Randomized Controlled Trial of Aerobic Exercise for Smoking Cessation among Individuals with Elevated Depressive Symptoms.

INTRODUCTION: Adults with depression have higher rates of cigarette smoking and are more likely to relapse than those without depression. Pharmacological, psychological, and combined interventions have largely yielded small improvements in smoking outcomes for adults with depression. Aerobic exercise (AE) may facilitate smoking cessation in this subpopulation. METHODS: This study was a 12-week two-arm randomized controlled trial that evaluated the effect of a moderate-intensity AE program compared to a health education contact (HEC) control on smoking cessation in adults with elevated depressive symptoms (mild to severe). Participants (n=231) were randomized to AE or HEC and received smoking cessation treatment (telephone counseling and nicotine replacement therapy). Primary (biologically confirmed 7-day point prevalence abstinence) and secondary (depressive symptoms, objective and self-reported physical activity, and cardiorespiratory fitness) outcomes were assessed at baseline, 3-, 6-, and 12-months. Data were analyzed with mixed-effects generalized linear models controlling for age, gender, nicotine dependence, history of major depression disorder, and month of follow-up assessment. RESULTS: There were no significant differences in primary or secondary outcomes between the AE and HEC groups. CONCLUSIONS: The AE program was not superior to HEC in facilitating smoking cessation, increases in physical activity, or improved depressive symptoms. Given evidence for the positive acute effects of exercise on mood and smoking urges, future research should consider testing alternative exercise approaches for aiding smoking cessation beyond structured, aerobic exercise programs. IMPLICATIONS: This study found that an adjunctive aerobic exercise (AE) program was not superior to a health education contact control for adults with elevated depressive symptoms, all of whom also received standard smoking cessation treatment. This finding adds to the growing body of literature that structured aerobic exercise programs for smoking cessation may have limited efficacy for cessation outcomes. Future research is needed to test alternative methods of integrating AE into smoking cessation treatment, such as strategically using exercise to manage cravings and low mood in the moment.

User-centered preferences for a gait-informed alcohol intoxication app.

Background: mHealth technology can be used as a potential intervention for alcohol-related consequences. Applications designed to monitor alcohol use and relay information to the user may help to reduce risky behavior. Acceptability of such applications needs to be assessed. Methods: Survey data from 139 participants (29.8 years on average, 58% female) completing a single-session study for developing an application to detect blood alcohol concentration (BAC) from gait was analyzed to examine user preferences. Participants reported on their interest in an application for monitoring BAC from gait. Participants also reported on their preference for controlling features of the application. Acceptability and feasibility data were collected. Data were examined for the entire sample as well as differences in preference by age and gender were examined. Results: The majority of the sample indicated that they were interested in using an mHealth application to infer BAC from their gait. Users were interested in being able to control features of the application, such as monitoring BAC and reporting information to other individuals. Adults, as compared to emerging adults, preferred the ability to turn off the BAC-monitoring feature of the app. Females reported a preference for an app that does not allow the user to turn off notifications for BAC as well as safety features of the app. Conclusions: Results of the survey data indicate general interest in mHealth technology that monitors BAC from passive input. These results suggest that such an app may be accepted and used as an intervention for monitoring alcohol levels, which could mediate drinking and alcohol-related consequences.

HIV-PASS (Pain and Sadness Support): Randomized Controlled Trial of a Behavioral Health Intervention for Interference Due to Pain in People Living With HIV, Chronic Pain, and Depression.

OBJECTIVE: This study aimed to determine whether HIV-Pain and Sadness Support (HIV-PASS), a collaborative behavioral health intervention based on behavioral activation, is associated with decreased pain-related interference with daily activities, depression, and other outcomes in people living with HIV. METHODS: We conducted a three-site clinical trial ( n = 187) in which we randomly assigned participants to receive either HIV-PASS or health education control condition. In both conditions, participants received seven intervention sessions, comprising an initial in-person joint meeting with the participant, their HIV primary care provider and a behavioral health specialist, and six, primarily telephone-based, meetings with the behavioral health specialist and participant. The intervention period lasted 3 months, and follow-up assessments were conducted for an additional 9 months. RESULTS: Compared with health education, HIV-PASS was associated with significantly lower pain-related interference with daily activities at the end of month 3 (our primary outcome; b = -1.31, 95% confidence interval = -2.28 to -0.34). We did not observe other differences between groups at 3 months in secondary outcomes that included worst or average pain in the past week, depression symptoms, anxiety, and perceived overall mental and physical health. There were no differences between groups on any outcomes at 12 months after enrollment. CONCLUSIONS: A targeted intervention can have positive effects on pain interference. At the end of intervention, effects we found were in a clinically significant range. However, effects diminished once the intervention period ended. TRIAL REGISTRATION: ClinicalTrials.gov NCT02766751.

