Effect of Flavored on! Nicotine Pouch Products on Smoking Behaviors: Protocol for a Sequential, Multiple Assignment, Randomized Controlled Trial.

BACKGROUND: Cigarette smoking is a leading cause of morbidity and mortality. For adults who smoke cigarettes and cannot or will not quit smoking, smoke-free products, such as nicotine pouches, have been recognized as a potential alternative to smoking combusted cigarettes to reduce harm due to cigarette smoking. The role of flavors in these smoke-free products in tobacco harm reduction has not been fully understood. OBJECTIVE: This study evaluates the effect of flavors in on! nicotine pouch products (research products) in the reduction of cigarette smoking among adults who smoke cigarettes in their natural environment. METHODS: This study uses a sequential, multiple assignment, randomized trial design. Approximately 400 eligible adults who smoke cigarettes will be enrolled and randomized to have access to either the Original (unflavored) on! nicotine pouch product only or a complete flavor profile (ie, Berry, Cinnamon, Citrus, Coffee, Mint, Original, and Wintergreen) of on! nicotine pouch products. After 3 weeks, participants in the Original-only arm will be randomized again, with half remaining in the Original-only arm and half having access to the complete flavor profile for another 3 weeks. Primary outcomes are expired-air carbon monoxide (CO) levels. Secondary outcomes are self-reported cigarette consumption and CO-verified cigarette abstinence. RESULTS: Recruitment and data collection started in September 2023 and is projected to last until March 2025. We anticipate completing the data analysis in 2025. As of May 2024, we have enrolled 314 participants. CONCLUSIONS: This study will provide empirical evidence about the effect that flavor availability in smoke-free products may have in reducing cigarette smoking. TRIAL REGISTRATION: ClinicalTrials.gov NCT06072547; https://clinicaltrials.gov/study/NCT06072547. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56565.

Mutual pathways between peer and own e-cigarette use among youth in the United States: a cross-lagged model.

BACKGROUND: Electronic cigarettes (e-cigarettes) have become the most common tobacco product used among adolescents in the United States (US). Prior research has shown that peer e-cigarette use was associated with increased risk of own e-cigarette use. Nonetheless, there is little empirical evidence on the directionality of these associations-if peer use predicts own use (peer influence) or if own use predicts peer use (peer selection). METHODS: We estimated the association between peer and own e-cigarette use among US adolescents 12-17 years of age. We used the cross-lagged model to investigate the mutual relationship between peer and own e-cigarette use over time using data from a population-based longitudinal study, Population Assessment of Tobacco and Health. Stratified analyses were conducted by sex and age subgroups. RESULTS: Results from a cross-lagged model showed a statistically significant predicting path leading from peer use at the prior time point to own use at the following time point, but not vice versa. CONCLUSIONS: We found strong relationships between peer e-cigarette use and own e-cigarette use at within-individual levels. Peer influence paths were more robust than peer selection paths for e-cigarette use. Incorporating peers into prevention and intervention programs may help enhance these strategies.

Awareness and use of tobacco products among underage individuals: findings from the altria client services underage tobacco use survey 2020-2022.

BACKGROUND: Tobacco use among underage individuals is a public health concern. Timely data about tobacco products, especially emerging products such as novel oral nicotine products (NPs), can provide critical information for the prevention of underage tobacco use. With a recent federal law raising the legal age of purchase of tobacco products from 18 to 21, it is of interest to benchmark awareness and use of tobacco products in the new underage population, young adults 18-20 years old. This study provides estimates on awareness and use of tobacco products among underage individuals 13-20 years old during May 2020 to August 2022 in the United States. METHODS: Altria Client Services Underage Tobacco Use Survey (UTUS) is a repeated cross-sectional survey conducted every quarter-year. A stratified random sampling approach was used to draw nationally representative samples of household dwelling individuals 13-20 years old. Information about the awareness and use of tobacco products was obtained via online self-administration or phone interviews after a consent/assent process. RESULTS: A sizable portion of underage individuals were aware of NPs (~ 40% among youth and ~ 50% among underage young adults), although past 30-day use was low (< 2%). The lowest levels of awareness and use were observed for heated tobacco products and snus. E-cigarettes were the most used tobacco products among underage individuals. Underage young adults (i.e., 18-20 year olds) were more likely to use tobacco products than youth (i.e., 13-17 year olds). There was no substantial change over time in the awareness and use of tobacco products during the study period despite a slight increase in past 30-day prevalence of e-cigarette use among youth between quarter 1 of 2021 and quarter 2 of 2022. CONCLUSIONS: The awareness and use of tobacco products remained relatively stable between May 2020 and August 2022. There is a notable level of awareness of novel NPs among underage individuals.

Youth susceptibility to tobacco use: is it general or specific?

