate on negative consequences. METHODS The sample included 318 college students (Mage = 19.8, 47% female, 76% non-Hispanic White) who were co-users of alcohol and cannabis, recruited from three U.S. college campuses. Participants completed 56 days of data collection (number of drinking days ranged from 1 to 38). Two measures of drinking rate were examined: (1) daily rate (number of drinks divided by number of hours spent drinking per day); and (2) peak hour rate (maximum number of drinks consumed in a single hour) to account for anomalous drinking days of long duration. Generalized linear mixed models examined: (1) associations of co-use with peak hour rate (model 1a) and daily rate (model 1b); (2) associations of peak hour rate (model 2a) and daily rate (model 2b) with experiencing any negative consequence; and (3) interactions of co-use with peak hour rate (model 3a) and daily rate (model 3b) on experiencing a consequence. RESULTS Co-use was positively associated with peak hour rate but not daily rate. Both peak hour and daily rate positively predicted likelihood of experiencing a negative consequence. The interaction of both peak hour and daily rate by co-use was significant such that the association of rate with experiencing a consequence was stronger on alcohol-only days compared to co-use days. CONCLUSIONS Daily drinking rate and peak hour drinking rate are unique and should be considered when discussing drinking patterns. Both predict negative consequences and may be important aspects of interventions for negative drinking-related outcomes among college students.
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Affiliation(s)
- Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Megan M. Drohan
- University of Rhode Island, South Kingstown, Rhode Island, USA
| | - Holly K. Boyle
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Angela K. Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Helene R. White
- Center of Alcohol and Substance Studies, Rutgers University, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Kristina Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
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10
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Stevens AK, Gunn RL, Sokolovsky AW, Colby SM, Jackson KM. Examining the heterogeneity of polysubstance use patterns in young adulthood by age and college attendance. Exp Clin Psychopharmacol 2022; 30:701-713. [PMID: 33970653 PMCID: PMC8578597 DOI: 10.1037/pha0000472] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Substance use in young adulthood and polysubstance users (PSU), in particular, pose unique risks for adverse consequences. Prior research on young adult PSU has identified multiple classes of users, but most work has focused on college students. We examined PSU patterns by age and college attendance during young adulthood in two nationally representative samples. Using National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 1 and NESARC-III data sets, multigroup latent class analysis (MG-LCA) was employed to examine PSU patterns based on age (18-24 vs. 25-34) and determine whether solutions were similar (i.e., statistically invariant) by college attendance/graduation. Classes were estimated by binary past-year use of sedatives, tranquilizers, opioids/painkillers, heroin, amphetamines/stimulants, cocaine, hallucinogens, club drugs, and inhalants, and past-year frequency of alcohol, cigarette, and cannabis use. PSU patterns are largely replicated across waves. Model fit supported 3-class solutions in each MG-LCA: Low frequency-limited-range PSU (alcohol, cigarettes, and cannabis only), medium-to-high frequency limited-range PSU (alcohol, cigarettes, and cannabis only), and extended-range PSU (ER PSU; all substances). Apart from one model, MG-LCA solutions were not invariant by college attendance/graduation, suggesting important differences between these groups. Except for alcohol, cannabis, and cigarette use frequency, results showed that probabilities of illicit and prescription drug use declined in the older age group. Findings also supported examining college and noncollege youth separately when studying PSU. ER PSU may be uniquely vulnerable to coingesting substances, particularly for nongraduates, warranting future research to classify patterns of simultaneous PSU and identify predictors and consequences of high-risk combinations (e.g., alcohol and opioids). (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Angela K Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | | | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
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11
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Stevens AK, Boyle HK, Sokolovsky AW, White HR, Jackson KM. Nuanced relations between simultaneous alcohol and cannabis use motives and negative consequences among college students: The role of multiple product use. Exp Clin Psychopharmacol 2022; 30:593-608. [PMID: 33705200 PMCID: PMC8433268 DOI: 10.1037/pha0000454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Simultaneous alcohol and marijuana (SAM) use is common, but it exacerbates negative consequences. Individuals use alcohol and cannabis products in different ways and have distinct reasons for use. The present study examines day-level effects of motives on consequences on SAM-use days, accounting for consumption, and tests whether using multiple alcohol (e.g., beer + liquor) and/or cannabis (e.g., concentrate + leaf) products on the same day mediates these relations. College students engaging in SAM use at least once in the past month (N = 281; Mage = 20.17) completed two bursts of 28 consecutive days of data collection. We examined within-person effects of motives (effect-enhancement, social, offered [it was offered], coping) on number of negative consequences and on experiencing hangover, nausea, or blackout; and indirect effects via two concurrent mediators: using multiple alcohol products and multiple cannabis products. Total effect models showed effect-enhancement motives were related to nausea, social motives to number of total consequences and hangover, and coping motives to blackout. Effect-enhancement, social, and offered motives evinced significant indirect effects on consequence outcomes via multiple alcohol, but not cannabis, product use. Coping motives did not exhibit significant indirect effects, and were related to multiple cannabis, but not alcohol, product use, although all other motives were related to both mediators. Findings support recent work demonstrating within-person relations between social motives and negative consequences on SAM-use days. Limiting the number of alcohol products consumed on SAM-use days may be beneficial, particularly for young adults using to enhance intoxication or for social reasons. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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12
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Szapary CL, Avila JC, Monnig MA, Sokolovsky AW, DeCost G, Ahluwalia JS. Adherence to COVID-19 Guidelines among Current, Former, and Never Smokers. Am J Health Behav 2022; 46:442-455. [PMID: 36109860 DOI: 10.5993/ajhb.46.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this paper, we explore the adherence patterns to US Centers for Disease Control and Prevention (CDC) COVID-19 mitigation guidelines among current, former, and never smokers. Methods: We used an online cross-sectional survey of adults 18 years or older in 5 northeastern states of the US (N=1084). Results: Unadjusted analyses revealed that current smokers reported lower adherence to the CDC guidelines than former smokers (27.5 vs 29.4, p<.05). After accounting for sociodemographic covariates, this finding was no longer statistically significant. However, compared to former smokers, never smokers reported wearing their mask less often (OR=0.65; 95% CI=0.45-0.94) and current smokers were less likely to report always practicing illness-related hygiene skills (OR=0.60; 95% CI=0.39-0.93).Conclusions: Never smokers had poorer adherence to CDC guidelines than former smokers, namely wearing their masks, and current smokers were less likely to always follow the hygiene recommendations. Results should inform future public health efforts in targeting current smokers with lower adherence to CDC guidelines and learning from the ability of former smokers to demonstrate high adherence.
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Affiliation(s)
- Claire L Szapary
- Claire L. Szapary, Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States;,
| | - Jaqueline Contrera Avila
- Jaqueline Contrera Avila, Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Mollie A Monnig
- Mollie A. Monnig, Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, and Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - Alexander W Sokolovsky
- Alexander W. Sokolovsky, Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, and Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - Grace DeCost
- Grace DeCost, Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Jasjit S Ahluwalia
- Jasjit S. Ahluwalia, Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, and Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
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13
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Avila JC, Sokolovsky AW, Nollen NL, Lee J, Schmid CH, Ahluwalia JS. The effect of race/ethnicity and adversities on smoking cessation among U.S. adult smokers. Addict Behav 2022; 131:107332. [PMID: 35436698 PMCID: PMC9870094 DOI: 10.1016/j.addbeh.2022.107332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Black and Hispanic individuals in the US experience more socioeconomic adversities that are associated with disparities in tobacco use and cessation than White individuals. This study examined if racial/ethnic differences in smoking abstinence were mediated by socioeconomic (SES) adversities. METHODS Data from 7,101 established smokers were identified in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) and followed to Wave 4 (2016-2018). The study outcome was cigarette abstinence at Wave 4. The main independent variable was race/ethnicity (Non-Hispanic White [White], Non-Hispanic Black [Black] and Hispanic). The mediators were five measures of SES adversities (unemployment, poverty, difficulty with money, lower education level, lack of health insurance). A weighted Generalized Structural Equation Model (GSEM) was used to estimate the total, direct, and indirect effect of race/ethnicity on the odds of quitting mediated by the five SES adversities. This model was adjusted by study covariates, including health and smoking characteristics. RESULTS The indirect effect of race/ethnicity on cessation showed that differences in quitting between Black and White individuals as well as Hispanic and White individuals were mediated by SES adversities. However, the differences in quitting between Hispanic and Black individuals were not mediated by SES adversities. Black and Hispanic individuals were less likely to quit than White individuals, but Hispanic individuals were more likely to quit than Black individuals. There were no direct effects between Black or Hispanic individuals compared to White individuals. Those with higher SES were more likely to quit compared to those with lower SES. DISCUSSION Smoking abstinence is higher in White individuals compared to Black and Hispanic individuals and is mediated by SES adversities. However, smoking abstinence is higher among Hispanic individuals compared to Black individuals and it is not mediated by SES adversities. Future studies should consider the role of other factors, such as psychosocial support, racism, discrimination, and stress over the life course in explaining differences in smoking abstinence between Black and Hispanic individuals.