Effects of a bout of exercise on mood in people with depression with and without physical pain.

Physical and mental health symptoms can reduce participation in physical activity. The current study assessed the impact of a bout of exercise on mood state in depressed participants with and without current physical pain. We enrolled a community sample of 147 participants (Mage = 45.5; SD = 11.98; 87.1% female) with elevated depressive symptoms. Individuals rated their mood state, completed a 1-mile walk test on a treadmill, and rated their mood state again. Pairwise comparisons between pre- and post-exercise mood ratings were statistically significant (p < .001) and showed improved mood state. People with at least moderate pain showed greater decreases in sadness and irritability from pre- to post- exercise bout. A single bout of exercise was associated with decreased sadness, anxiety, and irritability, and increased energy in a sample of adults with depression. The changes in sadness and irritability were greatest in those who reported at least moderate physical pain.

Single-arm Pilot Trial of Hatha Yoga for Adolescents with Depression.

The prevalence of adolescent depression is increasing, particularly among girls. Existing evidence-based treatments have limitations and/or may not be acceptable to all adolescents and parents. There is evidence that hatha yoga may be useful as an adjunctive treatment for depression in adults. The purpose of the current study was to assess acceptability and feasibility of hatha yoga for depression in teens. We conducted a single-arm pilot trial of 12 weeks of manualized yoga classes specifically targeted toward teens with elevated depression symptoms. We assessed acceptability and feasibility by several metrics and compared our results against a priori benchmarks. We also collected qualitative feedback on the classes. We enrolled 11 teens. We met a priori benchmarks for recruitment and retention rates, credibility of the yoga classes, satisfaction with classes, and (lack of) adverse events causally related to classes. Class attendance and amount of home practice fell below planned benchmarks. Qualitative feedback was positive from the majority, although not all, participants. Results from this study may be used to further refine yoga classes for depressed teens.

Improving functioning in HIV+ patients with chronic pain and comorbid depression: Protocol for a randomized clinical trial testing a collaborative behavioral health intervention based on behavioral activation.

OBJECTIVE: Persons living with HIV (PWH) experience a disproportionate level of comorbid chronic pain and depression compared to individuals who do not have a diagnosis of HIV. Many PWH report pain that impairs daily function, is severe, and requires medical management. Depression alone is associated with HIV disease progression, medication non-adherence, and increased mortality. Given that numerous studies show that PWHs have chronic pain and depression despite pharmacologic treatment, there is a clear need for additional treatment modalities to address these conditions. DESIGN: In this paper, we describe our protocol for a multisite, randomized controlled trial of the effectiveness of a collaborative behavioral intervention, called HIV-Pain and Sadness Support (HIVPASS), designed for PWH who endorse chronic pain and depressive symptoms, as compared to an attention matched Health Education (HE) condition. The HIVPASS intervention is based on Behavioral Activation and designed to target both pain and depression using an integrated model that promotes collaboration between HIV medical and psychological providers. SETTING AND METHODS: We plan to (1) recruit PWH who endorse chronic pain and depression in three sites located in New England and the Midwestern United States and (2) compare our HIVPASS intervention to a full attention matched HE intervention with the primary outcome of pain interference, and secondary outcomes of depression, physical activity, HIV medication adherence, and health-related quality of life. Follow-up assessments will occur monthly for three months during the intervention phase and then during the post-intervention phase at months four, six, nine and twelve. CONCLUSIONS: We provide descriptions of our protocol and interventions of our randomized controlled trial for comorbid chronic pain and depression in PWH. TRIAL REGISTRATION: http://ClinicalTrials.govNCT02766751 https://clinicaltrials.gov/ct2/show/NCT02766751?term=stein%2C+michael&draw=2&rank=5.

