Cannabis Use Among Female Community College Students Who Use Alcohol in a State With and a State Without Nonmedical Cannabis Legalization in the US.

INTRODUCTION: Female community college students who use alcohol may be an at-risk group for cannabis use, especially in US states with nonmedical cannabis legalization. This study examined cannabis use among this population. We tested differences in current cannabis use across a state with versus a state without (Washington vs Wisconsin, respectively) nonmedical cannabis legalization. METHODS: This cross-sectional study included female students aged 18-29 who were current alcohol users attending a community college. An online survey assessed lifetime and current cannabis use (last 60 days) via the Customary Drinking and Drug Use Record. Logistic regression tested whether community college state and demographic characteristics were associated with current cannabis use. RESULTS: Among 148 participants, 75.0% (n = 111) reported lifetime cannabis use. The majority of participants from Washington (81.1%, n = 77) and Wisconsin (64.2%, n = 34) reported ever trying cannabis. Almost half of participants (45.3%, n = 67) indicated current cannabis use. Among Washington participants, 57.9% (n = 55) reported current use compared to 22.6% (n = 12) of Wisconsin participants. Washington school attendance was positively associated with current cannabis use (OR = 5.97; 95% CI, 2.50-14.28, P < 0.001), after controlling for age, race, ethnicity, grade point average, and income. CONCLUSIONS: High cannabis use in this sample of female drinkers - particularly in a state with nonmedical cannabis legalization - underscores the need for prevention and intervention efforts targeted to community college students.

Strategies to reduce COVID-19 vaccine hesitancy among pregnant individuals: Data from a prospective survey of unvaccinated pregnant women.

OBJECTIVE: To explore strategies that could reduce coronavirus disease 2019 (COVID-19) vaccine hesitancy in pregnancy. METHODS: In 2021, the authors conducted a survey of pregnant women assessing attitudes and beliefs regarding COVID-19 vaccination. The present analysis reviewed trusted sources of information about COVID-19 vaccination that could reduce vaccine hesitancy among pregnant respondents. RESULTS: A total of 295 surveys were analyzed. Using 10-point Likert scales, intentions to accept COVID-19 vaccine were split between individuals with low (n = 126, 43%) and high (n = 141, 48%) intentions to receive the vaccine, with only a small percentage of women having midrange vaccination intentions (n = 28, 10%). When asked what would reduce their COVID-19 vaccine concerns, published data was the leading answer in both low (46.2%) and medium (35.7%) intention groups followed by personally knowing someone who got vaccinated during pregnancy (21.0% and 28.6% for low and medium groups, respectively). In contrast, an obstetrician's recommendation was the most common answer in the group with high intention to vaccinate (37.2%). Knowing someone who received the vaccine in pregnancy was the leading response for reducing concerns of COVID-19 vaccination among Black respondents. CONCLUSION: The survey identified several innovative and culturally specific approaches to address vaccine confidence and complacency and improve vaccine uptake in pregnant people.

Digital Technology and Media Use by Adolescents: Latent Class Analysis.

