'You are looked upon as a luxury tool': Young Tanzanian women's perception of community norms supporting partner violence during transactional sex (kudanga)

This paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls' and young women's vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga.

The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study

PLAIN LANGUAGE STATEMENT

Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.

WhatsApp-propriate? Exploring "WhatsApp" as a Tool for Research Among Ghanaian Immigrants in the United States

African immigrants remain underrepresented in research due to challenges in recruitment. Mobile instant messaging applications, such as WhatsApp, present novel, and cost-effective opportunities for conducting health research across geographic and temporal distances, potentially mitigating the challenges of maintaining contact and engagement in research with migrant populations. Moreover, WhatsApp has been found to be commonly used by African immigrant communities. However, little is known about the acceptability and use of WhatsApp as a tool for health research among African immigrants in the US. In this study, we examine the acceptability and feasibility of WhatsApp as a tool for research among Ghanaian immigrants- a subset of the African immigrant population group. We used WhatsApp to recruit 40 participants for a qualitative interview about their use of the mobile messaging application. Three distinct themes related to the acceptability and feasibility of WhatsApp emerged from the interviews: (1) preference for using WhatsApp as a medium of communication; (2) positive perception of WhatsApp; and (3) preference for using WhatsApp for research. The findings indicate that for African immigrants in the US, WhatsApp is a preferred method for recruiting and collecting data. It remains a promising strategy to utilize in future research involving this population.

Understanding social network support, composition, and structure among cancer caregivers

OBJECTIVE

We examined the social network support, composition, and structure of pediatric cancer caregivers.

METHODS

We used a self-report survey to collect egocentric social network data from 107 caregivers of pediatric cancer patients and calculated descriptive statistics to examine cancer-related support network composition, function, and structure. We then ran logistic regressions to examine the relationships between network characteristics and overall satisfaction with social support.

RESULTS

Family members were the most common source of emotional support and logistical support, and health care providers were the most common source of informational support. Participants perceived the "most helpful" forms of support as being: (1) emotional support from family and health care providers; (2) informational support from health care providers and other cancer caregivers; and (3) logistical support from family. Overall, caregivers wished that 9.8% of their network ties had provided more support, with family members being the most common alter type to disappoint caregivers and offer less support than needed/expected. Caregivers who reported higher network disappointment (having network members who offered less support than needed/expected) were significantly less satisfied with emotional support than those with lower network disappointment (Odds Ratio = 0.18, p = 0.02), and caregivers with higher network disappointment were significantly less satisfied with logistical support compared to those with lower network disappointment (Odds Ratio = 0.14, p = 0.01).

CONCLUSION

Our results show differences in the nature of social support provided by different types of network members. These findings have implications for tailoring social network interventions to improve caregiver and family outcomes.

Social media interventions addressing physical activity among emerging adults who use cannabis: A pilot trial of feasibility and acceptability

PURPOSE

Cannabis use is common among emerging adults (ages 18-25), yet few prevention interventions have targeted this unique developmental period. Physical activity (PA) is an under-utilized intervention target for cannabis use, despite research showing its potential utility. Based on prior promising social media-delivered interventions targeting cannabis and PA separately, we developed and piloted, in a randomized controlled feasibility trial (NCT04901910), interventions for emerging adults who use cannabis that focused on PA.

PROCEDURES

Using social media, we recruited 60 emerging adults (Mean age=21.7 years; 63.3% female sex) who used cannabis (>=3 times/week for the past month) and could engage in PA. We randomized participants into one of 3 conditions (PA-Only; PA+Cannabis, Attention-Control) that each lasted 8 weeks and were delivered in secret Facebook groups by health coaches. We collected follow-up data at 3- and 6-months post-group start. Outcomes are presented descriptively given the pilot nature and limited sample size.

RESULTS

The interventions were rated favorably, with ratings of the content in each condition averaging around 3 on a 5-point scale. Both intervention groups demonstrated larger reductions in cannabis consequences and cannabis-impaired driving over time than the control condition. Findings were mixed regarding patterns of change in cannabis use in the intervention conditions. Proportions of group members reporting increased PA ranged from 38.9% to 80.0% across time.

CONCLUSIONS

Interventions targeting PA and delivered via social media to emerging adults who regularly use cannabis offer a novel intervention target. These interventions warrant future investigation in larger trials over a longer follow-up period.

Superhydrophobic 3D-Assembled Metallic Nanoparticles for Trace Chemical Enrichment in SERS Sensing

The performance of surface-enhanced Raman spectroscopy (SERS) is determined by the interaction between highly diluted analytes and boosted localized electromagnetic fields in nanovolumes. Although superhydrophobic surfaces are developed for analyte enrichment, i.e., to concentrate and transfer analytes toward a specific position, it is still challenging to realize reproducible, uniform, and sensitive superhydrophobic SERS substrates over large scales, representing a major barrier for practical sensing applications. To overcome this challenge, a superhydrophobic SERS chip that combines 3D-assembled gold nanoparticles on nanoporous substrates is proposed, for a strong localized field, with superhydrophobic surface treatment for analyte enrichment. Intriguingly, by concentrating droplets in the volume of 40 µL, the sensitivity of 1 nm is demonstrated using 1,2-bis(4-pyridyl)-ethylene molecules. In addition, this unique chip demonstrates a relative standard deviation (RSD) of 2.2% in chip-to-chip reproducibility for detection of fentanyl at 1 µg mL^-1 concentration, revealing its potential for quantitative sensing of chemicals and drugs. Furthermore, the trace analysis of fentanyl and fentanyl-heroin mixture in human saliva is realized after a simple pretreatment process. This superhydrophobic chip paves the way toward on-site and real-time drug sensing to tackle many societal issues like drug abuse and the opioid crisis.

An initial investigation of using smartphone-enabled micro-temporal data collection to increase acceptability, feasibility, and validity of research on cancer caregiving

PURPOSE

Smartphone-enabled micro-temporal data collection has potential to increase reliability, validity, and feasibility of participant-reported data and is a promising strategy for pediatric oncology supportive care and quality-of-life research. Given the demands of pediatric cancer caregiving, we sought to understand the feasibility and acceptability of smartphone data collection that included short surveys administered daily for 14 days via text message link.

METHODS

We recruited pediatric cancer caregivers, whose children (ages 0-18 years) were on active treatment, to complete a 14-day daily survey study via smartphone. We implemented our study procedures and examined feasibility through study enrollment rates, reasons for refusal, retention rates, number of reminders and number of completed surveys. We examined acceptability using caregiver ratings of survey length, burden, and ease of completion on a smartphone.

RESULTS

We recruited (N = 75) caregivers to the study and had an 84% enrollment rate. Reasons for declining participation included passive refusal (n = 13) and too busy (n = 1). The participant retention rate was 100% and compliance with daily survey completion was 99%. Most surveys were completed following two prompts and took participants 5 minutes or less to complete. Caregivers rated the surveys as easy to complete, low burden, and just right in length.