Pharmacologic and Non-Pharmacologic Treatments for Chronic Pain Used by Patients with Pain, HIV, and Depression.

The objective of this study was to understand pain treatment utilization, perceived efficacy, and differences in utilization by gender, clinic site, chronicity of pain, pain severity, and depression severity among people living with HIV (PLWH), chronic pain, and elevated depression symptoms. Participants included 187 PLWH at three HIV clinics in the U.S. Overall, 85% of participants reported taking a pain medication. One quarter (25%) reported non-pharmacological professional treatments for pain (e.g., massage, physical therapy), 60% reported mind-body treatments, including exercise, meditation, and yoga, and 62% reported other non-pharmacological self-administered treatments (e.g., heat/cold). Most pain treatments were considered "slightly helpful" or "moderately helpful." Non-pharmacological self-administered treatments were more commonly used among women than men and among individuals with constant vs. intermittent pain. Further research is needed to evaluate the efficacy of the preferred analgesic modalities of PLWH.

Combined intervention approaches for initiating and maintaining physical activity in depressed individuals: design and rationale of the Project MOVE randomized clinical trial.

INTRODUCTION: Regular engagement in physical activity decreases risks for many chronic conditions, and may also improve depression symptoms. However, rates of physical activity and adherence to exercise interventions remain low among depressed individuals relative to non-depressed individuals. METHODS: This is a study protocol for Project MOVE. This study is a theoretically-driven, 3-arm randomized controlled trial for increasing physical activity with depressed adults. Each successive arm includes an added component that may serve to increase and maintain physical activity. The arms are: 1) Brief advice (BA) to exercise alone (minimal treatment control condition); 2) BA + supervised and home-based exercise (SHE) + health education (HE; serves as contact control for CBEX); and 3) BA + SHE +cognitive-behavioral sessions focused on increasing and maintaining exercise (CBEX). The target sample size is 240. Assessments are conducted at baseline, Month 1.5, end of intervention (month 3), and at 6 and 9 months. The primary outcome is minutes of moderate-to-vigorous physical activity, assessed via an accelerometer. Secondary outcomes include cardiorespiratory fitness, body composition, and depression, and maintenance of moderate-vigorous physical activity through 6 and 9 month follow-ups. Mediators and moderators derived from behavior change theories, including the Health Behavior Model, Self-Determination Theory, and Social Ecological Theory, will be examined. CONCLUSION: Project MOVE is designed to test primarily whether both a structured exercise program (SHE) and a cognitive-behavioral group (CBEX) increase physical activity in depressed adults during both a 3-month intervention period, and during the 6-months that follow.

Categorizing Cannabis and Alcohol Use Patterns of Emerging Adults in Psychiatric Partial Hospitalization Treatment.

BACKGROUND: Emerging adulthood is a common and problematic time for alcohol and cannabis use. Emerging adulthood also represents a vulnerable time period for anxiety and depression. Substance use and mental health issues are highly comorbid, yet substance use is commonly neglected in psychiatric care. OBJECTIVE: The goal of this study was to categorize the cannabis and alcohol use patterns of emerging adults in psychiatric care and to evaluate relationships with use-related problems, psychiatric symptomatology, and motives for use. METHODS: Participants were emerging adults who were consecutive admissions to a young adult psychiatric partial hospital program from 2017 to 2018. Of 318 participants who completed questionnaires, 244 (76.7%) reported cannabis and/or alcohol use in the previous month. Cluster analyses and analysis of variance tests were conducted to categorize and differentiate between participants who reported use. RESULTS: Results from cluster analyses identified 4 categories of use: low cannabis/high alcohol (35.7%), low cannabis/low alcohol (17.6%), high cannabis/low alcohol (29.1%), and high cannabis/high alcohol (17.6%). Individuals in categories with the highest rates of use and co-use reported more alcohol problems (F=24.31, P<0.001), cannabis problems (F=36.75, P<0.001), depression (F=3.60, P=0.01), and motives: social (F=6.12, P<0.001), coping with anxiety (F=20.43, P<0.001), coping with depression (F=17.80, P<0.001), enhancement (F=7.85, P<0.001), and conformity (F=4.92, P<0.01). CONCLUSIONS/IMPORTANCE: Clear categories of substance use emerged. Participants who were heavier users were more likely to use to alleviate psychiatric symptomatology, yet they also reported greater psychiatric symptomatology and use-related problems. Among a psychiatric sample of emerging adults, cannabis and alcohol use was common and problematic. Thus, substance use should be evaluated for and, if present, targeted with interventions during psychiatric care.