BACKGROUND: Digital technology and media use is integral to adolescents' lives and has been associated with both positive and negative health consequences. Previous studies have largely focused on understanding technology behaviors and outcomes within adolescent populations, which can promote assumptions about adolescent technology use as homogeneous. Furthermore, many studies on adolescent technology use have focused on risks and negative outcomes. To better understand adolescent digital technology use, we need new approaches that can assess distinct profiles within study populations and take a balanced approach to understanding the risks and benefits of digital technology use. OBJECTIVE: The purpose of this study was to identify profiles of adolescent technology use within a large study population focusing on four evidence-based constructs: technology ownership and use, parental involvement, health outcomes, and well-being indicators. METHODS: Adolescent-parent dyads were recruited for a cross-sectional web-based survey using the Qualtrics (Qualtrics International, Inc) platform and panels. Technology use measures included ownership of devices, social media use frequency, and the Adolescents' Digital Technology Interactions and Importance scale. Parent involvement measures included household media rules, technology-related parenting practices, parent social media use frequency, and the parent-child relationship. Health outcome measures included physical activity, sleep, problematic internet use, and mental health assessments. Well-being indicators included mental wellness, communication, and empathy. We used latent class analysis (LCA) to identify distinct profile groups across the aforementioned 4 critical constructs. RESULTS: Among the 3981 adolescent-parent dyads recruited, adolescent participants had a mean age of 15.0 (SD 1.43) years; a total of 46.3% (1842/3981) were female, 67.8% (2701/3981) were White, and 75% (2986/3981) lived in a household with an income above the poverty line. The LCA identified 2 discrete classes. Class 1 was made up of 62.8% (2501/3981) of the participants. Class 1 participants were more likely than Class 2 participants to report family-owned devices, have lower technology importance scores, have household technology rules often centered on content, have positive parent relationships and lower parent social media use, and report better health outcomes and well-being indicators. CONCLUSIONS: Findings from this national cross-sectional survey using LCA led to 2 distinct profile groups of adolescent media use and their association with technology use and parent involvement as well as health and well-being outcomes. The two classes included a larger Class 1 (Family-Engaged Adolescents) and a smaller Class 2 (At-Risk Adolescents). The findings of this study can inform interventions to reinforce positive technology use and family support.

Adolescent Digital Technology Interactions and Importance: Associations with Depression and Well-Being.

Adolescents' digital technology use is nearly ubiquitous and has been associated with health benefits and risks, including risks of depression. The Adolescents' Digital Technology Interactions and Importance (ADTI) scale provides a novel approach to measuring how adolescents prioritize their technology use. The purpose of this study was to investigate the relationship between adolescents' technology interactions and mental health measures, including depression and mental well-being. This cross-sectional online survey study recruited adolescents aged 12-18 years using Qualtrics panels. Survey measures included the ADTI and assessments of depression and well-being. Analyses included the Kruskal-Wallis test and multivariate logistic regression analyses. The 4,592 participants had a mean age of 15.6 years (SD = 1.68), 46.4 percent were female, 66.9 percent were Caucasian, and 74.5 percent lived in a household with an income above the poverty line. The median ADTI total score was 48 (range 18-90), 23.0 percent (n = 1,055) of participants were categorized for at risk for depression and 54.8 percent (n = 2,477) of participants were categorized as high mental well-being. Participants with higher ADTI total scores were more likely to be at risk for depression (odds ratio [OR] = 1.059, 95 percent confidence interval [CI]: 1.054-1.064). Furthermore, participants with a higher ADTI total score were more likely to have a higher mental well-being (OR = 1.015, 95 percent CI: 1.012-1.019). We found that ADTI total scores were significantly higher both among adolescents who screened positive for depression and among adolescents with higher mental well-being. This intriguing finding suggests that it is possible that digital technology use intensifies either the positive or the negative mental states that adolescents bring to their online environment.

A Content Analysis of Cannabis Company Adherence to Marketing Requirements in Four States.

OBJECTIVE: Marketing messages can influence adolescents' attitudes and behaviors toward alcohol and tobacco. In the era of legalized cannabis use, retail cannabis companies often use social media marketing on platforms popular among youth. The purpose of this study was to evaluate adherence to state-based regulations for restricted and required content across social media from recreational cannabis businesses. METHOD: A retrospective content analysis was used to evaluate one year of publicly displayed posts by retail cannabis companies on Facebook and Instagram from four states in which recreational cannabis use is legal (Alaska, Colorado, Oregon, and Washington State). We evaluated restricted content including the following: (a) business practices, such as avoiding discounts/promotions or promoting branded products; (b) modeling cannabis use or overconsumption; (c) youth-focused messaging; and (d) health benefits. We evaluated required content including three types of warnings: (a) limiting cannabis use to those age 21 and over, (b) avoiding impaired driving, and (c) describing health risks. RESULTS: A total of 2,660 posts were evaluated from 14 businesses. In the area of restricted content, discounts/promotions were present in approximately 35% of all posts. Another common category was overconsumption, found in 12% of posts. Required content regarding warnings was present in less than half of all social media posts. CONCLUSIONS: Despite state-based advertising restrictions, recreational cannabis business pages use messages with youth appeal. Required safety message adherence is not typical on social media business pages.