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Affiliation(s)
- Jaqueline C. Avila
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, United States,Corresponding author at: 121 S Main street, Box G-S121-4, Providence, RI 02912, United States. (J.C. Avila)
| | - Alexander W. Sokolovsky
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, United States
| | - Nicole L. Nollen
- Department of Population Health, School of Medicine, University of Kansas Medical Center, United States
| | - Juhan Lee
- Department of Psychiatry, School of Medicine, Yale University, United States
| | - Christopher H. Schmid
- Department of Biostatistics, School of Public Health, Brown University, United States
| | - Jasjit S. Ahluwalia
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, United States,Department of Medicine, Alpert School of Medicine, Brown University, United States
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14
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DeAtley T, Sokolovsky AW, Snell ML, Tidey J. Mediational pathways of tobacco use among adult daily smokers with psychiatric symptoms in the Population Assessment of Tobacco and Health (PATH) survey. Addict Behav 2022; 129:107249. [PMID: 35104739 PMCID: PMC8969557 DOI: 10.1016/j.addbeh.2022.107249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Individuals with psychiatric conditions suffer disproportionately from tobacco-related morbidity and mortality, but the factors driving this relationship remain unclear. We used data from the Population Assessment of Tobacco and Health (PATH) to investigate whether associations between internalizing psychiatric symptoms and change in smoking heaviness (as measured by cigarettes per day (CPD) were mediated by self-reported respiratory symptoms, smoking risk perceptions, and cigarette dependence. METHODS This study used data from PATH Waves 1 through 4 (2013-2017, n = 4,152). Psychiatric symptoms were indexed with the internalizing sub-scale of the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) among daily smokers. We fit auto-regressive structural equation models (SEM) to data from Wave 1-3 and 2-4 to determine the direct and indirect associations between internalizing symptom scores and CPD through each mediator. RESULTS The association between internalizing symptoms and CPD was mediated by cigarette dependence (indirect: B = 0.004, SE = 0.041, p = 0.023) and respiratory symptom severity (indirect: B = 0.018, SE = 0.097, p < 0.001). Internalizing symptoms predicted higher harm perceptions (B = 0.056, SE = 0.035, p < 0.001) but the indirect relationship with CPD was non-significant. Findings from Waves 2-4 replicated these results. CONCLUSION Our results indicate that cigarette dependence and respiratory symptom severity partially mediate the relationship between internalizing symptoms and CPD but risk perceptions were not significant predictors in our models. This suggests that efforts to reduce smoking among people with internalizing disorders should focus on decreasing nicotine dependence and increasing awareness of respiratory symptoms to encourage a quit attempt or switch to a less harmful source of nicotine.
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Affiliation(s)
- Teresa DeAtley
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Morgan L Snell
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Jennifer Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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15
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Lanza ST, Sokolovsky AW, Linden-Carmichael AN, White HR, Jackson KM. Understanding Heterogeneity Among Simultaneous Alcohol and Marijuana Users: Latent Classes Derived From Daily Diary Data. J Stud Alcohol Drugs 2022; 83:358-363. [PMID: 35590176 PMCID: PMC9134998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Simultaneous use of alcohol and marijuana (SAM) is common among U.S. college students, but little research has examined specific substance use behaviors during SAM use episodes. This study identified latent classes of SAM users based on their SAM, alcohol-only, and marijuana-only use episodes. METHOD College student SAM users (N = 284; 50.7% female; M age = 19.8 years) completed up to five surveys each day across two 4-week bursts. Latent class analysis (LCA) was used to characterize SAM users based on seven latent class indicators of use behavior. Sex was examined in relation to latent class membership. RESULTS Five unique classes emerged: Frequent Marijuana-Focused SAM users (21%); Frequent Alcohol-Initiating SAM users (29%); Heavy-Drinking Infrequent SAM users (12%); Moderate SAM users (29%); and Light Infrequent SAM users (9%). These groups were differentiated primarily by their frequency of SAM use, form of marijuana, whether marijuana was used on non-SAM occasions, and whether consequences were experienced. Groups differed significantly by sex. CONCLUSIONS College student SAM users are heterogeneous with respect not only to their degree of SAM use but also in their pattern of drinking, type of marijuana use, relative focus on alcohol versus marijuana, and risk of experiencing acute negative consequences. Describing this heterogeneity is an important step toward developing interventions for different types of users.
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Affiliation(s)
- Stephanie T. Lanza
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania,Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania,Correspondence may be sent to Stephanie T. Lanza at the Department of Biobehavioral Health, Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, 302 Health and Human Development Building, University Park, PA 16802, or via email at:
| | | | - Ashley N. Linden-Carmichael
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | - Helene R. White
- Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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16
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Lanza ST, Sokolovsky AW, Linden-Carmichael AN, White HR, Jackson KM. Understanding Heterogeneity Among Simultaneous Alcohol and Marijuana Users: Latent Classes Derived From Daily Diary Data. J Stud Alcohol Drugs 2022; 83:358-363. [PMID: 35590176 PMCID: PMC9134998 DOI: 10.15288/jsad.2022.83.358] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/02/2021] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Simultaneous use of alcohol and marijuana (SAM) is common among U.S. college students, but little research has examined specific substance use behaviors during SAM use episodes. This study identified latent classes of SAM users based on their SAM, alcohol-only, and marijuana-only use episodes. METHOD College student SAM users (N = 284; 50.7% female; M age = 19.8 years) completed up to five surveys each day across two 4-week bursts. Latent class analysis (LCA) was used to characterize SAM users based on seven latent class indicators of use behavior. Sex was examined in relation to latent class membership. RESULTS Five unique classes emerged: Frequent Marijuana-Focused SAM users (21%); Frequent Alcohol-Initiating SAM users (29%); Heavy-Drinking Infrequent SAM users (12%); Moderate SAM users (29%); and Light Infrequent SAM users (9%). These groups were differentiated primarily by their frequency of SAM use, form of marijuana, whether marijuana was used on non-SAM occasions, and whether consequences were experienced. Groups differed significantly by sex. CONCLUSIONS College student SAM users are heterogeneous with respect not only to their degree of SAM use but also in their pattern of drinking, type of marijuana use, relative focus on alcohol versus marijuana, and risk of experiencing acute negative consequences. Describing this heterogeneity is an important step toward developing interventions for different types of users.
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Affiliation(s)
- Stephanie T. Lanza
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | | | - Ashley N. Linden-Carmichael
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | - Helene R. White
- Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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17
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Micalizzi L, Sokolovsky AW, Delaney DJ, Gunn RL, Hernandez L, Kemp K, Spirito A, Stein LAR. A psychometric assessment of the Brief Situational Confidence Questionnaire for Marijuana (BSCQ-M) in juvenile justice-involved youth. Addict Behav 2022; 125:107154. [PMID: 34735980 PMCID: PMC8662708 DOI: 10.1016/j.addbeh.2021.107154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Cannabis refusal self-efficacy, defined as confidence in the ability to refuse cannabis or to avoid cannabis use, is associated with decreased cannabis use. Juvenile justice-involved youth are at high risk for cannabis use and may have lower refusal self-efficacy. While court-involved, non-incarcerated (CINI) and incarcerated youth are groups that are both at high-risk for cannabis use, the experience of incarceration may impact the measurement of refusal self-efficacy for cannabis. The factor structure, measurement invariance, and concurrent validity of the Brief Situational Confidence Questionnaire for Cannabis (BSCQ-M) was assessed among CINI (n = 148) and incarcerated (n = 199) youth (80.7% male, Mage = 16.3). Confirmatory factor analyses indicated that a correlated 3-factor model including positive/good times, negative internal, and negative external situational factors best fit the data. Multigroup measurement invariance testing revealed that the BSCQ-M demonstrated configural, metric, scalar, and residual invariance across CINI and incarcerated samples, indicating measurement invariance across the two groups. Negative binomial regressions revealed that BSCQ-M scores were significantly negatively associated with concurrent cannabis use. Results suggest that the BSCQ-M is a brief, psychometrically sound measure of refusal self-efficacy for cannabis among juvenile justice-involved youth that can be utilized with both CINI and incarcerated youth.