CONCLUSION

A daily self-report, using a brief (≤5 minutes) survey administered on a smartphone via text message prompt, is a feasible and acceptable method. Future research should extend these findings to understand the generalizability across pediatric cancer caregiving contexts.

Barriers to HIV Pre-Exposure Prophylaxis Uptake and Ways to Mitigate Them: Perspectives of Ghanaian Immigrants in the United States

African immigrants in the United States experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) effectively prevents HIV infection, yet uptake is low among racial and ethnic minorities. To better understand PrEP adoption among African immigrants, in March 2020, we conducted interviews with Ghanaian immigrants (N = 40) to explore the barriers and ways to overcome these barriers to PrEP adoption. Participants described several barriers (e.g., low HIV knowledge and risk perception, fear of social judgment, cultural values, and norms), which may impede PrEP adoption. We categorized these barriers according to the levels of the socioecological model (individual, interpersonal, community, and organizational/structural factors). Participants also identified strategies to overcome the barriers, such as providing comprehensive education on HIV and PrEP. Our research provides foundational knowledge that can inform future PrEP research with Ghanaian and other African immigrants and offers important insights into factors that may impact PrEP adoption in this population.

Use of Inhaled Nicotine and Cannabis Products among Adults Who Vape Both Substances

BACKGROUND

Co-occurring use (co-use) of nicotine and cannabis is common, and represents a broad range of use behaviors, including concurrent use, sequential use, and co-administration. Co-use has primarily been examined through the lens of smoked tobacco and cannabis. Little is known about those who co-use vaped nicotine and cannabis, and the degree to which specific co-use behaviors are associated, based on mode of use and/or substance.

METHODS

We conducted an online pilot survey on use behaviors related to inhaled modes of nicotine and cannabis. The survey was administered to 112 concurrent vapers of these substances. Descriptive analyses examined sample characteristics and co-administered vaping and smoking behaviors. Logistic regressions examined associations in use behaviors by mode and substance.

RESULTS

Participants who vaped nicotine and cannabis monthly also reported monthly smoking of cannabis (100%), and cigarettes (58%). Most exhibited moderate-to-high degrees of mental health and substance use problems requiring clinical intervention. Monthly concurrent use exhibited more differences by mode, and more similarities by substance. Specific sequential use practices showed mode-specific associations; with greater frequency of cigarette smoking and nicotine vaping. Co-administration was associated with more frequent tobacco and cannabis smoking.

CONCLUSIONS

Those who regularly vape nicotine and cannabis tend to engage in some form of smoking. Different subsets of nicotine and cannabis co-use behaviors showed different associations with patterns of use and modes of drug delivery. Findings underscore the diversity of nicotine and cannabis use behaviors among co-users, and the importance of considering associations by both substance and mode of use.

Exploring Awareness, Perceptions, and Willingness to Use HIV Pre-Exposure Prophylaxis: A Qualitative Study of Ghanaian Immigrants in the United States

HIV/AIDS disproportionately burdens African immigrants in the United States. Oral pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at high HIV risk, yet uptake is low among racial and ethnic minorities-particularly immigrants. This study explores the awareness, perception, and willingness to use PrEP among Ghanaian immigrants in the United States. WhatsApp, a social media platform, was used to recruit and conduct semi-structured oral interviews with 40 Ghanaian immigrants in March 2020. Interview questions explored awareness of PrEP (whether the participants knew or had knowledge of PrEP before the study), perceptions of PrEP and PrEP users, and willingness to use PrEP. Interviews were audiorecorded, and transcribed. We used NVivo-12 Plus to analyze transcripts for emergent themes. Our sample consisted of Ghanaian adult immigrants (N = 40, 57% male, 71% college educated, age = 32.8 ± 5.7 years, 68% had lived in the United States between 1 and 10 years) residing in 12 US cities. Four major themes emerged: (1) low awareness of PrEP; (2) positive perception of PrEP for HIV prevention; (3) divergent views on PrEP users; and (4) mixed views on willingness to use PrEP. This study presents formative qualitative work, which suggests that Ghanaian immigrants, despite having low awareness of PrEP, may be willing to use PrEP. A key study implication was that stigma reduction interventions might facilitate PrEP scale-up in this population.

Reasons for individual and concurrent use of vaped nicotine and cannabis: their similarities, differences, and association with product use

BACKGROUND

Understanding similarities, differences, and associations between reasons people vape nicotine and cannabis may be important for identifying underlying contributors to their co-use.

METHODS

A cross-sectional survey of 112 co-users of vaped nicotine and cannabis was conducted in 2020. A convenience sample of participants was recruited for the survey using Amazon Mechanical Turk. Participants responded to questions about their reasons for individual nicotine and cannabis product use and co-use and rated their level of agreement using numerical scales. Mean ratings for each reason for use subscale were examined across all participants and compared using paired samples t tests. Associations between reasons for use ratings and product consumption behaviors were examined using linear and logistic regression analyses.

RESULTS

Cannabis vaping and smoking exhibited similar mean ratings for user experience and product/substance-related reasons for use. Mean ratings for reasons related to product utility were similar for cannabis vaping and nicotine vaping. Mean ratings for utility-related reasons for use were higher for cannabis vaping than cannabis smoking (mean (SD), 3.6 (± 1.0) vs. 2.6 (± 1.2), p < 0.0001). On average, harm reduction-related reasons for use were rated higher for nicotine vaping than cannabis vaping (2.4 (± 1.6) vs. 1.8 (± 1.4), p < 0.0001). Regression models showed higher average ratings for utility-related (b = 0.32; 95% CI, 0.03-0.60) and harm reduction-related (b = 0.21; 95% CI, 0.04-0.37) reasons for nicotine vaping were associated with more frequent nicotine vaping (both p < 0.05). Higher average ratings for instrumentality-related reasons for co-use corresponded with more frequent monthly nicotine vaping (b = 0.26; 95% CI, 0.08-0.44) and higher odds of ever chasing cannabis with nicotine (aOR, 3.06; 95% CI, 1.29-7.30).

CONCLUSIONS

Vaping serves purposes that differ by substance; nicotine vaping was more closely related to reducing tobacco smoking-related harms, and cannabis vaping was more closely related to circumventing social problems posed by cannabis smoking. Lifetime sequential co-use practices and more frequent nicotine vaping were associated with enhancing the intoxicating effects of cannabis. While replication of these findings using non convenience-based sampling approaches is warranted, results underscore the need to consider shared and unique aspects of nicotine and cannabis vaping, as well as cross-substance interactions between nicotine and cannabis.