Adolescents' Digital Technology Interactions and Importance: Associations with Demographics and Social Media Frequency.

The Adolescents' Digital Technology Interactions and Importance (ADTI) scale evaluates perceived importance of technology interactions. Adolescents were recruited via Qualtrics panels for an online survey. Among 4592 participants, findings illustrated positive associations between ADTI scores and use frequency. Findings further validate the ADTI and contribute baseline scales by groups.

Cyber-ethnography of cannabis marketing on social media.

BACKGROUND: Since 2012, several states have legalized non-medical cannabis, and cannabis businesses have used social media as a primary form of marketing. There are concerns that social media cannabis exposure may reach underage viewers. Our objective was to identify how cannabis businesses cultivate an online presence and exert influence that may reach youth. METHODS: We chose a cyber-ethnographic approach to explore cannabis retailers on social media. We searched cannabis retailers with Facebook and Instagram presence from Alaska, Oregon, Colorado, and Washington, and identified 28 social media business profiles. One year of content was evaluated from each profile. In-depth, observational field notes were collected from researchers immersed in data collection on business profiles. Field notes were analyzed to uncover common themes associated with social media cannabis marketing. RESULTS: A total of 14 businesses were evaluated across both Facebook and Instagram, resulting in 14 sets of combined field notes. A major theme was Normalization of Cannabis, involving both Broad Appeal and Specific Targeting. CONCLUSIONS: It is concerning that Normalization of Cannabis by cannabis businesses may increase cannabis acceptability among youth. In a digital world where the majority of youth are spending time online, it is important for policymakers to examine additional restrictions for cannabis businesses marketing through social media.

Effect of a Family Media Use Plan on Media Rule Engagement Among Adolescents: A Randomized Clinical Trial.

Importance: The American Academy of Pediatrics recommends that all families use a family media use plan to select and engage with media rules. To date, the effectiveness of this tool in promoting adolescent media rule engagement is unknown. Objective: To test the effect of a family media use plan on media rule engagement in adolescents. Design, Setting, and Participants: This randomized clinical trial with parallel design used the online Qualtrics platform for recruitment, data collection, and intervention delivery. Parents and their children (aged 12 to 17 years) who spoke and read in the English language were recruited, enrolled, and randomized to either the intervention or control group. Parent-adolescent dyads in both groups completed baseline surveys individually, and the dyads in the intervention group completed the family media use plan survey. Baseline recruitment was conducted from April 8, 2019, to May 1, 2019, and follow-up surveys were completed between June 11, 2019, and July 2, 2019. Interventions: The American Academy of Pediatrics family media use plan. Main Outcomes and Measures: The primary outcome was media rule engagement reported by adolescents. Media rules were extracted from the family media use plan, and adolescents rated each rule (using Likert scales) according to whether the rule was present or followed in their home. Secondary outcomes were adolescent-perceived technology importance and changes in sleep, physical activity, and depression. Results: A total of 1520 parent-adolescent dyads were enrolled in the trial and randomized to either the intervention or control group. Adolescents had a mean (SD) age of 14.5 (1.6) years, and 789 were female (51.9%) and 1027 were White (67.6%) individuals. Parents had a mean (SD) age of 44.1 (8.5) years, and 995 were women (65.5%) and 1021 were White individuals (67.2%). For media rule engagement, the between-group difference was -0.1 (95% CI, -1.1 to 0.9). Conclusions and Relevance: This randomized clinical trial found that completing a family media use plan did not lead to statistically significant changes in media rule engagement for adolescents in the intervention group. Future studies should consider revising the family media use plan and exploring the importance of technology as an intervention outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT03881397.