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Affiliation(s)
- Lauren Micalizzi
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States
| | - Alexander W. Sokolovsky
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States
| | - Daniel J. Delaney
- Department of Psychology, Chafee Social Science Center, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, United States
| | - Rachel L. Gunn
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States
| | - Lynn Hernandez
- CUNY School of Medicine, The City College of New York, 160 Convent Avenue, New York, NY 10031
| | - Kathleen Kemp
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States,Rhode Island Family Court Mental Health Clinic, 1 Dorrance Street, Providence, RI 02903 United States
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States
| | - L. A. R. Stein
- Center for Alcohol & Addiction Studies, Brown University School of Public Health, Box G-S121-5 Providence, RI 02903, United States,Department of Behavioral and Social Sciences, Box G-S121-5, Brown University School of Public Health, Providence, RI 02912, United States,Department of Psychology, Chafee Social Science Center, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, United States,Rhode Island Training School, Department of Children, Youth & Families, 57 Power Road, Cranston, RI 02920, United States
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18
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Murphy CM, Micalizzi L, Sokolovsky AW, Borrelli B, Jennings EG, Lee CS, Parker DR, Risica PM. Motivational interviewing telephone counseling to increase postpartum maintenance of abstinence from tobacco. J Subst Abuse Treat 2022; 132:108419. [PMID: 34098201 PMCID: PMC8531179 DOI: 10.1016/j.jsat.2021.108419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 01/03/2023]
Abstract
Although many women quit smoking while pregnant, rates of relapse after delivery are high. We examined the effectiveness of motivational interviewing (MI) in maintaining postpartum abstinence from smoking among pregnant women who recently quit smoking (N = 382), randomized to receive five brief MI phone counseling calls or to a prenatal and postpartum care as usual control condition. Relapse to smoking was assessed at 3, 6, and 12 months postpartum based on self-report and urine cotinine. Cox regressions compared conditions on relapse outcomes and hazard ratio of total number of MI calls was examined to probe dose-response effects. Results revealed no difference in the hazard ratio of relapse between treatment condition and no dose-response effect of total number of MI calls. Phone counseling in the prenatal and postpartum period did not facilitate maintenance of abstinence among new mothers. Considerations for future intervention development studies on relapse prevention during the postpartum period are discussed.
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Affiliation(s)
- Cara M Murphy
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Lauren Micalizzi
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Belinda Borrelli
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Ernestine G Jennings
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, USA
| | - Christina S Lee
- Department of Clinical Practice, Boston University School of Social Work, Boston, MA, USA
| | - Donna R Parker
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Patricia Markham Risica
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown School of Public Health, Providence, RI, USA.
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19
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Reed GL, Colby SM, Sokolovsky AW, Snell LM, DeAtley T, Tidey JW. Predicting Non-Adherence With Very Low Nicotine Content Cigarettes Among Adults With Serious Mental Illness Who Smoke. Nicotine Tob Res 2021; 24:914-918. [PMID: 34958368 PMCID: PMC9048920 DOI: 10.1093/ntr/ntab271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Reducing the nicotine content of cigarettes is a promising policy intervention to decrease cigarette dependence among people who smoke. Randomized trials support the potential efficacy of a reduced nicotine product standard for cigarettes. However, interpretation of such trials is challenged by incomplete adherence to the randomized treatment assignment, as some participants may continue to use commercial cigarettes not provided by the trial. The current study examined prevalence and predictors of non-adherence among trial participants with serious mental illness (SMI). AIMS AND METHODS Adults with SMI who smoke daily and were not trying to quit (N = 58) were randomized to receive very low nicotine content (VLNC) or normal nicotine content cigarettes over 6 weeks. We investigated predictors of biologically assessed non-adherence in participants assigned to VLNC cigarettes (n = 30). Predictors included subjective responses to VLNC cigarettes, baseline nicotine dependence and dependence motives, and psychiatric symptom severity. We fit a series of linear models regressing non-adherence metrics onto covariates (gender; menthol preference) and focal predictors. RESULTS Nearly all participants (96%) were estimated to be less than completely adherent to VLNC cigarettes. Lower enjoyment ratings of respiratory tract sensations of VLNC cigarettes predicted a greater degree of non-adherence (b = -.40, SE = .14, 95% CI: -0.71, -0.10). CONCLUSIONS Less positive subjective response to smoking VLNC cigarettes was the only significant predictor of incomplete adherence among individuals with SMI, consistent with prior research in a general population sample. This suggests the potential for shared strategies to help different smoking populations adjust to a reduced nicotine product standard. IMPLICATIONS Results offer preliminary insight into potential barriers to adherence in SMI populations. Adherence might be enhanced by supplementing VLNC cigarettes with alternative sources of non-combusted nicotine, paired with educational campaigns to encourage quitting or switching to less harmful products. Future studies should replicate these analyses in a larger sample of individuals with SMI who smoke.
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Affiliation(s)
- Grace L Reed
- Corresponding Author: Grace L. Reed, Center for Alcohol and Addiction Studies, Brown University School of Public Health, 69 Brown St, #4867, Providence, RI 02912, USA. Telephone: 401-595-2666; E-mail:
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Teresa DeAtley
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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20
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Stevens AK, Blanchard BE, Sokolovsky AW, Gunn RL, White HR, Jackson KM. Forgoing plans for alcohol and cannabis use in daily life: Examining reasons for nonuse when use was planned in a predominantly white college student sample. Alcohol Clin Exp Res 2021; 45:2167-2178. [PMID: 34762304 DOI: 10.1111/acer.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/18/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The reasons for college students to abstain from alcohol and cannabis use on a given day can inform efforts to prevent or intervene in those behaviors. Research on reasons for alcohol nonuse remains in its nascent stages and no study to date has examined reasons for cannabis nonuse on a given day. Here we examine reasons for nonuse among college students after they planned to use alcohol and/or cannabis. METHODS College students (N = 341; Mage = 19.79; 53% women; 74% White) from 3 universities completed 54 days of data collection across which approximately 50% were nonuse days. Each morning, participants indicated whether they planned to use that day; nonuse reasons were assessed the next morning, if applicable. Generalized linear mixed-effects models were used to disentangle within- and between-person effects. RESULTS On a given nonuse day (at the within-person level), "work" and "school" were reasons associated with having no plan to use alcohol and "to feel in control" was linked to having no plan to use cannabis. "Did not want to get high" was related to forgoing plans (did not use when originally planned) for alcohol use at the within-person level. At the between-person level, "no desire" was associated with no plans for alcohol or cannabis use and "did not want to get high" was related to no plans for cannabis use. "School" and "could not get" were related to forgoing plans for alcohol and cannabis use, respectively, at the between-person level. CONCLUSION An examination of earlier intentions for alcohol and/or cannabis use on nonuse days yielded novel findings on the intention-behavior gap. Reasons for nonuse can inform intervention and prevention strategies (e.g., those involving social norms or just-in-time adaptive efforts) for alcohol and cannabis use on college campuses.
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Affiliation(s)
- Angela K Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Helene R White
- Center of Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
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21
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Monnig MA, Treloar Padovano H, Sokolovsky AW, DeCost G, Aston ER, Haass-Koffler CL, Szapary C, Moyo P, Avila JC, Tidey JW, Monti PM, Ahluwalia JS. Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey. JMIR Public Health Surveill 2021; 7:e29319. [PMID: 34591780 PMCID: PMC8582757 DOI: 10.2196/29319] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/11/2021] [Accepted: 09/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. OBJECTIVE The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. METHODS A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon's Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. RESULTS The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=-0.24, 95% CI -0.44 to -0.05) and nonusers (B=-0.57, 95% CI -0.76 to -0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=-0.16, 95% CI -0.30 to -0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. CONCLUSIONS In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors.