Marijuana use motives mediate the association between experiences of childhood abuse and marijuana use outcomes among emerging adults.

INTRODUCTION: Experiences of childhood sexual abuse (CSA) and childhood physical abuse (CPA) are associated with poor mental health outcomes including substance use in subsequent years. Marijuana use motives (i.e., coping with negative affect, enhancing positive affect, or improving social interactions) may influence problematic substance use among young adults. Specifically, motives may be associated with severity of marijuana use outcomes among individuals who have experienced CSA or CPA. This study investigated the indirect effect of marijuana use motives between experiences of CSA or CPA and marijuana use and problems among emerging adults. METHOD: Participants were 397 young adults (50.1% male, 66.2% White) between ages 18-25 years, who reported 15.85 (SD = 11.66) days of marijuana use in the past month. Participants reported on history of childhood abuse, marijuana use days, problems, and motives for use. RESULTS: Findings suggest a significant indirect effect of coping motives in the association between CPA and marijuana use days and marijuana problems. Further, both coping motives and marijuana use days indicated a significant indirect effect between CPA and problems. Motives of socializing or enhancement did not have a significant indirect effect between CPA and marijuana use or problems. There were no significant findings with CSA and marijuana use outcomes. DISCUSSION: Coping motives might be an important potential target for future marijuana interventions in persons with childhood physical abuse.

Emerging Adults' Discussion of Substance Use and Sexual Behavior with Providers.

Emerging adulthood (ages 18-25) is a time of increased autonomy and associated with a high rate of risky substance use and sexual behavior. As emerging adults (EA) increasingly have more independence, they have the ability to make health decisions, including whether to see a provider (primary care (PCP) and/or gynecologist (GYN)) and whether to discuss substance use and sexual behavior. The current study aimed to determine: (1) factors associated with PCP and GYN health-care seeking by sexually active EA who use alcohol and/or marijuana; (2) gender differences in substance use and sexual risk topics initiated by providers; (3) whether PCPs compared to GYNs discuss different topics with women. Alcohol and/or marijuana-using, sexually active EA (n = 500) were recruited as part of a health behaviors study. Among participants, 39% did not see a PCP in the previous year. Women, White individuals, and EA with health insurance were most likely to attend a PCP appointment. Even among participants who saw a provider, many participants reported that providers did not initiate a discussion about substance use (approximately half discussed substance use) and sexual behavior (about half discussed STI history, two-thirds discussed condom use, and three-quarters discussed sexual partners). Among women with a PCP and GYN provider, discussions on substance use were more likely to be initiated by a PCP while sexual issues were more likely to be initiated by a GYN. Thus, even among sexually active, substance-using EA, central topics - specifically substance use and sexual behavior - are not routinely brought up by providers.

Impact of Nicotine and Other Stimulants on Sleep in Young Adults.

OBJECTIVES: Sleep problems can have long-term negative consequences. This study explored the relationship of commonly used stimulant substances to poor sleep quality in young adults. METHODS: We surveyed 498 participants, aged 18 to 25, who reported recent alcohol or marijuana use. Stimulant substances measured included coffee, energy drinks, nonmedical prescription stimulants (NPS), cocaine, and nicotine. Sleep outcomes were measured using the Pittsburgh Sleep Quality Index (PSQI) and its components. RESULTS: Participants averaged 21.3 (±2.07) years of age, 47.8% male, 65.5% non-Latino white, 10.8% African-American, 12.3% Latino, and 11.5% other ethnic origins. In the past 30 days, 24.9% had used cigarettes, 48.1% energy drinks, 17.3% NPS, 79.3% coffee, and 7.9% cocaine. Mean PSQI global score was 6.21 (±3.66, median = 5). After adjusting for background characteristics, PSQI global scores were positively and significantly associated with number of cigarettes/day (b = 0.16, 95% confidence interval 0.07 to 0.25, P < 0.001) and days of NPS (b = 0.10, 95% confidence interval 0.01 to 0.18, P = 0.030). CONCLUSIONS: NPS negatively affects sleep, but nicotine is particularly deleterious to sleep quality. Addressing smoking cessation to improve sleep may be a novel way to motivate young adult smokers to quit.