Does state self-control depletion predict relationship functioning and partner aggression? An ecological momentary assessment study of community couples

Intimate relationship functioning depends upon the ability to accommodate one's partner and to inhibit retaliatory and aggressive impulses when disagreements arise. However, accommodation and inhibition may be difficult when self-control strength is weak or depleted by prior exertion of self-control. The present study considered whether state self-control depletion prospectively predicts male and female self-reports of anger with partner and arguing with partner. Consistent with the I³ Model (Finkel, 2014, Adv Exp Soc Psychol, 49, 1-104), we also considered whether the association between elevated anger and arguing (i.e., instigation) and partner aggression was stronger when state self-control (i.e., inhibition) was depleted or among people high in negative urgency. In this ecological momentary assessment (EMA) study, heavy drinking married and cohabiting heterosexual couples (N = 191) responded to three randomly signaled reports each day for 30 days. Depletion predicted anger and arguing with partners both cross-sectionally and prospectively for men and women. However, after controlling for prior levels of anger and arguing, these effects were diminished, and supplemental analyses revealed that anger and arguing with partner predicted subsequent depletion. Anger and arguing were strongly associated with concurrent reports of partner aggression perpetration and victimization (verbal and/or physical). However, neither state self-control depletion nor negative urgency moderated these effects. Overall, results suggest a modest impact of depletion on daily couple functioning as well as a potential cyclical effect of arguing on depletion.

Is deployment status the critical determinant of psychosocial problems among reserve/guard soldiers?

A general assumption that deployment is the primary catalyst for psychological and social difficulties may contribute to underrecognition and undertreatment of problems among never-deployed service members (i.e., having no history of ever being deployed). We aimed to determine if ever-deployed (i.e., having a history of at least one deployment) and never-deployed United States Army Reserve and National Guard (USAR/NG) soldiers differed in mental health, substance use, and resiliency factors, and to determine the relative influence of deployment status and each of these factors on poor psychosocial outcomes. We analyzed a subset of data from Operation: SAFETY (Soldiers and Families Excelling Through the Years) (N = 404), an ongoing study examining the health and well-being of USAR/NG soldiers. Bivariate analyses demonstrated that soldiers did not significantly differ across a range of measures on the basis of deployment status (ps > 0.05). In fact, Factor Analyses and Discriminant Function Analysis revealed that deployment status was the least salient factor to psychosocial problems among the measured variables and that the observed variables could not accurately discriminate between ever-deployed and never-deployed soldiers, F(8, 374) = 1.34, p > .05. Measures of mental health and substance use were more salient to psychosocial problems (ps < .05). Measures of resiliency loaded negatively onto psychosocial problems (ps < .05), indicating that they contribute to better well-being. Targeting screening and intervention efforts only on soldiers who have been deployed will miss opportunities to intervene on an equally affected group. Resiliency factors should be considered as intervention targets. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Knowledge and Practice of Harm Reduction Strategies Among People Who Report Frequent Cannabis Use

We examined knowledge and practice of harm reduction strategies among people who use cannabis attending an annual public cannabis advocacy event. We also assessed the sources from which they glean information about cannabis. Participants (n = 472) completed a brief survey assessing cannabis use, sources for information on cannabis, and harm reduction strategies. Participants' knowledge of cannabis was based mostly on their own experiments and experiences rather than on information from health professionals. Participants generally had low accuracy in identifying effective harm reduction techniques and low rates of utilizing effective harm reduction techniques, using them at the same rate overall as techniques without empirical support. Results from this survey will be useful to public health professionals developing and implementing harm reduction educational strategies related to cannabis use.

A preliminary test of a brief intervention to lessen young adults' cannabis use: Episode-level smartphone data highlights the role of protective behavioral strategies and exercise

Brief interventions are increasingly being used to help young adults to moderate their cannabis use. We conducted a randomized clinical trial of a brief (4 weekly sessions), in-person intervention that included a smartphone application that reinforced the use of protective behavioral strategies (PBSs) to lessen cannabis use. Young adults (N = 37; 24 men) who regularly used cannabis were randomized to 2 intervention conditions rooted in cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET). Along with learning CBT + MET strategies, participants in 1 of the conditions were instructed to engage in exercise. All participants used smartphone-based ecological momentary assessment to provide episode-level reports about use of cannabis and PBSs. Two multilevel structural equation models were run to test the study hypotheses that (a) cannabis use would be reduced over the course of the 6-month study, (b) reductions would be moderated by intervention condition, and (c) episode-level PBS use would predict episode-level cannabis use. Participants reduced their cannabis use by approximately 1 half of a standard joint per time point. The MET + CBT + Exercise condition reduced cannabis use to a greater degree than did the MET + CBT condition. With episode-level PBS use in the model, reductions in cannabis use were independent of intervention condition. Our findings suggest that young adults will engage with a smartphone app that serves as a component of an in-person intervention to moderate their cannabis use. Intervention content that promotes the use of PBSs and exercise facilitates reductions in cannabis use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Modes of delivery in concurrent nicotine and cannabis use ("co-use") among youth: Findings from the International Tobacco Control (ITC) Survey

BACKGROUND

Cannabis use is more common among nicotine users than non-users. This study characterized concurrent use of nicotine and cannabis ("co-use") among 12,064 youth aged 16-19 years residing in Canada, the United States, and England in 2017. Methods: Data were from the ITC Youth Tobacco & Vaping Survey (Wave 1). Seven modes of cannabis delivery (MOD) were characterized by country of residence and past 30-day use of combusted tobacco and electronic cigarettes. Weighted multivariable regression models were fitted to assess the correlates of co-use and each cannabis MOD. Results: Seventy percent of cannabis users reported nicotine use. Co-users exhibited behavioral and demographic differences compared to exclusive users of either substance. "Smoking cannabis without tobacco" was the most popular form of use (78%). Use of nicotine-containing e-cigarettes was associated with "using an e-cigarette to vape cannabis oil/liquid" (aOR: 4.96, 95%CI: 2.23-11.06). Combustible tobacco use was associated with "smoking cannabis with tobacco in a joint/blunt" (aOR: 2.93, 95%CI: 1.89-4.56). Country-level differences were detected. Conclusions: Nicotine use is substantial among cannabis users, and associations exist between modes of delivery for both drugs. Results underscore the importance of studying cannabis and nicotine use concurrently, and the need to address the use of both substances in developing interventions for youth users.

Cannabis Enthusiasts’ Knowledge of Medical Treatment Effectiveness and Increased Risks From Cannabis Use

Purpose:

To compare cannabis enthusiasts’ knowledge about cannabis risks and effectiveness in treating medical conditions with existing empirical evidence.

Design:

A brief survey assessed cannabis use, information sources, and knowledge about risks and effectiveness.

Setting:

A cannabis advocacy event in April 2019 in a state with legal medical and recreational cannabis.

Participants:

Demographically diverse adults (N = 472) who frequently used cannabis; 85% used cannabis for health or medical purposes.