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Affiliation(s)
- Mollie A Monnig
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Hayley Treloar Padovano
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Grace DeCost
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Elizabeth R Aston
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Carolina L Haass-Koffler
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Claire Szapary
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Patience Moyo
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University, Providence, RI, United States
| | - Jaqueline C Avila
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Peter M Monti
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
- Center for Addiction and Disease Risk Exacerbation, Brown University, Providence, RI, United States
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22
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Rubenstein D, Sokolovsky AW, Aston ER, Nollen NL, Schmid CH, Rice M, Pulvers K, Ahluwalia JS. Predictors of smoking reduction among African American and Latinx smokers in a randomized controlled trial of JUUL e-cigarettes. Addict Behav 2021; 122:107037. [PMID: 34284312 DOI: 10.1016/j.addbeh.2021.107037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/07/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION E-cigarette (e-cig) use is widespread and may play an important role in facilitating smoking reduction. Racial/ethnic minorities are less likely than Whites to use e-cigs and suffer disproportionate tobacco-related disease, making them a priority for harm reduction. This paper explores factors associated with smoking reduction among African American (AA) and Latinx smokers enrolled in a trial assessing toxicant exposure in those assigned to e-cigs or smoking as usual. METHODS Participants were randomized to receive 6 weeks of JUUL e-cigs or continue smoking cigarettes as usual (N = 187). This analysis focuses on 109 participants randomized to e-cigs. We modeled cigarettes smoked in the past week at baseline and week 6 as a function of a priori selected predictors (number of JUUL pods used throughout the study, baseline cigarette dependence, and baseline cotinine) using a Poisson model fit with generalized estimating equations. RESULTS Over the six-week study, cigarette smoking decreased from an average of 82.4 to 15.5 cigarettes per week. Greater numbers of JUUL pods used predicted a greater smoking reduction by week 6 (IRR = 0.94 [0.91, 0.96], p < 0.001). Higher baseline cigarette dependence (IRR = 1.03 [1.01, 1.05], p = 0.004), and baseline cotinine (IRR = 1.18 [1.03, 1.37], p = 0.020) predicted a lesser smoking reduction. CONCLUSIONS AA and Latinx smokers reduced their cigarette consumption while using JUUL e-cigs. Higher e-cig use during an intervention to switch to e-cigs to reduce harm may facilitate a transition to smoking fewer cigarettes, offering an opportunity to narrow smoking-related health disparities.
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Affiliation(s)
- Dana Rubenstein
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States.
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
| | - Elizabeth R Aston
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Christopher H Schmid
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, United States
| | - Myra Rice
- Department of Psychology, California State University San Marcos, San Marcos, CA, United States
| | - Kim Pulvers
- Department of Psychology, California State University San Marcos, San Marcos, CA, United States
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
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23
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Jackson KM, Stevens AK, Sokolovsky AW, Hayes KL, White HR. Real-world simultaneous alcohol and cannabis use: An ecological study of situational motives and social and physical contexts. Psychol Addict Behav 2021; 35:698-711. [PMID: 34472880 DOI: 10.1037/adb0000765] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Given the adverse outcomes associated with simultaneous alcohol and marijuana (SAM) use, understanding factors that give rise to occasions of simultaneous use is critical. This study examines the relationships between situational motives and contexts and three situational outcomes: simultaneous alcohol and marijuana use (SAM) use versus cannabis-only use, number of cannabis uses, and subjective effects. METHOD Past-month SAM users (n = 341; 52% female; 75% White; 10% Latinx/Hispanic; age 18-24) from three U.S. college campuses completed 8 weeks of surveys up to five times a day. Three-level generalized linear mixed-effects models tested the effects of situational motives and social and physical contexts on occasion type (SAM vs. cannabis-only), cannabis use, and subjective effects. RESULTS Situational social and enhancement motives were related to greater odds of SAM relative to cannabis-only use; expansion motives were reported more often on cannabis-only occasions. Using with others and at friends' places, being with others consuming cannabis, and being with others who are intoxicated were more likely when combining alcohol with cannabis. Increased number of cannabis uses and subjective effects in a social context were evident only on cannabis-only occasions. Using alone and using at home were greater on cannabis-only occasions and were associated with lower cannabis use and subjective effects. CONCLUSIONS The combination of alcohol and cannabis use occurs during social situations and when motivated by positive reinforcement but number of cannabis uses is not increased when consuming cannabis with alcohol in social situations. Characterizing the complex interplay of situational factors that contribute to risky use will inform interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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24
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Sokolovsky AW, Hertel AW, Micalizzi L, White HR, Hayes KL, Jackson KM. Preliminary impact of the COVID-19 pandemic on smoking and vaping in college students. Addict Behav 2021; 115:106783. [PMID: 33360444 PMCID: PMC7834470 DOI: 10.1016/j.addbeh.2020.106783] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
We examined tobacco use changes in young adult college students in the context of the COVID-19 pandemic, focusing on smoking and vaping. First, we evaluated changes in tobacco use from pre to post campus closure focusing on smoking and electronic nicotine vaping frequency (days) and quantity (cigarettes/cartridges per day). Also, given the potential protective effects of pausing (temporarily or permanently discontinuing) smoking or vaping, we evaluated its predictors. We hypothesized that generalized anxiety and moving home would increase the odds of pausing. We also explored effects of COVID-related news exposure and seeking on tobacco use. We re-contacted young adults two years after they completed a study on alcohol and marijuana co-use. A subset (N = 83; 26.6% of the 312 respondents) were enrolled in college and reported use of cigarettes (n = 35) and/or e-cigarettes (n = 69) in the week prior to their campus closing (PC). Paired sample t-tests compared smoking and vaping frequency and quantity PC to past-week use since closing (SC). Multivariate logistic regression models were fit to examine predictors of pausing. Both smoking and vaping frequency decreased from PC to SC; however, decreased frequency did not correspond to reduced quantity. Twenty-four participants (28.9%) paused past-week use SC. Higher anxiety and moving home (versus living independently) were related to increased odds of pausing, whereas COVID-19 related news exposure and seeking were related to decreased odds of pausing. Characterizing COVID-19 related tobacco use change provides insights into how college students respond to novel health threats and informs potential interventions.
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Affiliation(s)
- Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States.
| | - Andrew W Hertel
- Department of Psychology, Knox College, 2 East South Street, Galesburg, IL 61401, United States
| | - Lauren Micalizzi
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
| | - Helene R White
- Rutgers Center of Alcohol and Substance Studies, 607 Allison Road, Piscataway, NJ 08854-8001, United States
| | - Kerri L Hayes
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
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25
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Fossos-Wong N, Kilmer JR, W Sokolovsky A, Lee HY, Jackson KM, White HR. Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana. Subst Use Misuse 2021; 56:1972-1981. [PMID: 34499566 PMCID: PMC8751539 DOI: 10.1080/10826084.2021.1963983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nonmedical use of prescription stimulants (NPS) continues to be a concern on college campuses. Previous research demonstrates a strong link between NPS and use of other substances, particularly alcohol and marijuana among college students. Simultaneous use of NPS with other substances has become an increasing concern. Given the high rates of NPS and simultaneous NPS with other substances, research examining substance use patterns and motives among students is warranted. Method: This study evaluated group differences in alcohol and marijuana use patterns, consequences, and motives among college students: a) with no NPS history (No NPS); b) engaged in NPS with no simultaneous use (Non-Sim NPS); and c) engaged in simultaneous NPS with alcohol and/or marijuana (Sim NPS). Participants included 1,108 students from three universities who reported past-year marijuana and alcohol use. Results: Overall, 32.8% reported lifetime NPS with 12.5% indicating NPS in the previous 3 months, of which 51.1% reported simultaneous NPS with alcohol and 40.2% with marijuana. Significant group differences for all drinking and marijuana outcomes were found, with heaviest rates among the Sim NPS group, followed by the Non-Sim NPS group, and the No NPS group. The Sim NPS group reported greater motives for using marijuana to alter the effects of other substances. Conclusions: College students engaged in simultaneous NPS with alcohol and marijuana are a high-risk group that should be the focus of prevention and intervention programs in the campus setting.