A longitudinal evaluation of the role of alcohol self-concept in alcohol use, motives, negative affect, and alcohol-related problems among emerging adults.

BACKGROUND AND OBJECTIVES: Emerging adulthood is a time of identity formation, and is also the most common time period for individuals to consume alcohol. Alcohol self-concept (or drinking identity) has been associated cross-sectionally with rates of alcohol use and use-related problems. Additionally, there is preliminary evidence that alcohol self-concept is related to negative affect and to alcohol use motives. However, less research has evaluated the longitudinal nature of these variables, particularly in a community sample. The current study evaluated relationships between self-concept, alcohol-related variables, and negative affect among emerging adults. Additionally, the study explored self-concept as a mediator between motives and alcohol use and problems. METHODS: Community-recruited participants (n = 226, 55.3% male) involved in a health behaviors study were assessed over the course of 12 months. RESULTS: Results substantiated both the cross-sectional and longitudinal relationships between these variables. Self-concept, rates of use, and problems decreased over the course of time. Decreases in motives for alcohol use (including coping and enhancement motives) were related to subsequent decreases in alcohol self-concept, which in turn were associated with decreases in use and use-related problems. Alcohol self-concept mediated the longitudinal relationship between coping motives and use as well as use-related problems. DISCUSSION AND CONCLUSIONS: Results from this study underscore the importance of motivation for alcohol use and internalization of alcohol identity in predicting changes in behavior across emerging adulthood and suggest future avenues of research. SCIENTIFIC SIGNIFICANCE: Alcohol self-concept may be a risk factor and intervention target. (Am J Addict 2018;27:501-508).

Identity as a cannabis user is related to problematic patterns of consumption among emerging adults.

INTRODUCTION: Cannabis use has become a more normative, socially-acceptable behavior in the United States, despite research indicating that frequent use may become problematic for some individuals. Emerging adulthood, a time of identity development, is the most common time for cannabis use. Cannabis self-concept, or one's identification with cannabis as part of their personality or identity, is one factor that may influence use behavior. This study extends previous research that reported a link between self-concept, motivational factors, and normative beliefs by evaluating relationships between cannabis self-concept, motives for use, motivation to change, perceived descriptive norms, as well as cannabis-related outcomes (use, using alone, and cannabis-related problems). METHODS: Emerging adults who used cannabis in the previous month (n=345, 53.9% male, mean age 21.0, 67.5% Non-Latino White) were recruited from a community sample for a health behaviors study. Participants were assessed for explicit cannabis self-concept, frequency of use, problems associated with use, motives for use, motivation to change, and normative beliefs about others' use. RESULTS: Participants reported using cannabis on an average of 17.9 (SD=11.1) days of the previous month. Correlational analyses revealed that cannabis self-concept was positively associated with frequency of use, use-related problems, several motives for use, descriptive norms, and with using cannabis alone. Multivariate analyses revealed that rates of use, problems, and social and enhancement motives were independently and positively associated (p<0.05) with cannabis self-concept, while self-concept was negatively associated with desire to reduce cannabis use. CONCLUSIONS: Cannabis self-concept may be a marker for more problematic patterns of use.

A developmental-based motivational intervention to reduce alcohol and marijuana use among non-treatment-seeking young adults: a randomized controlled trial.