Priorities and Outcomes for Youth-Adult Transitions in Hospital Care: Perspectives of Inpatient Clinical Leaders at US Children's Hospitals.

OBJECTIVES: Adults with chronic conditions originating in childhood experience ongoing hospitalizations; however, efforts to guide youth-adult transitions rarely address transitioning to adult-oriented inpatient care. Our objectives were to identify perceptions of clinical leaders on important and feasible inpatient transition activities and outcomes, including when, how, and for whom inpatient transition processes are needed. METHODS: Clinical leaders at US children's hospitals were surveyed between January and July 2016. Questionnaires were used to assess 21 inpatient transition activities and 13 outcomes. Perceptions about feasible and important outcome measures and appropriate patients and settings for activities were summarized. Each transition activity was categorized into one of the Six Core Elements (policy, tracking, readiness, planning, transfer, or completion). Associations between perceived transition activity importance or feasibility, hospital characteristics, and transition activity performance were evaluated. RESULTS: In total, 96 of 195 (49.2%) children's hospital leaders responded. The most important and feasible activities were identifying patients needing or overdue for transition, discussing transition timing with youth and/or families, and informing youth and/or families that future stays would be at an adult facility. Feasibility, but not importance, ratings were associated with current performance of transition activities. Inpatient transition activities were perceived to be important for children with medical and/or social complexity or high hospital use. Emergency department visits and patient experience during transition were top outcome measurement priorities. CONCLUSIONS: Children's hospital clinical leaders rated inpatient youth-adult transition activities and outcome measures as important and feasible; however, feasibility may ultimately drive implementation. This work should be used to inform initial research and quality improvement priorities, although additional stakeholder perspectives are needed.

Measuring Interests Not Minutes: Development and Validation of the Adolescents' Digital Technology Interactions and Importance Scale (ADTI).

BACKGROUND: Interactive digital technology use is integral to adolescents' lives and has been associated with both health benefits and risks. Previous studies have largely focused on measuring the quantity of technology use or understanding the use of specific platforms. To better understand adolescents' interactive digital technology use, we need new approaches that consider technology interactions and their importance. OBJECTIVE: This study aimed to develop an assessment tool to evaluate adolescents' digital technology interactions and their perceived importance. METHODS: We used a validated scale development approach comprising 2 initial steps to create an item pool: item pool development and item pool refinement. These steps relied upon empirical literature review and an expert convening. We then evaluated the item pool using a Web-based survey. Data were collected via Qualtrics panel recruitment from a national sample of 12- to 18-year-olds. Participant data were randomly split into a development subsample for exploratory factor analysis (EFA) and a test subsample for confirmatory factor analysis (CFA). We assessed Cronbach alpha as well as model fit characteristics including root mean square error of approximation (RMSEA) and comparative fit index (CFI). RESULTS: Our initial item pool had 71 items and the refined item pool contained 40. A total of 761 adolescents assessed the item pool via Web-based survey. Participants had a mean age of 14.8 (SD 1.7) years and were 52.8% (402/761) female and 77.5% (590/761) white. The EFA analysis included 500 participants and an 18-item draft scale was created. The CFA included 261 participants to test the draft scale. Adequate model fit for the scale was indicated by an RMSEA of 0.063 and a CFI of 0.95. The final scale included 18 items in a 3-factor model, with Cronbach alpha for the 3 factors of .87 (factor 1), .90 (factor 2) and .82 (factor 3). The 3 factors were named (1) technology to bridge online and offline experiences, (2) technology to go outside one's identity or offline environment, and (3) technology for social connection. CONCLUSIONS: The resulting Adolescents' Digital Technology Interactions and Importance (ADTI) scale is a promising and psychometrically validated tool for identifying the importance of distinct technology interactions. The scale is informed by relevant theory and expert input. The 3 subscales have utility for future studies to understand whether certain subscale score ranges are associated with health or well-being outcomes.