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Affiliation(s)
- Nicole Fossos-Wong
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jason R Kilmer
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ha-Yoon Lee
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Helene R White
- Center of Alcohol and Substance Studies and Department of Sociology, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
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26
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Stevens AK, Aston ER, Gunn RL, Sokolovsky AW, Padovano HT, White HR, Jackson KM. Does the Combination Matter? Examining the Influence of Alcohol and Cannabis Product Combinations on Simultaneous Use and Consequences in Daily Life. Alcohol Clin Exp Res 2021; 45:181-193. [PMID: 33242220 PMCID: PMC8142286 DOI: 10.1111/acer.14494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/20/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Alcohol and marijuana/cannabis are frequently used simultaneously (i.e., SAM use). SAM use is complex, and the ways in which alcohol and cannabis are simultaneously used may reveal differential effects. The purpose of this study was to examine day-level effects of distinct alcohol and cannabis product combinations on simultaneous use and consequences on that day. METHODS College student SAM users (N = 274; 50% women; Mage = 19.82 years) were recruited to complete 54 days of data collection, including 5 repeated daily surveys each day. We identified 12 distinct product combinations reported during SAM-use days. We tested 4 reference groups, with one reflecting the most common use pattern and 3 potentially risky use patterns. We considered 3 outcomes (negative consequences, number of drinks, and number of cannabis uses) and used generalized linear mixed-effects models disentangling within- from between-person effects in all analyses. RESULTS Using multiple products (≥2) of alcohol was consistently linked to higher odds of experiencing a negative consequence. Combining beer with only one cannabis product (leaf or concentrate) was consistently associated with lower odds of a consequence. Combining cannabis with multiple alcohol products was associated with heavier alcohol consumption. Using dual cannabis products also was associated with heavier cannabis consumption, but this pattern was not significantly different than using concentrate only on a given day. CONCLUSION This is the first study to examine day-level influences of distinct alcohol and cannabis product combinations on consumption and consequences among young adult SAM users. Findings suggest that mixing alcohol products confers greater risk for negative consequences and heavier consumption, whereas there is little difference in cannabis consumption when using concentrate only vs. 2 cannabis products on a given day, except for concentrate + beer. Our findings support existing protective strategies of not mixing alcohol products and avoiding use of cannabis concentrate for SAM use as well.
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Affiliation(s)
- Angela K. Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Helene R. White
- Center of Alcohol and Substance Studies, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
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27
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Stevens AK, Sokolovsky AW, Padovano HT, White HR, Jackson KM. Heaviness of Alcohol Use, Alcohol Problems, and Subjective Intoxication Predict Discrepant Drinking Reports in Daily Life. Alcohol Clin Exp Res 2020; 44:1468-1478. [PMID: 32530512 PMCID: PMC7572532 DOI: 10.1111/acer.14362] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Self-reported consumption is pervasive in alcohol research, though retrospective recall bias is a concern. Fine-grained methods are designed to limit retrospection; yet, discrepancies can arise when comparing responses on fine-grained surveys with responses to retrospective surveys across weeks or months. Many fine-grained studies use both repeated daily surveys (RDS) and end-of-day (EOD) summaries, but little research has examined whether these survey types are consistent. The purpose of this study was to quantify the magnitude and directionality of discrepancy between EOD summaries and RDS and identify alcohol-related predictors of discrepancy. METHODS As a part of a larger study, college student alcohol and cannabis users (N = 341; 53% women; Mage = 19.79 years) were recruited to complete 56 days of data collection, including 5 daily assessments of their substance use and related constructs, one of which included an EOD summary of the previous day. Generalized linear mixed-effects models were used to examine between- and within-person predictors of a 5-category, discrepancy outcome: no discrepancy, low discrepancy where RDS < EOD, low discrepancy where EOD < RDS, high discrepancy where RDS < EOD, and high discrepancy where EOD < RDS. RESULTS Discrepancies between EOD and RDS were observed in both directions. Alcohol problems predicted more alcohol consumption reported on the EOD survey than across RDS. Within-person alcohol quantity and hourly rate of consumption were most strongly related to less alcohol consumption reported on the EOD survey. Between- and within-person peak subjective intoxication and within-person liquor consumption were associated with discrepancies in both directions. CONCLUSIONS Surveys requiring more retrospection may overestimate alcohol consumption in problematic drinkers and underestimate consumption on days where more alcohol is consumed than typical. Evidence also suggests that greater day-to-day instability in alcohol behavior is linked to less consistent reporting overall. More research is needed to discern factors contributing to inconsistent reporting on fine-grained surveys to maximize the validity of reports.
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Affiliation(s)
- Angela K. Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Helene R. White
- Center of Alcohol and Substance Studies, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
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28
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Risi MM, Sokolovsky AW, White HR, Jackson KM. Factor Structure of the Cannabis Use Disorders Identification Test Revised (CUDIT-R) for Men and Women. ACTA ACUST UNITED AC 2020; 3:148-156. [PMID: 37041965 PMCID: PMC10085579 DOI: 10.26828/cannabis.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Cannabis Use Disorders Identification Test Revised (CUDIT-R) is an 8-item screening instrument designed to identify recent problematic cannabis use over the past 6 months. The purpose of the present study was to investigate the factor structure of the CUDIT-R separately for male and female college students. Participants included 1,390 male and female college students recruited from three state universities (61% female; Age: M= 19.8, SD= 1.3). We conducted exploratory and confirmatory factor analyses followed by tests of measurement invariance including configural invariance, metric invariance and scalar invariance across men and women. Results confirmed a one-factor structure for the CUDIT-R. The number of factors and item loadings were invariant between men and women. However, intercepts were non-invariant for an item asking about consumption of cannabis use indicating that the endorsement of this item varied between men and women. Follow-up validation tests indicated that using a sum score for analyses is appropriate despite non-invariance. However, more research is needed to determine if the cut-off scores of the CUDIT-R should be reevaluated by gender.
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Affiliation(s)
- Megan M. Risi
- Department of Psychology, University of Rhode Island, South Kingston, RI, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA
| | - Helene R. White
- Department of Sociology and Center of Alcohol Studies, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA
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Sokolovsky AW, Gunn RL, Micalizzi L, White HR, Jackson KM. Alcohol and marijuana co-use: Consequences, subjective intoxication, and the operationalization of simultaneous use. Drug Alcohol Depend 2020; 212:107986. [PMID: 32417362 PMCID: PMC7370922 DOI: 10.1016/j.drugalcdep.2020.107986] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol and marijuana are frequently co-used with overlapping effects. However, the absence of consistent operational definitions delineating simultaneous alcohol and marijuana use (SAM) from concurrent use (CAM) challenges consistent inferences about these behaviors. This study first examined whether daily alcohol and marijuana co-use predicted substance-use related consequences and subjective intoxication; and then evaluated whether competing operationalizations of SAM and CAM were associated with differences in these outcomes on co-use days. METHODS A sample of 341 young adult college students who reported past-month use of both alcohol and marijuana "at the same time so that their effects overlapped" completed a two-wave survey with paired 28-day daily experience sampling bursts examining alcohol and marijuana co-use. Outcomes were (a) daily substance-use related consequences; and (b) daily subjective intoxication. Focal predictors were daily drinks and marijuana uses; daily co-use versus single-substance use (Aim 1) or CAM versus SAM (Aim 2); and their interaction. RESULTS Participants reported more negative consequences on co-use days versus marijuana-only days and greater subjective intoxication relative to alcohol or marijuana-only days. Competing operationalizations of SAM, defined as daily co-use occurring within 1-240 min in increments of 1 min, found no difference in consequences or subjective intoxication regardless of operationalization. CONCLUSION Co-use days involve greater risk than alcohol-only or marijuana-only days. Although there was no evidence of additional daily risk from simultaneous use regardless of the timeframe used to operationalize it, investigating these effects remains challenging due to the generally small timeframe between substances on co-use days in this sample.