Measures:

Participants reported the sources of their cannabis information, health conditions they thought cannabis was effective in treating (n = 10), and health risks increased by cannabis (n = 6). Conditions and risks were based on ratings of evidence (ie, from substantial to insufficient) for therapeutic effects and risks identified in a review by The National Academies of Sciences, Engineering, and Medicine (NASEM, 2017).

Analyses:

Chi-square tests examined the correspondence between participants’ knowledge and NASEM conclusions.

Results:

Most participants’ (95% confidence interval [CI]: 74%-81%) knowledge of cannabis was from their own experiences; 18% (95% CI: 14%-21%) received information from primary care providers. On average, participants’ beliefs matched NASEM conclusions for half of effectiveness (95% CI: 50%-53%) and risk items (95% CI: 55%-57%). Many (95% CI: 38%-42%) thought that cannabis use did not increase any risk. Contrary to NASEM conclusions, many thought cannabis was effective in treating cancer (76%), depressive symptoms (72%), and epilepsy (68%). Those who received cannabis information from their primary care providers had better knowledge of medical effectiveness. Medicinal cannabis use frequency inversely predicted knowledge of medical effectiveness and increased risks of adverse events.

Conclusion:

There were considerable discrepancies between cannabis users’ knowledge and available evidence, highlighting the need for more research and education (by physicians, caregivers, and dispensaries) on effectiveness and health risks, especially for users with specific health issues such as pregnant women and people with depression.

Does morning affect contribute to daily Cannabis use?

Several theories posit that cannabis and other substances are used to reduce negative affect. This daily report study considered whether variations in positive and negative affect, reported each morning, contributed to the likelihood of cannabis use later that day. We also explored whether levels of positive and negative affect reported immediately after cannabis use improved, relative to that day's morning levels. The sample included 183 men and 183 women representing heterosexual, cannabis-using couples from the community. Participants made independent, daily reports of affect and cannabis use episodes for 30 consecutive days. Using multilevel modeling, we modeled men's and women's use of cannabis on a given day as a function of morning levels of positive, hostile, and anxious affect, accounting for partner cannabis use that day, and mean levels of positive and negative affect. Men and women were more likely to use cannabis on a given day when morning positive affect was lower than typical for the person and when partner used cannabis that day. Neither hostile nor anxious affect contributed to later use of cannabis. Immediately after cannabis use, positive affect increased, and hostile and anxious affect decreased relative to that day's morning levels. The improved affect immediately after use suggests a mechanism of positive reinforcement.

Examining cannabis protective behavioral strategy use using multiple methods

Purpose –

Cannabis use among young adults is increasing, despite being associated with several negative consequences. Protective behavioral strategies (PBSs) are a potential mechanism of behavior change for reducing substance use, yet PBS use for cannabis is not well understood. The purpose of this paper is to further define and measure the PBS construct for cannabis.

Design/methodology/approach –

A community sample of cannabis users (n = 54) participated in eight focus groups discussing the use of PBSs. Participants completed surveys regarding demographics, cannabis use habits and cannabis problems. The authors also administered an existing measure of cannabis PBS and asked them to generate new or unique protective strategies that they had used or had heard of others using.

Findings –

Thematic analysis of qualitative focus group data provided information about cannabis users' reasons for regulating cannabis use (e.g. health or legal problems, interpersonal) as well as strategies to moderate cannabis use or attenuate their risk for experiencing adverse consequences (e.g. distraction, existential/spiritual strategies). Analyses of quantitative survey data revealed that use of PBSs was negatively correlated with cannabis outcomes. Perceived helpfulness of strategies was an important predictor of decreased cannabis use and adverse consequences.

Research limitations/implications –

Findings expand the understanding of the definition and measurement of strategies for regulating cannabis use and reducing related risk of experiencing adverse consequences.

Originality/value –

This is the first study to examine cannabis-related PBS using both qualitative and quantitative methods, which provide insights into the definition of PBS and for future refinements of PBS measurement.

Effects of exercise on experimentally manipulated craving for cannabis: A preliminary study

Cannabis is the most commonly used illicit drug in the United States, and craving for cannabis is related to cannabis use. Exercise has been demonstrated to reduce craving for substances. To examine the effects of exercise on cannabis craving, we conducted a 3-week within-subject crossover experiment. Young-adult men (n = 35) and women (n = 11), age 18-25 years (M = 20.76, SD = 1.68), who regularly (≥3 times per week) used cannabis participated in a cue exposure paradigm to stimulate craving. After each of three separate craving inductions, they completed a 10-min bout of exercise that varied in intensity (rest, moderate, vigorous). Craving was assessed before and after the induction, immediately following the exercise, and at three 10-min intervals (total of 30 min). Results of condition-specific, repeated measures analyses of variance showed nonsignificant reductions in immediate postexercise craving for the moderate and vigorous conditions. We used latent growth modeling to examine the trajectory of craving rebound during the 30 min following exercise and explored the effect of baseline weekly cannabis use in predicting craving rebound. Within 30 min postexercise, craving rebounded for both the moderate, F(3, 135) = 9.10, p < .01, and vigorous, F(3, 135) = 3.48, p < .05, conditions. We found that among cannabis users reporting larger quantities of typical weekly cannabis use, craving rebounded more quickly following vigorous than moderate exercise, b = 0.02, SE = 0.02, 95% confidence interval [0.00, 0.06]. The findings suggest that moderate exercise may be useful for reducing craving, particularly among those who use larger quantities of cannabis. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Does Marijuana Contribute to Intimate Partner Aggression? Temporal Effects in a Community Sample of Marijuana-Using Couples

OBJECTIVE

Although patterns of marijuana use are positively associated with intimate partner aggression, there is little evidence that episodes of marijuana use contribute to the occurrence of episodes of relationship conflict and aggression. The present ecological momentary assessment study considered the temporal relationship between marijuana use episodes and the occurrence of conflict, verbal aggression, and physical aggression between intimate partners in the next 2 hours.

METHOD

A sample of 183 cohabiting marijuana-using couples (ages 18-30) were recruited from the community. For 30 consecutive days, each partner independently reported episodes of marijuana use and partner conflict, including verbal and physical aggression perpetration and victimization within conflicts. Temporal associations between each partner's marijuana use and subsequent conflict and aggression were examined using the Actor-Partner Interdependence Model. Analyses accounted for between-person effects of marijuana use frequency and total conflicts.

RESULTS

We observed temporal effects of actor (but not partner) marijuana use on men's and women's reports of conflict and verbal aggression perpetration and victimization within 2 hours of use. Marijuana use episodes did not alter the likelihood of physical aggression in the next 2 hours. Partner concordance in marijuana use had no effect on verbal or physical aggression or victimization. The positive temporal effects of marijuana on conflict and verbal aggression remained significant after accounting for the effect of drinking episodes.