AIMS: To test the hypothesis that among non-treatment-seeking emerging adults (EA) who both use marijuana and have alcohol binges, a brief, longitudinally delivered, developmentally based motivational intervention would show greater reductions in the use of these two substances compared with a health education control condition. DESIGN: Parallel, two-group, randomized controlled trial with follow-up interventions conducted at 1, 3, 6 and 9 months and final assessments at 12 and 15 months. SETTING: Hospital-based research unit in the United States. PARTICIPANTS: Community-based 18-25-year-olds who reported at least monthly binge drinking and at least weekly marijuana use. INTERVENTION: Motivational intervention (EA-MI) focused primarily on themes of emerging adulthood (identity exploration, instability, self-focus, feeling in-between, a sense of possibilities) and the subjects' relationship to substance use (n = 110) compared with an attention-matched health education control condition (n = 116). MEASUREMENTS: The primary outcomes were days of binge alcohol, marijuana and dual use day as measured using the timeline follow-back method analysing the treatment by time interaction to determine relative differences in the rate of change between intervention arms. FINDINGS: At baseline, the mean rate (days/30) of binge drinking was 5.23 (± 4.31) of marijuana use was 19.4 (± 10.0) and of dual (same day) use was 4.11 (± 4.13). Relative to baseline, there were reductions in the rate of binge alcohol use, marijuana use and days of combined binge alcohol and marijuana use (P < 0.001) at all follow-up assessments. However, the treatment × time interaction was not statistically significant for alcohol (P = 0.37), for marijuana (P = 0.07) or for dual use (P = 0.55). Averaged over all follow-ups, mean reductions in binge, marijuana and dual use days were 1.16, 1.45 and 1.08, respectively, in the health education arm, and 1.06, 1.69 and 0.96 in EA-MI. Bayes factors were < 0.01 for frequency of binge alcohol use and frequency of dual binge alcohol and marijuana and 0.016 for marijuana use. CONCLUSIONS: A brief, longitudinally delivered, developmentally based motivational intervention for young adults did not produce reductions in binge alcohol, marijuana use or dual use days relative to a control condition.

Energy drinks and alcohol-related risk among young adults.

BACKGROUND: Energy drink consumption, with or without concurrent alcohol use, is common among young adults. This study sought to clarify risk for negative alcohol outcomes related to the timing of energy drink use. METHODS: The authors interviewed a community sample of 481 young adults, aged 18-25, who drank alcohol in the last month. Past-30-day energy drink use was operationalized as no-use, use without concurrent alcohol, and concurrent use of energy drinks with alcohol ("within a couple of hours"). Negative alcohol outcomes included past-30-day binge drinking, past-30-day alcohol use disorder, and drinking-related consequences. RESULTS: Just over half (50.5%) reported no use of energy drinks,18.3% reported using energy drinks without concurrent alcohol use, and 31.2% reported concurrent use of energy drinks and alcohol. Relative to those who reported concurrent use of energy drinks with alcohol, and controlling for background characteristics and frequency of alcohol consumption, those who didn't use energy drinks and those who used without concurrent alcohol use had significantly lower binge drinking, negative consequences, and rates of alcohol use disorder (P < .05 for all outcomes). There were no significant differences between the no-use and energy drink without concurrent alcohol groups on any alcohol-related measure (P > .10 for all outcomes). CONCLUSIONS: Concurrent energy drink and alcohol use is associated with increased risk for negative alcohol consequences in young adults. Clinicians providing care to young adults could consider asking patients about concurrent energy drink and alcohol use as a way to begin a conversation about risky alcohol consumption while addressing 2 substances commonly used by this population.

Hazardously Drinking Jailed Women: Post-Release Perceived Needs and Risk of Reincarceration.

Women who drink hazardously face a high risk for re-arrest and reincarceration when they return to their communities after a jail stay. This study is the first to examine the associations between women's own reports of basic needs 1 month after jail release, and reincarceration (defined as spending at least one night in jail) during the next 5 months among unsentenced, female pretrial jail detainees who drink hazardously. Perceived needs for housing (adjusted odds ratio [AOR] = 3.63; p < .01), substance treatment services (AOR = 2.65; p < .01), assistance/benefits (AOR = 2.37; p < .05), and mental health counseling (AOR = 2.07; p < .05) at 1 month after jail release were associated with reincarceration during the next 5 months for the 165 hazardously drinking jailed women in this study. These findings demonstrate that self-reported needs during the high-risk period immediately following jail release are associated with heightened odds of reincarceration among hazardously drinking jailed women.

Mostly Smokers: Identifying Subtypes of Emerging Adult Substance Users.