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Affiliation(s)
- Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
| | - Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
| | - Lauren Micalizzi
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI, 02912, United States; University of Saint Joseph, 1678 Asylum Avenue, West Hartford, CT, 06117, United States.
| | - Helene R. White
- Rutgers Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854-8001
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
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Gunn RL, Aston ER, Sokolovsky AW, White HR, Jackson KM. Complex cannabis use patterns: Associations with cannabis consequences and cannabis use disorder symptomatology. Addict Behav 2020; 105:106329. [PMID: 32044680 DOI: 10.1016/j.addbeh.2020.106329] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Historically, cannabis researchers have assumed a single mode and product of cannabis (e.g., smoking plant). However, patterns of use, products (e.g., concentrates, edibles), and modes (e.g. blunts, vaporizers) are diversifying. This study sought to: 1) classify cannabis users into groups based on their use of the full range of cannabis products, and 2) examine user group differences on demographics, cannabis consequences and cannabis use disorder (CUD) symptomatology. METHODS In a sample of college students (data collected in Fall 2017), who used cannabis in the past year (N = 1390), latent class analysis (LCA) was used to characterize cannabis users. We then added demographic characteristics, cannabis consequences, and CUD symptomatology scores separately to LCA models to examine class differences. RESULTS Five unique classes emerged: high-frequency all-product users, high-frequency plant/moderate-frequency edible and concentrate users, low-frequency plant users, moderate-frequency plant and edible users, and low-frequency edible users. Demographic characteristics, cannabis consequences, and CUD symptomatology differed across classes characterized by frequency as well as product. CONCLUSIONS Results reflect the increasing variety of cannabis products, modes, and use patterns among college students. In this sample, frequency of use remains a strong predictor of cannabis-related consequences, in addition to type of product. As variation in cannabis use patterns continue to evolve, it is essential for researchers to conduct comprehensive assessments.
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Affiliation(s)
- Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, United States.
| | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, United States
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, United States
| | - Helene R White
- Center of Alcohol Studies, Rutgers, the State University of NJ, Piscataway, NJ 08854, United States
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, United States
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Jackson KM, Sokolovsky AW, Gunn RL, White HR. Consequences of alcohol and marijuana use among college students: Prevalence rates and attributions to substance-specific versus simultaneous use. Psychol Addict Behav 2020; 34:370-381. [PMID: 31944787 PMCID: PMC7064425 DOI: 10.1037/adb0000545] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
College students who use alcohol and marijuana often use them simultaneously, so that their effects overlap. The present study examined whether negative consequences experienced by simultaneous alcohol and marijuana (SAM) users vary from those experienced by individuals who use alcohol and marijuana concurrently but not simultaneously (CAM) or single-substance users. We considered 9 types of consequences: cognitive, blackout, vomiting, academic/occupational, social, self-care, physical dependence, risky behaviors, and driving under the influence (DUI). Further, we examined whether consequences experienced by SAM users are attributed to using alcohol, marijuana, or both simultaneously. The sample included past-year alcohol and marijuana users age 18-24 (N = 1,390; 62% female; 69% White; 12% Hispanic) recruited from 3 U.S. college campuses. SAM users experienced a greater overall number of consequences than CAM or alcohol-only users, even controlling for frequency and intensity of alcohol and marijuana use and potentially confounding psychosocial and sociodemographic factors. Experiencing specific consequences differed between simultaneous and concurrent users, but after adjusting for consumption and other covariates, only blackouts differed. In contrast, SAM users were more likely to experience each consequence than alcohol-only users, with strongest effects for DUI, blackouts, and cognitive consequences. Among SAM users, consequences were most likely to be attributed to alcohol and were rarely attributed to simultaneous use. Being a user of both alcohol and marijuana and using alcohol and marijuana together so that their effects overlap each contribute to risk, suggesting there is value in targeting the mechanisms underlying type of user as well as those underlying type of use. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Kristina M Jackson
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University
| | - Rachel L Gunn
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University
| | - Helene R White
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
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Denlinger-Apte RL, Cassidy RN, Colby SM, Sokolovsky AW, Tidey JW. Effects of Cigarette Nicotine Content and Menthol Preference on Perceived Health Risks, Subjective Ratings, and Carbon Monoxide Exposure Among Adolescent Smokers. Nicotine Tob Res 2019; 21:S56-S62. [PMID: 31867646 PMCID: PMC6939772 DOI: 10.1093/ntr/ntz127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Minimal research exists on adolescent smokers' perceptions of very low-nicotine-content (VLNC) cigarettes. As approximately half of adolescent smokers prefer menthol cigarettes, it is important to consider the influence of menthol preference on VLNC cigarette perceptions and to what extent menthol preference may affect VLNC smoking behavior. This study examined the effects of cigarette nicotine content and menthol preference or menthol smoking on health risk perceptions, subjective ratings, and carbon monoxide (CO) boost in adolescent smokers. METHODS Across two counterbalanced sessions, adolescent smokers sampled VLNC and normal nicotine content (NNC) research cigarettes following overnight abstinence. Cigarettes were mentholated or non-mentholated consistent with participants' usual brand. In each session, participants smoked the research cigarette and then completed the Perceived Health Risk Scale and Cigarette Evaluation Scale. Breath CO readings were obtained pre- and post-smoking. Mixed-factor ANOVA tests compared outcomes with cigarette type (VLNC vs. NNC) as the within-subjects factor and menthol preference as the between-subjects factor. RESULTS Participants (N = 50) were M = 17.7 years old, smoked M = 8.2 cigarettes/day, and 56% typically smoked menthol cigarettes. Participants reported lower risk of developing lung cancer, other cancers, emphysema, bronchitis, and heart disease (ps ≤ .05) when smoking VLNC cigarettes relative to NNC cigarettes. Perceived risk of addiction and stroke did not differ by nicotine content. Menthol preference or menthol smoking did not moderate risk perceptions, subjective ratings, or CO boost. CONCLUSIONS Adolescents may incorrectly perceive that VLNC cigarettes are less harmful products. Health communication campaigns could help to correct VLNC misperceptions and potentially minimize unintended consequences of a nicotine reduction policy.
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Affiliation(s)
- Rachel L Denlinger-Apte
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI
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Chesaniuk M, Sokolovsky AW, Ahluwalia JS, Jackson KM, Mermelstein R. Dependence motives of young adult users of electronic nicotine delivery systems. Addict Behav 2019; 95:1-5. [PMID: 30784873 DOI: 10.1016/j.addbeh.2019.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Nicotine dependence contributes to changes in tobacco use among young adults. However, research examining salient dependence motives in young adult users of electronic nicotine delivery systems (ENDS) is limited. This study examined the association of dependence motives with ENDS use or lifetime quit attempt, and tests sex moderation in these relationships. METHODS Young adults (N = 304; age 18-24) self-identifying as regular ENDS users and self-reporting vaping within a week of data collection completed an online survey. They reported demographics, past 30-day vaping and smoking days and frequency, and lifetime quit attempt. Dependence motives were measured with the 14-item Wisconsin Inventory for Smoking Dependency Motives. Backward-stepwise models regressed ENDS use behaviors or lifetime quit attempt onto dependence motives, and separately onto the interactions between motives and sex. RESULTS Tolerance was positively associated with daily ENDS use frequency (b = 0.34, p < .001) past 30-day vaping days (b = 1.50, p < .001), and negatively associated with lifetime quit attempt (OR = 0.58, p = .005). Loss of control was negatively associated with daily ENDS use frequency (b = -0.24, p < .001) and past 30-day vaping days (b = -1.48, p < .001), and positively associated with lifetime quit attempt (OR = 1.56, p = .002). Craving was positively associated with lifetime quit attempt among males (OR = 1.83, p = .006) but not females (OR = 0.84, p = .51). CONCLUSION Tolerance and loss of control were uniquely associated with ENDS use behaviors across all analytic models, although effects for loss of control were counter-intuitive. Understanding the relationship between dependence motives and ENDS use behaviors or attempts to quit may provide targets for preventive interventions against increased or continued ENDS use.