CONCLUSIONS

Within generally concordant, marijuana-using young couples, marijuana use episodes contribute to the occurrence of relationship conflict and verbal aggression.

Perceived Risks and Benefits in a Text Message Study of Substance Abuse and Sexual Behavior

To inform ethical procedures for human subjects research using mobile health (mHealth), we examined perceived risks and benefits of study participation among emerging adults (N=54) with drug use who completed text message assessments of substance use and sexual behaviors. Most participants reported comfort with participation and some reported perceived benefits, such as improved relationships. Perceived risks were infrequently reported, including negative emotions, and legal or financial concerns. In conclusion, participants from a vulnerable population reported few perceived harms of participation in longitudinal mHealth assessments of sensitive behaviors. Researchers should continue characterizing participants' perspectives on ethical aspects of mHealth research.

Descriptive Epidemiology for Community-wide Naloxone Administration by Police Officers and Firefighters Responding to Opioid Overdose

Recently implemented New York State policy allows police and fire to administer intranasal naloxone when responding to opioid overdoses. This work describes the geographic distribution of naloxone administration (NlxnA) by police and fire when responding to opioid overdoses in Erie County, NY, an area of approximately 920,000 people including the City of Buffalo. Data are from opioid overdose reports (N = 800) filed with the Erie County Department of Health (July 2014-June 2016) by police/fire and include the overdose ZIP code, reported drug(s) used, and NlxnA. ZIP code data were geocoded and mapped to examine spatial patterns of NlxnA. The highest NlxnA rates (range: 0.01-84.3 per 10,000 population) were concentrated within the city and first-ring suburbs. Within 3 min 27.3% responded to NlxnA and 81.6% survived the overdose. The average individual was male (70.3%) and 31.4 years old (SD = 10.3). Further work is needed to better understand NlxnA and overdose, including exploring how the neighborhood environment creates a context for drug use, and how this context influences naloxone use and overdose experiences.

Prevalence and motives for drugged driving among emerging adults presenting to an emergency department

OBJECTIVES

Drugged driving [DD] is a public health concern, particularly among emerging adults who have the highest rates of drug use. Understanding involvement with DD could inform prevention efforts for this population. We evaluated the prevalence of, motives for, and correlates of past-year DD among emerging adults from an urban, under-resourced community.

METHODS

Emerging adults (N=586) ages 18-25years (54% male, 56% African American, 34% European American) seeking care in an urban emergency department completed past-year surveys of demographics, frequency of DD within 4h of substance use, reasons for DD, and substance use.

RESULTS

DD was reported by 24% of participants (with 25% of those engaging in high frequency DD). DD after cannabis use was most common (96%), followed by prescription opioids, sedatives, and stimulants (9%-19%). Common reasons for DD were: needing to go home (67%), not thinking drugs affected driving ability (44%), not having to drive far (33%), and not feeling high (32%). Demographics were not associated with DD, but, as expected, those with DD had riskier substance use.

CONCLUSIONS

In this clinical sample, using a conservative measure, DD, particularly following cannabis use, was relatively common among emerging adults. Based on these data, clinical interventions for cannabis and other drug use should include content on prevention of DD, with particular attention to motives such as planning ahead for alternatives to get home safely and weighing benefits and risks of DD.

The Indirect Effects of Self-Efficacy on Cannabis Use via Cannabis Protective Strategies: A Preliminary Study

Cannabis use has more than doubled in the past decade and nearly three of 10 users develop a cannabis use disorder. The increase in users, combined with the ongoing changes in the medical, legal and social status of cannabis, has contributed to interest in the antecedents of cannabis use. In the current preliminary study, we gathered information from a community sample (N = 54) of regular cannabis using young adults. Assessments included perceived self-efficacy for reducing intake or abstaining (SE-R/A), use of cannabis protective strategies (CPS), and average quantity of cannabis use per day. We systematically explored which specific CPS were most strongly associated with self-efficacy and cannabis use. Three clinically relevant subgroups of CPS emerged from this analysis: strategies strongly associated with only self-efficacy, only cannabis use, and both variables. We hypothesized that self-efficacy would be associated with less cannabis use via use of CPS. Among specific CPS examined, "Use a little and then wait to see how you feel before using more" had the strongest association with self-efficacy while "Avoid methods of using cannabis that can make you more intoxicated than you would like" had the strongest negative association with cannabis use. We observed a significant indirect relationship from self-efficacy to cannabis use through use of CPS. Our findings suggest that use of CPS is a potential mechanism by which cannabis users reduce use, and a more proximal antecedent of cannabis use than personal confidence in one's ability to stop using. These preliminary findings highlight the value of studying individual strategies. They also may have implications for promoting use of cannabis protective strategies when treating those with cannabis use problems.

Daily associations between cannabis motives and consumption in emerging adults

BACKGROUND

Increasing rates of cannabis use among emerging adults is a growing public health problem. Intensive longitudinal data can provide information on proximal motives for cannabis use, which can inform interventions to reduce use among emerging adults.

METHOD

As part of a larger longitudinal study, patients aged 18-25 years (N=95) recruited from an urban Emergency Department completed daily text message assessments of risk behaviors for 28days, including daily cannabis quantity and motives. Using a mixed effects linear regression model, we examined the relationships between daily quantity of cannabis consumed and motives (i.e., enhancement, social, conformity, coping, and expansion).

RESULTS

Participants were, on average, 22.0 years old (SD=2.2); 48.4% were male, 45.3% were African American, and 56.8% received public assistance. Results from the multi-level analysis (clustering day within individual), controlling for gender, race, and receipt of public assistance, indicated daily use of cannabis use for enhancement (β=0.27), coping (β=0.15), and/or social motives (β=0.34) was significantly associated with higher quantities of daily cannabis use; whereas expansion and conformity motives were not.

CONCLUSIONS

Daily data show that emerging adults who use cannabis for enhancement, social, and coping motives reported using greater quantities of cannabis. Future research should examine more comprehensive cannabis motives (e.g., boredom, social anxiety, sleep) and test tailored interventions focusing on alternative cognitive/behavioral strategies to address cannabis motives.

Time spent online: Latent profile analyses of emerging adults' social media use

Studies of youth social media use (SMU) often focus on its frequency, measuring how much time they spend online. While informative, this perspective is only one way of viewing SMU. Consistent with uses and gratification theory, another is to consider how youth spend their time online (i.e., degree of engagement). We conducted latent profile analyses of survey data from 249 U.S. emerging adults (ages 18-26) to explore their SMU in terms of frequency and engagement. We derived separate 3-profile solutions for both frequency and engagement. High frequency social media users tended to be women and to have more Facebook friends. Highly engaged users (i.e., those most interactive online) tended to be White and more highly educated. Findings from this exploratory study indicate that youth SMU frequency and SMU engagement warrant separate consideration. As SMU becomes more ingrained into the fabric of daily life, it is conceivable that engagement may be a more meaningful way to assess youth SMU, especially in relation to the digital divide, since it can be used to meet important needs, including social interaction, information exchange, and self-expression.