BACKGROUND: The concurrent use of marijuana and other substances among emerging adults (ages 18-25) is a major public health problem. This study examined if there are distinct subtypes of emerging adult marijuana users and if these are associated with demographic and substance use variables. METHODS: The design was a cross-sectional interview with a community sample of 1,503 emerging adults in the northeastern U.S. who reported last month marijuana use. We used latent class analysis (LCA) to identify distinct subtypes of emerging adults who used additional substances and examined predictors of the latent classes. RESULTS: We identified three distinct classes of emerging adults who use substances: "mostly smokers" (those who primarily use marijuana and nicotine), "moderate users" (those who primarily use marijuana and/or heavy episodic alcohol), and "polysubstance users." Polysubstance users had higher probabilities of use of all assessed substances (e.g. cocaine, opiates, sleep medications, stimulants, synthetic marijuana, and inhalants) than the other two groups. Not being currently enrolled in school and male gender were associated with mostly smokers and polysubstance users group status. CONCLUSIONS: We identified a distinct group of emerging adult marijuana users who primarily smoke marijuana and cigarettes, suggesting that there could be a shared vulnerability for risk of co-occurrence.

An Open Trial of Electronic Cigarettes for Smoking Cessation Among Methadone-Maintained Smokers.

INTRODUCTION: Smoking cessation pharmacotherapies tested in persons with opioid use disorder have produced low quit rates. Electronic cigarettes (e-cigarettes) have been used by many methadone-maintained (MMT) smokers, but controlled trials evaluating cessation and reduction outcomes have not been performed in this population with deleterious tobacco-related health consequences. METHODS: In this open trial of NJOY e-cigarettes, MMT smokers received 6 weeks of treatment and were instructed to use only e-cigarettes. Outcomes included carbon monoxide confirmed 7-day point smoking cessation prevalence at week 7 (end of treatment) and self-reported change in mean cigarettes per day (CPD) at each 2-week assessment. The final assessment was 2 weeks after treatment ended (week 9). RESULTS: The 12 participants averaged 46 years old and 50% were male. On average, participants reported smoking 17.8 (±5.3) CPD. One person had a biochemically confirmed quit at week 7. Participants tended to report marked reductions in mean CPD between quit day (week 1) and the week 3 assessment. Relative to baseline, statistically significant reductions in mean CPD were observed at all follow-up assessments. Mean reductions in CPD were -12.4 (95% confidence interval [CI]: -15.0, -9.9; P < .001), -14.8 (95% CI: -17.4, -12.2; P < .001), -13.9 (95% CI: -16.6, -11.2), and -10.8 (95% CI: -13.4, -8.2; P < .01) at the 3-, 5-, 7-, and 9-week assessments, respectively. Adherence to e-cigarettes was 89.1% during the 6 treatment weeks. CONCLUSIONS: E-cigarettes were associated with reductions in cigarette use. Smoking cessation rates in MMT smokers are low and whether long-term smoking reductions can persist and produce health benefits should be studied. IMPLICATIONS: E-cigarettes were associated with reduced tobacco use in MMT smokers. Adherence to e-cigarettes is high among methadone smokers. Week-7 smoking quit rates are similar to pharmacotherapies tested in this population.

Synthetic Cannabinoids: Use and Predictors in a Community Sample of Young Adults.

BACKGROUND: Synthetic cannabinoids (SCs) are a class of drugs of abuse with deleterious consequences. Despite governmental regulations related to distribution and sale, SC variants are still available online. More research is needed to determine SC use prevalence and factors associated with SC use, especially among young adults. METHODS: One thousand eighty individuals, 18-25 years old, were surveyed, between January 2012 and July 2013, during recruitment for a randomized controlled trial investigating health behaviors in young adults. Advertisements were placed online and in community locations seeking individuals "who had recently used marijuana or alcohol." Respondents were queried about their use of alcohol and drugs, including SCs, in the last month. RESULTS: Participants averaged 21.4 years old and were 53.4% male. Nearly 59% were non-Hispanic white, 15% were African American, 15% were Hispanic, and 11% identified as other. Approximately 9% reported SC use in the last month, a level higher than the reported use of opioids, cocaine, or hallucinogens. SC use was significantly associated with male gender, not being enrolled in school, and with use of cigarettes, binge alcohol drinking, daily and weekly marijuana use, and other drugs of abuse. There was a significant decrease in SC use after the federal ban in July 2012. CONCLUSIONS: SC use was common in the past month and often overlaps with other drug use, particularly marijuana use, and should be asked about during clinical encounters with young adults.