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White HR, Kilmer JR, Fossos-Wong N, Hayes K, Sokolovsky AW, Jackson KM. Simultaneous Alcohol and Marijuana Use Among College Students: Patterns, Correlates, Norms, and Consequences. Alcohol Clin Exp Res 2019; 43:1545-1555. [PMID: 31135972 PMCID: PMC6640138 DOI: 10.1111/acer.14072] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/17/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alcohol and marijuana users often engage in simultaneous alcohol and marijuana (SAM) use (i.e., using the 2 substances together so that their effects overlap), which can result in more negative consequences than using either substance alone. Nevertheless, little is known about SAM use among contemporary college students to aid in the development of preventive interventions. This study examined SAM use patterns, demographic correlates of SAM use, and normative influences on SAM use and related negative consequences among college students. METHODS Students who had used alcohol and marijuana in the past year were recruited from 3 state universities in states with different laws regarding recreational marijuana use (N = 1,389). They completed an online survey, which assessed their own alcohol, marijuana, and SAM use and related consequences, their perceptions of the proportion of same-gender peers and close friends who engaged in SAM use, marijuana access, and demographic characteristics. RESULTS About three-fourths of participants reported at least 1 occasion of SAM use in the past year with an average frequency of twice per month among SAM users. There were significant differences in SAM use prevalence and frequency by sociodemographic characteristics controlling for past-year alcohol and marijuana frequency. Students in a state with decriminalized recreational marijuana use reported higher frequency of past-year SAM use than students in states with legalized or criminalized use. There were significant demographic differences in perceived norms regarding SAM use among close friends and same-gender peers. SAM users endorsed significantly higher perceived peer and friend norms than nonusers. Also, higher perceived norms predicted more frequent SAM use and more negative consequences of use. CONCLUSIONS Results indicate a need for prevention programs on college campuses that address SAM use. Interventions that use personalized normative feedback may be effective.
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Affiliation(s)
- Helene R. White
- Center of Alcohol Studies and Department of Sociology, Rutgers, the State University of New Jersey, Piscataway 08854-8001, USA
| | - Jason R. Kilmer
- Health and Wellness, Division of Student Life, University of Washington, 109 Elm Hall, Seattle, WA 98105, USA
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA 98105, USA
| | - Nicole Fossos-Wong
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th St, Suite 300, Seattle, WA 98105, USA
| | - Kerri Hayes
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island 02912, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island 02912, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island 02912, USA
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Zamboanga BL, Merrill JE, Olthuis JV, Milroy JJ, Sokolovsky AW, Wyrick DL. Secondary effects of myPlaybook on college athletes' avoidance of drinking games or pregaming as a protective behavior strategy: A multisite randomized controlled study. Soc Sci Med 2019; 228:135-141. [PMID: 30909157 PMCID: PMC7117876 DOI: 10.1016/j.socscimed.2019.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 01/01/2019] [Accepted: 02/10/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE Student-athletes are at risk for engaging in drinking games and pregaming. Research suggests that brief motivational and alcohol education intervention approaches designed to reduce harmful drinking behaviors may not be effective in lowering students' participation in drinking games or pregaming. METHOD We evaluated the effects of myPlaybook (a student-athlete-specific web-based alcohol intervention) on student-athletes' avoidance of drinking games and pregaming over a 4-month period. Seventy-three NCAA member institutions were randomly assigned to the treatment condition or a no-intervention control. Student-athletes at these schools (N = 2449) completed assessments at baseline, 1-, and 4-months post-intervention. At each assessment, participants indicated how often they used each of several harm prevention strategies when they drank in the past month including "avoided drinking games" and "avoided drinking before going out (i.e., pregaming or pre-drinking)." RESULTS Controlling for gender and race/ethnicity, treatment condition was not associated with change in avoidance of drinking games and pregaming between baseline and either follow-up. Athletic season did not moderate treatment effects on avoidance of either behavior. We found no evidence that myPlaybook, a general alcohol-reduction intervention, is efficacious in influencing student-athletes' avoidance of drinking games or pregaming as a protective strategy. CONCLUSIONS Findings from the present study as well as other research suggest that general alcohol-focused interventions may not have secondary effects on reducing students' participation in drinking games and pregaming and as such, more specific targeted interventions should be investigated.
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Affiliation(s)
- Byron L Zamboanga
- Smith College Department of Psychology, 44 College Lane, Bass Hall, Northampton, MA, 01063, USA.
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Micalizzi L, Sokolovsky AW, Janssen T, Jackson KM. Parental Social Support and Sources of Knowledge Interact to Predict Children's Externalizing Behavior Over Time. J Youth Adolesc 2019; 48:484-494. [PMID: 30560511 PMCID: PMC6391213 DOI: 10.1007/s10964-018-0969-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
Parental social support and monitoring are associated with children's externalizing behavior but clarity is needed on how these mechanisms interact to influence youth. This study examined if parental social support magnifies the protective effects of sources of parental knowledge (Parental Control, Parental Solicitation, Child Disclosure) on the development of substance initiation and delinquency across adolescence. Participants were 6-8th graders (N = 1023; 52% female; 83% White; 87.8% non-Hispanic) from six (one urban, two rural, three suburban) Rhode Island schools assessed annually for four years. Parental control protected against substance initiation, but only in supportive relationships. All sources of parental knowledge were associated with less delinquency, but only in supportive relationships. Interventions focused on increasing children's perceptions of parental social support may enhance the effectiveness of sources of parental knowledge in buffering against children's externalizing behavior.
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Affiliation(s)
- Lauren Micalizzi
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA.
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Tim Janssen
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Kristina M Jackson
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
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Sokolovsky AW, Janssen T, Barnett NP, Colby SM, Bernstein MH, Hayes KL, Jackson KM. Adolescent recanting of alcohol use: A longitudinal investigation of time-varying intra-individual predictors. Drug Alcohol Depend 2018; 193:83-90. [PMID: 30347310 PMCID: PMC6335962 DOI: 10.1016/j.drugalcdep.2018.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recanting - denying previous reports of lifetime substance use - occurs frequently in longitudinal investigations of adolescent substance use. While research has focused on how individual differences contribute to recanting, intra-individual factors associated with recanting over time remain understudied. METHODS Adolescents (n = 1023) were assessed six times between 2009 - 2015. The sample included participants who reported ever-sipping alcohol in at least one assessment who maintained or recanted ever-sipping at the subsequent assessment (n = 543, 53.1% of full sample; 54.5% female; 84.9% white; 89.5% non-Hispanic). The majority (58.6%) of the sample recanted ever-sipping. We fit linear mixed models to investigate whether prospective changes in perceived peer drinking, peer approval, alcohol expectancies, and fear of reprisal predicted recanting. To explore whether mechanisms of recanting differed for delayed (i.e., two assessments or later) recanting, we refit the models in a subset of data excluding immediate (i.e., subsequent assessment) recanters. RESULTS Prospective increases in perceived peer drinking (OR = 0.65), peer approval of drinking (OR = 0.82), and positive and negative alcohol expectancies (OR = 0.96; 0.98, respectively) predicted lower odds of recanting. Similar effects were observed among only delayed recanters. CONCLUSION Time-varying, intra-individual factors uniquely predicted recanting over time. Although most recanting occurs immediately following the initial report of ever-sipping, the observed effects were consistent between delayed recanters and the sample as a whole. Considering the systematic patterns evident in recanting, researchers should consider using computer-assisted or other research methods that minimize or verify recanting when it occurs while also informing missing data models.