Feasibility and Acceptability of Text Messaging to Assess Daily Substance Use and Sexual Behaviors among Urban Emerging Adults

BACKGROUND

Daily process research can help distinguish causal relationships between substance use and sexual risk behaviors in high-risk groups, such as urban emerging adults. We employed text messaging to assess 18-25 year-olds' daily substance use and sexual risk behaviors over 28 days. We describe the implementation of this method, attitudes regarding the daily surveys, and correlates of survey completion.

METHOD

We recruited 111 emerging adults from an urban Emergency Department in a resource-limited area who reported recent drug use and unprotected sex (M_age=22.0; 53.2% female; 45.1% African American; 43.2% receiving public assistance).

RESULTS

Respondents completed M=18.0 (SD = 8.7) of 28 daily surveys (27 items each). Participants completing a 1-month follow-up found the surveys not at all/only a little annoying (90.3%) and were comfortable with questions about drugs/alcohol (97.9%) and sex (94.6%). Completion was higher on weekdays versus weekends, and earlier in the study. Daily survey completion was unrelated to same-day substance use measured by the Timeline Follow Back at follow-up; polysubstance use and drinks consumed were associated with lower odds of next-day completion. School enrollment, public assistance, unlimited texting plan, lower baseline alcohol use, and depression symptoms at follow-up were associated with higher completion. Technology difficulties were commonly mentioned barriers to completion.

CONCLUSIONS

Participants in this urban, resource-constrained sample found the daily text message methodology acceptable for reporting sensitive information. With rapid advancements in technologies and increased accessibility, text messaging remains a promising methodology for the study of daily processes in substance use and HIV risk behaviors. Keywords: text messaging; assessment; emerging adults; substance use; risky sex; mobile technology.

The effects of perceived quality on behavioral economic demand for marijuana: A web-based experiment

BACKGROUND

Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including "demand" for marijuana, varied as a function of its perceived quality.

METHODS

Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20.

RESULTS

We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., P_max, elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use.

CONCLUSIONS

This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products.

Fruit and vegetable intake as a moderator of the association between depressive symptoms and cigarette smoking

BACKGROUND

Studies have consistently reported associations among depression, cigarette smoking, and fruit and vegetable intake (FVI). This study evaluated FVI as a moderator of the association between depressive symptoms and smoking.

METHODS

The authors analyzed data from the National Longitudinal Survey of Youth 1979: Child and Young Adult. The study sample was adults aged 19-33 years at baseline in the year 2004 from the Young Adult Survey portion. Moderation analyses were performed using the Johnson-Neyman technique to assess whether baseline FVI moderated the association between depressive symptoms and smoking status cross-sectionally and as a predictor of smoking cessation longitudinally at 4-year follow-up.

RESULTS

Cross-sectionally, at lower levels of FVI (<4.9 times/day), there was a significant association between smoking and depressive symptoms (P < .05), but not at higher levels of FVI (≥4.9 times/day; P > .05). Longitudinally, there was an inverse association between depressive symptoms and quitting smoking at FVI <1.2 times/day (P < .05), but there was not a significant association at FVI ≥1.2 times/day (P ≥ .05).

CONCLUSIONS

FVI moderated the association between depressive symptoms and cigarette smoking cross-sectionally and longitudinally. The cross-sectional findings might be partially explained by the longitudinal findings paired with prior research; there might be fewer smokers with high FVI because depressive symptoms are removed as an impediment to cessation. Further experimental research is warranted to test the efficacy of increased FVI as an adjunct to smoking cessation, with a possible mechanism of action being reduced depressive symptoms during quit attempts.

Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study

Background

The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives.

Objective

Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions.

Methods

We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m². Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention.

Results

All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight.

Conclusions

We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions.

Individual Differences in Approach and Avoidance Inclinations Moderate the Effect of Self-Control Depletion on Ad-Lib Drinking

BACKGROUND

This study sought to examine how exerting self-control to inhibit stereotype use affects alcohol consumption. In addition, we sought to expand previous findings via examination of how individual differences in motivations to approach or avoid alcohol consumption interact with self-control depletion to determine the regulation of ad-lib drinking behavior.

METHODS

Sixty-one social drinkers (31 female) were recruited to participate in a socially relevant self-control depletion task in which they were randomly assigned to 1 of 2 creative writing conditions: (i) the self-control depletion condition with explicit instructions to refrain from using stereotypes, or (ii) the nondepletion condition in which no instructions were given regarding the use of stereotypes. Participants then completed an ad-lib drinking task and self-report questionnaires pertaining to their motivation to consume alcohol.

RESULTS

As predicted, results indicated a significant 3-way interaction between depletion condition, approach inclinations, and avoidance inclinations. Specifically, self-control depletion predicted greater drinking disinhibition (i.e., mean sip size, total alcohol consumption) only among participants high in both approach and avoidance.

CONCLUSIONS

Taken together, results from this study highlight the importance of both approach and avoidance inclinations in the failure to regulate alcohol consumption following a routine, socially relevant form of self-control depletion. Our results also suggest that the high approach/high avoidance motivational profile may predict the greatest risk among those actively trying to regulate their drinking.

Increasing condom use by changing people's feelings about them: An experimental study

OBJECTIVE

Given the well-documented efficacy of condoms as a means of preventing pregnancy and sexually transmitted infection transmission, the low rates of condom use among young adults necessitates a deeper understanding of the factors that influence condom use decision making. The central purpose of the current study was to examine how experimentally manipulated affective associations with condoms influence subsequent behavior in a condom selection task, thereby providing support for a causal relation of affective associations to behavior in this health domain.

METHOD

Following a baseline assessment of cognitively based beliefs and affective associations, participants' (N = 171) affective associations with condoms were experimentally manipulated with an evaluative conditioning (EC) procedure. Images of condoms were paired repeatedly with positive or neutral affective stimuli. The key outcome measure was a behavioral choice task in which participants selected condoms upon completion of the experiment.

RESULTS

Participants in the positive condition reported more positive affective associations post-EC compared with those in the neutral condition, β = 0.33, p = .025, 95% CI (0.041, 0.63). For participants who regularly used condoms at baseline, those in the positive condition also selected significantly more condoms, RR = 1.39, p = .015, 95% CI (1.07, 1.83). This condition effect on behavior was partially mediated by the change in affective associations. There was no effect of condition on condom selection among participants who rarely used condoms at baseline.

CONCLUSION

The current study extends our theoretical understanding of the affect-behavior relation in the realm of condom use, and provides preliminary support for interventions that target affective associations with condoms.

Couples' marijuana use is inversely related to their intimate partner violence over the first 9 years of marriage

Research on the association between marijuana use and intimate partner violence (IPV) has generated inconsistent findings, and has been primarily based on cross-sectional data. We examined whether husbands' and wives' marijuana use predicted both husbands' and wives' IPV perpetration over the first 9 years of marriage (Wave 1, n = 634 couples). We also examined moderation by antisocial behavior, the spouse's marijuana use, and whether IPV was reported during the year before marriage. These predictive associations were calculated using a time-lagged multivariate generalized multilevel model, simultaneously estimating predictors of husband and wife IPV. In fully adjusted models, we found that more frequent marijuana use by husbands and wives predicted less frequent IPV perpetration by husbands. Husbands' marijuana use also predicted less frequent IPV perpetration by wives. Moderation analyses demonstrated that couples in which both spouses used marijuana frequently reported the least frequent IPV perpetration. There was a significant positive association between wives' marijuana use and wives' IPV perpetration, but only among wives who had already reported IPV perpetration during the year before marriage. These findings suggest there may be an overall inverse association between marijuana use and IPV perpetration in newly married couples, although use may be associated with greater risk of perpetration among women with a history of IPV perpetration.

A behavioral economic approach to assessing demand for marijuana

In the United States, marijuana is the most commonly used illicit drug. Its prevalence is growing, particularly among young adults. Behavioral economic indices of the relative reinforcing efficacy (RRE) of substances have been used to examine the appeal of licit (e.g., alcohol) and illicit (e.g., heroin) drugs. The present study is the first to use an experimental, simulated purchasing task to examine the RRE of marijuana. Young-adult (M age = 21.64 years) recreational marijuana users (N = 59) completed a computerized marijuana purchasing task designed to generate demand curves and the related RRE indices (e.g., intensity of demand-purchases at lowest price; Omax-max. spent on marijuana; Pmax-price at which marijuana expenditure is max). Participants "purchased" high-grade marijuana across 16 escalating prices that ranged from $0/free to $160/joint. They also provided 2 weeks of real-time, ecological momentary assessment reports on their marijuana use. The purchasing task generated multiple RRE indices. Consistent with research on other substances, the demand for marijuana was inelastic at lower prices but became elastic at higher prices, suggesting that increases in the price of marijuana could lessen its use. In regression analyses, the intensity of demand, Omax, and Pmax, and elasticity each accounted for significant variance in real-time marijuana use. These results provide support for the validity of a simulated marijuana purchasing task to examine marijuana's reinforcing efficacy. This study highlights the value of applying a behavioral economic framework to young-adult marijuana use and has implications for prevention, treatment, and policies to regulate marijuana use.

Analytical Problems and Suggestions in the Analysis of Behavioral Economic Demand Curves

Behavioral economic demand curves (Hursh, Raslear, Shurtleff, Bauman, & Simmons, 1988) are innovative approaches to characterize the relationships between consumption of a substance and its price. In this article, we investigate common analytical issues in the use of behavioral economic demand curves, which can cause inconsistent interpretations of demand curves, and then we provide methodological suggestions to address those analytical issues. We first demonstrate that log transformation with different added values for handling zeros changes model parameter estimates dramatically. Second, demand curves are often analyzed using an overparameterized model that results in an inefficient use of the available data and a lack of assessment of the variability among individuals. To address these issues, we apply a nonlinear mixed effects model based on multivariate error structures that has not been used previously to analyze behavioral economic demand curves in the literature. We also propose analytical formulas for the relevant standard errors of derived values such as P max, O max, and elasticity. The proposed model stabilizes the derived values regardless of using different added increments and provides substantially smaller standard errors. We illustrate the data analysis procedure using data from a relative reinforcement efficacy study of simulated marijuana purchasing.

Sexual assault risks among gay and bisexual men

The goal of this study was to examine lifetime patterns of sexual assault and associated risks among a purposive sample of gay and bisexual men (N = 183; 18 to 35 years old, M = 24.3). Cross-sectional data were collected via written, self-administered questionnaires and face-to-face, event-based qualitative interviews. Alcohol severity scores indicated high rates of hazardous drinking (53.0%) and possible dependence (14.2%) among participants. One-half of men (50.8%) reported childhood sexual abuse (CSA), and 67.2% reported adult sexual assault (ASA). Average age at most recent ASA was 21 years. Most perpetrators (83.9%) of recent ASA incidents were male; 67.0% of participants reported consuming alcohol and/or drugs prior to the most recent incident. Regression findings indicated more severe CSA experiences and past alcohol-related problems predicted recent severe ASA. Although we found similarities between gay and bisexual men in lifetime sexual assault history, we found some distinct differences in ASA risk factors. Bisexual men reported higher alcohol severity scores, more female ASA perpetrators, higher internalized homophobia scores, and fewer male sexual partners than gay men. Findings suggest the need for interventions that reduce ASA risk among sexual minority men-and the potential benefits of focusing on alcohol consumption in risk reduction efforts.

Marijuana withdrawal and aggression among a representative sample of U.S. marijuana users

BACKGROUND

Previous laboratory-based research suggests that withdrawal from marijuana may cause increased aggression. It is unclear whether this finding extends beyond the laboratory setting to the general population of marijuana users. The purpose of this study was to test a cross-sectional association between marijuana withdrawal symptoms and aggression among a representative sample of U.S. adult marijuana users, and to test whether this association was moderated by previous history of aggression.

METHODS

Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions. Wave Two data (2004-2005) were used for all variables except for history of aggression, which was assessed during the Wave One interview (2001-2002). Two outcomes were examined: self-report general aggression and relationship aggression. Odds ratios for aggression based on withdrawal symptoms and the interaction between withdrawal symptoms and history of aggression were calculated using logistic regression, adjusting for covariates and accounting for the complex survey design.

RESULTS

Among marijuana users with a history of aggression, marijuana withdrawal was associated with approximately 60% higher odds of past year relationship aggression (p<0.05). There was no association between withdrawal symptoms and relationship aggression among those without a history of aggression, and no association with general aggression regardless of history of aggression.

CONCLUSIONS

The findings from this study support the notion that laboratory-based increases in aggression due to marijuana withdrawal extend to the general population of marijuana users who have a previous history of aggression.