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Affiliation(s)
- Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University, 121 Main St., Providence, RI 002903, USA,Correspondence: Alexander W. Sokolovsky, Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, Phone: (401) 863-6629,
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University, 121 Main St., Providence, RI 002903, USA
| | - Nancy P. Barnett
- Center for Alcohol and Addiction Studies, Brown University, 121 Main St., Providence, RI 002903, USA
| | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University, 121 Main St., Providence, RI 002903, USA
| | - Michael H. Bernstein
- Center for Alcohol and Addiction Studies, Brown University, 121 Main St., Providence, RI 002903, USA
| | - Kerri L. Hayes
- Center for Alcohol and Addiction Studies, Brown University, 121 Main St., Providence, RI 002903, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University, 121 Main St., Providence, RI 002903, USA
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Metrik J, Gunn RL, Jackson KM, Sokolovsky AW, Borsari B. Daily Patterns of Marijuana and Alcohol Co-Use Among Individuals with Alcohol and Cannabis Use Disorders. Alcohol Clin Exp Res 2018; 42:1096-1104. [PMID: 29656401 PMCID: PMC5984172 DOI: 10.1111/acer.13639] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/04/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND The study aims were to examine daily associations between marijuana and alcohol use and the extent to which the association differs as a function of cannabis use disorder (CUD) and/or alcohol use disorder (AUD) diagnosis. METHODS Timeline Followback interview data was collected in a study of veterans (N = 127) recruited from a Veterans Affairs hospital who reported at least 1 day of co-use of marijuana and alcohol in the past 180 days (22,860 observations). Participants reported 40% marijuana use days, 28% drinking days, with 37% meeting DSM-5 criteria for CUD, 40% for AUD, and 15% for both. Use of marijuana on a given day was used to predict a 3-level gender-adjusted drinking variable (heavy: ≥5 (men)/4 (women) drinks; moderate: 1 to 4/3 drinks; or none: 0 drinks). A categorical 4-level variable (no diagnosis, AUD, CUD, or both) was tested as a moderator of the marijuana-alcohol relationship. RESULTS Multilevel modeling analyses demonstrated that participants were more likely to drink heavily compared to moderately (OR = 2.34) and moderately compared to not drinking (OR = 1.61) on marijuana use days relative to nonuse days. On marijuana use days, those with AUD and those with AUD + CUD were more likely to drink heavily (OR = 1.91; OR = 2.51, respectively), but those with CUD were less likely to drink heavily (OR = 0.32) compared to moderately, nonsignificant differences between any versus moderate drinking in interaction models. CONCLUSIONS Heavy drinking occurs on days when marijuana is also used. This association is particularly evident in individuals diagnosed with both AUD and CUD and AUDs alone but not in those with only CUDs. Findings suggest that alcohol interventions may need to specifically address marijuana use as a risk factor for heavy drinking and AUD.
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Affiliation(s)
- Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
- Providence VA Medical Center, Providence, RI, 02908, USA
| | - Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Brian Borsari
- San Francisco VA Health Care System, San Francisco, CA, 94121, USA
- Department of Psychiatry, University of California – San Francisco, San Francisco, CA, 94103, USA
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Zulauf CA, Sokolovsky AW, Grabell AS, Olson SL. Early risk pathways to physical versus relational peer aggression: The interplay of externalizing behavior and corporal punishment varies by child sex. Aggress Behav 2018; 44:209-220. [PMID: 29368346 DOI: 10.1002/ab.21744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 11/05/2022]
Abstract
Children who aggress against their peers may use physical or relational forms, yet little research has looked at early childhood risk factors and characteristics that uniquely predict high levels of relational versus physical aggression in preadolescence. Accordingly, the main aim of our study was to link early corporal punishment and externalizing behavior to children's physical and relational peer aggression during preadolescence and to examine how these pathways differed by sex. Participants were 193, 3-year-old boys (39%) and girls who were reassessed following the transition to kindergarten (5.5 years) and preadolescence (10.5 years). A series of autoregressive, cross-lagged path analyses were conducted to examine the relationships between child externalizing problems and corporal punishment at ages 3 and 5.5 years, and their association with physical and relational aggression at age 10.5. Multiple group analysis was used to determine whether pathways differed by sex. Three developmental pathways were identified: (i) direct associations between stable childhood externalizing problems and later physical aggression; (ii) a direct pathway from early corporal punishment to preadolescent relational and physical peer aggression; and (iii) an indirect pathway from early corporal punishment to later physical aggression via continuing externalizing problems in middle childhood. Child sex moderated the nature of these pathways, as well as the direction of association between risk and outcome variables. These data advance our understanding of the etiology of distinct forms of peer aggression and highlight the potential for more efficacious prevention and intervention efforts in the early childhood years.
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Affiliation(s)
- Courtney A. Zulauf
- Psychology Department; University of Illinois at Chicago; Chicago Illinois
| | | | - Adam S. Grabell
- Department of Psychological and Brain Sciences; University of Massachusetts, Amherst; Amherst Massachusetts
| | - Sheryl L. Olson
- Psychology Department; The University of Michigan; Ann Arbor Michigan
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Sokolovsky AW, Mermelstein RJ, Hedeker D. Factors predicting compliance to ecological momentary assessment among adolescent smokers. Nicotine Tob Res 2013; 16:351-8. [PMID: 24097816 DOI: 10.1093/ntr/ntt154] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Ecological momentary assessments (EMAs) are increasingly used in smoking research to understand contextual and individual differences related to smoking and changes in smoking. To date, there has been little detailed research into the predictors of EMA compliance. However, patterns or predictors of compliance may affect key relationships under investigation and introduce sources of bias in results. The purpose of this study was to investigate predictors of compliance to random prompts among a sample of adolescents who had ever smoked. METHODS Data for this study were drawn from a sample of 461 adolescents (9th and 10th graders at baseline) participating in a longitudinal study of smoking escalation. We examined 2 outcomes: subject-level EMA compliance (overall rate of compliance over a week-long EMA wave), and in-the-moment prompt-level compliance to the most proximal random prompt. We investigated several covariates including gender, race, smoking rate, alcohol use, psychological symptomatology, home composition, mood, social context, time in study, inter-prompt interval, and location. RESULTS At the overall subject level, higher mean negative affect, smoking rate, alcohol use, and male gender predicted lower compliance with random EMA prompts. At the prompt level, after controlling for significant subject-level predictors of compliance, increased positive affect, being outside of the home, and longer inter-prompt interval predicted lower momentary compliance. CONCLUSIONS This study identifies several factors associated with overall and momentary EMA compliance among a sample of adolescents participating in a longitudinal study of smoking. We also propose a conceptual framework for investigating the contextual and momentary predictors of compliance within EMA studies.
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Affiliation(s)
- Alexander W Sokolovsky
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
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Lora CM, Sokolovsky AW, Touchette DR, Jin J, Hu X, Gao W, Gerber BS. ACE inhibitor and ARB medication use among Medicaid enrollees with diabetes. Ethn Dis 2013; 23:189-195. [PMID: 23530300 PMCID: PMC3711220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To examine ace-inhibitor (ACEI) and angiotensin receptor blockers (ARB) prescription and adherence patterns by race in diabetic public aid recipients. DESIGN, PARTICIPANTS, AND MEASURES We analyzed prescription records of 27,529 adults aged 18-64 with diabetes who had at least one clinical indication for receiving an ACEI/ ARB prescription and were enrolled in the State of Illinois public aid program during 2007. We calculated proportion of days covered (PDC) to assess adherence. Multivariate models adjusted for age, sex, ACEI/ARB indication, and any significant interaction terms. RESULTS Only 47.4% of individuals with at least one indication for ACEI/ARB had filled an ACEI/ARB prescription. African American men were more likely than Caucasian men to ever fill an ACEI/ARB prescription (adjusted odds ratio, [AOR] [95% CI] 1.69 [1.55-1.83]). Hispanic English and Spanish speaking men were also more likely than Caucasian men to ever fill an ACEI/ARB prescription (AOR [95% CI] 1.37 [1.16-1.62] and 1.27 [1.05-1.53], respectively). Similarly, African American and Hispanic English and Spanish speaking women were more likely than Caucasian women to ever fill an ACEI/ARB prescription (AOR [95% CI] 1.70 [1.59-1.81], 1.55 (1.36-1.76), and 1.98 (1.73-2.28), respectively. However, African Americans and Hispanics were less likely than Caucasians to achieve a PDC> or =80%. Compared to Caucasians, Hispanic Spanish speakers were the least likely to be adherent (AOR [95% CI] .49 [.41-.58]). Furthermore, older individuals were more likely to achieve a PDC> or =80% than younger individuals. CONCLUSION African Americans and Hispanics with diabetes receiving public aid in Illinois were more likely than Caucasians to have filled at least one ACEI/ARB prescription. However, they were less adherent with these medications. Future studies should assess barriers to medication adherence in this population.
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Affiliation(s)
- Claudia M Lora
- Department of Medicine, Section of Nephrology, 820 S. Wood Street M/C 793, Chicago, IL 60612, USA.
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