Women bar drinkers' discussions about birth control and risky sexual behavior

This study evaluated how birth control discussions prior to sexual activity affected condom use in a sample of 225 young women bar drinkers. The use of alcohol and other drugs (AOD) and partner type also were assessed. Data were collected through daily reports and qualitative interviews over 12 weeks. A total of 1671 sexual events were reported (M = 7.4 events per participant), of which 64.7% (n = 1081) did not involve condom use. Discussions of birth control occurred prior to 10.9% (n = 183) of all sexual events. These discussions were more likely to be initiated by the woman and to occur when AOD had been used. Thematic analysis revealed four common themes: confirmation of the need to use condoms, confirmation of oral/hormonal contraceptive use, use of sufficient birth control, and discrepant condom use. The discussions reduced rates of risky sex when the sexual partner was more intimate (i.e., boyfriend/dating partner), regardless of AOD use and when the sexual partner was a friend or ex-partner and no AOD were used. The thematic analysis suggested that pregnancy prevention was a stronger motivation for discussing condom use, rather than risk of contracting an STI. Given the substantial rate of high risk partners, history of STIs, and limited amount of time women reported knowing "regular" partners, we suggest that interventions designed to reduce risky sex should be tailored to increase women's awareness of STI and pregnancy risk when under the influence of AOD, and promote condom use regardless of partner type.

The influence of marijuana and alcohol use on condom use behavior: findings from a sample of young adult female bar drinkers

Prevalence data indicate that alcohol and marijuana are frequently used intoxicants among young adults in the United States. In a number of studies, both alcohol use and marijuana use have been associated with failure to use condoms, a high-risk sexual behavior. The purpose of the current study was to assess the individual and additive effects of alcohol and marijuana use on this risky sexual behavior among 251 young adult, female bar drinkers. Multilevel modeling was used to assess the likelihood of condom use during sexual events that occurred as a function of substance use (none, only alcohol, only marijuana, or both) prior to and partner type (known or casual) during the event, as well as individual differences in sexual assertiveness. Initial model testing (Levels 1 and 2) revealed that there were significant main effects for partner type (known), substance use (alcohol and marijuana) and sexual assertiveness (refusal, pregnancy/STI prevention) on risky sex. Final model testing indicated that sexual assertiveness interacted with substance use to influence risky sex. Women who were low in sexual assertiveness refusal were more likely to engage in risky sex on days when they had consumed both alcohol and marijuana prior to the sexual activity. These findings highlight the complex nature of the relationship between substance use and risky sex.

A beverage-specific measure of expectancies for malt liquor: development and initial testing

Malt liquor (ML) is a unique, high alcohol content beverage marketed to encourage heavy drinking. We developed the Malt Liquor Expectancy Questionnaire (MLEQ), a beverage-specific measure of alcohol expectancies, and examined its association with typical weekly ML use, typical weekly alcohol use, and alcohol problems. Forty positive and 40 negative expectancy items were administered to a sample of 639 young adults who regularly consumed ML. Exploratory and confirmatory factor analyses led to the development of the 30-item MLEQ. The MLEQ consists of two positive (i.e., Social Facilitation and Enjoyment, Enhanced Sexuality) and two negative factors (i.e., Aggression and Negative Consequences; Impairment and Physical Symptoms) that possess good internal consistency, test-retest reliability, and convergent validity. The psychometrically sound MLEQ contributes to the limited research on beverage-specific expectancies and heavy drinking.

Social networks and alcohol use among nonstudent emerging adults: a preliminary study

We examined the social networks and alcohol use of a community-based sample of nonstudent emerging adults (N=59). The research examined (1) personal network characteristics and the drinking habits of its members, (2) the link between network alcohol use and personal alcohol involvement, (3) perceived social norms as they related to network alcohol use, and (4) relationship between perceived social norms and personal alcohol involvement. Men and women (M age=27 years) were equally represented in the social network. Level of educational attainment of members was diverse. On average, respondents were in contact on a daily basis with network members and about 38% of the network was known between 1 and 5 years. The majority (57%) of the network consisted of household or family members. There were some associations between network drinking and personal alcohol involvement. The proportion of "drinking buddies" in one's network was directly associated with perceived drinking norms. Perceived drinking norms also were positively associated with personal alcohol use, alcohol-related problems, and approval of drinking behaviors. Findings from this study have implications for understanding social factors in the drinking behavior of nonstudent emerging adults and could inform the development of effective prevention and treatment interventions for this important, but understudied group of drinkers.

Emotion Differentiation as Resilience Against Excessive Alcohol Use

Some people are adept at using discrete emotion categories ( anxious, angry, sad) to capture their felt experience; other people merely communicate how good or bad they feel. We theorized that people who are better at describing their emotions might be less likely to self-medicate with alcohol. During a 3-week period, 106 underage social drinkers used handheld computers to self-monitor alcohol intake. From participants’ reported experiences during random prompts, we created an individual difference measure of emotion differentiation. Results from a 30-day timeline follow-back revealed that people with intense negative emotions consumed less alcohol if they were better at describing emotions and less reliant on global descriptions. Results from ecological momentary assessment procedures revealed that people with intense negative emotions prior to drinking episodes consumed less alcohol if they were better at describing emotions. These findings provide support for a novel methodology and dimension for understanding the influence of emotions on substance-use patterns.

Solitary and social heavy drinking, suicidal ideation, and drinking motives in underage college drinkers

In college students, solitary heavy drinking (i.e., while alone) is associated with depression and with higher rates of drinking problems than heavy drinking in social contexts. This study explored the relationship among heavy episodic drinking context, suicidal ideation, and drinking motives among underage college drinkers (n=91) with a history of passive suicidal ideation. Participants completed measures of depression, suicidal ideation, alcohol consumption and problems, and drinking motives. Multiple regression analyses revealed that suicidal ideation, but not depression, was significantly related to solitary heavy drinking. Neither was related to social heavy drinking. Enhancement motives for drinking, but not other drinking motives (i.e., social, conformity, drinking to cope), were significantly associated with social heavy drinking. In contrast, only drinking to cope was associated with solitary heavy drinking. These findings suggest that greater suicidal ideation is associated with greater frequency of becoming intoxicated while alone, and that this drinking is motivated by attempts to cope. Solitary heavy drinking is a potentially dangerous coping strategy for an individual experiencing suicidal ideation.

Drinking to cope as a statistical mediator in the relationship between suicidal ideation and alcohol outcomes among underage college drinkers

Etiological models of alcohol use that highlight the role of negative affect and depression have not been applied to the association of suicidality and alcohol use. The authors examined whether a motivational model of alcohol use could be applied to understand the relationship between suicidal ideation and alcohol outcomes in a sample of underage college drinkers who had a history of passive suicidal ideation (n = 91). In this cross-sectional study, regression analyses were conducted to examine whether drinking to cope with negative affect statistically mediated or was an intervening variable in the association between suicidal ideation and alcohol outcomes. Results revealed that drinking to cope was a significant intervening variable in the relationships between suicidal ideation and alcohol consumption, heavy episodic drinking, and alcohol problems, even while controlling for depression. These results suggest that the relationship between suicidal ideation and alcohol outcomes may be due to individuals using alcohol to regulate or escape the distress associated with suicidal ideation. Consideration of alcohol-related models can improve the conceptualization of research on suicidality and alcohol use.