BACKGROUND: Susceptibility to tobacco use predicts tobacco use onset among youth. The current study aimed to estimate the extent of overlap in susceptibilities across various tobacco products, investigate sociopsychological correlates with susceptibilities, and examine whether the relationship linking susceptibility with the onset of use is product-specific or is accounted for by a general susceptibility-onset relationship. METHODS: The study population consisted of US youth 12-17 years old who had never used a tobacco product, sampled in the longitudinal Population Assessment of Tobacco and Health study wave 4 (Dec. 2016-Jan. 2018; n = 10,977). Tobacco product-specific susceptibility at wave 4 was assessed via questions about curiosity, likelihood to try, and likelihood of use if a best friend offered. The onset of use of various tobacco products was defined as first use occurring between the wave 4 and wave 4.5 (Dec. 2017-Dec. 2018) assessments (n = 8841). Generalized linear regression and structural equation models were used for data analysis. RESULTS: There is a large degree of overlap in susceptibilities across tobacco products (65% of tobacco-susceptible youth were susceptible to more than one tobacco product). Tobacco-susceptible youths were more likely to have recently used cannabis, consumed alcohol, or to have been associated with tobacco-using peers. Structural equation models suggest that the susceptibility-onset relationship largely operates in a non-product-specific manner after accounting for the general susceptibility-to-tobacco-onset relationship. CONCLUSIONS: Youth susceptibility to tobacco use overlaps widely across different tobacco products and other risky behaviors. Findings from this study support a holistic approach towards the prevention of risk behaviors, supplemented by product-specific strategies when needed.

Correlates of transitions from alcohol use to disorder diagnosed by DSM-5 in China.

BACKGROUND: This study aimed to describe the prevalence and lifetime criteria profiles of DSM-5 alcohol use disorder (AUD) and the transitions from alcohol use to disorder in Chifeng, China. METHODS: Face-to-face interviews were conducted using Composite International Diagnostic Interview-3.0 (CIDI-3.0) among 4528 respondents in Chifeng. RESULTS: The weighted lifetime and 12-month prevalence of DSM-5 AUD were 3.03 and 1.05%, respectively. Mild lifetime AUD was the most prevalent severity level (69.53%). The two most common criteria were "failure to quit/cutdown" and "drinking more or for longer than intended." Lifetime prevalence was 65.59% for alcohol use, and 22.97% for regular drinking. Male and domestic violence were risk factors for the transition from alcohol use to regular drinking or AUD and from regular drinking to AUD. Younger age was risk factor for the transition to AUD from alcohol use or regular drinking. Poverty (OR = 2.49) was risk factor for the transition from alcohol use to regular drinking. The earlier drinkers were more likely to develop to regular drinking (OR = 2.11). CONCLUSION: AUD prevalence in Chifeng was not as high as that in Western countries. The study revealed that multiple risk factors might contribute to the transition across different stages of alcohol use. Further research should explore the underlying mechanisms.

Major depressive symptoms and escalation of drinking among new drinkers in the United States: Variations across sex and age groups.

BACKGROUND: Heavy episodic drinking is common in the United States (US) and causes substantial burden to individuals and the society. The transition from first drinking to first heavy drinking episode is a major milestone in the escalation of drinking. There is limited evidence about whether major depressive symptoms predict the progression from drinking to heavy drinking and potential variations across age, sex, and depressive symptoms. In this study, we aim to estimate the association between history of major depressive symptoms and the risk of first heavy drinking episode among new drinkers in the US. METHODS: Study population was US non-institutionalized civilian new drinkers 12 years of age and older who had their first drink during the past 12 months drawn from the National Survey on Drug Use and Health. History of major depressive symptoms and alcohol drinking behaviors were assessed via audio-computer-assisted self-interviews. Logistic regressions and structural equation modeling were used for analysis. RESULTS: Depressed mood and/or anhedonia predicted the transition from the first drink to a heavy drinking episode among underage female new drinkers, whereas null associations were found among males and female new drinkers who had their first drink at 21 and later. Among new drinkers with depressed mood and/or anhedonia, low mood or energy positively predicted the progression to a heavy drinking episode among late-adolescent boys, but negatively among late-adolescent girls; neurovegetative symptoms positively predicted the progression to a heavy drinking episode among young adult new drinkers. CONCLUSIONS: The relationships linking major depressive symptoms and the transition from drinking to first heavy drinking episode vary across age, sex, and depressive symptoms.

Stigma and discrimination associated with mental illness and other stigmatizing conditions in China using two cultural-sensitive measures of stigma: interpersonal distance and occupational restrictiveness.

BACKGROUND: Reducing stigma is a perennial target of mental health advocates, but effectively addressing stigma relies on the ability to correctly understand and accurately measure culture-specific and location-specific components of stigma and discrimination. METHODS: We developed two culture-sensitive measures that assess the core components of stigma. The 40-item Interpersonal Distance Scale (IDS) asks respondents about their willingness to establish four different types of relationships with individuals with 10 target conditions, including five mental health-related conditions and five comparison conditions. The 40-item Occupational Restrictiveness Scale (ORS) asks respondents how suitable it is for individuals with the 10 conditions to assume four different types of occupations. The scales - which take 15 min to complete - were administered as part of a 2013 survey in Ningxia Province, China to a representative sample of 2425 adult community members. RESULTS: IDS and ORS differentiated the level of stigma between the 10 conditions. Of the total, 81% of respondents were unwilling to have interpersonal relationships with individuals with mental health-related conditions and 91% considered them unsuitable for various occupations. Substantial differences in attitudes about the five mental health-related conditions suggest that there is no community consensus about what constitutes a 'mental illness'. CONCLUSIONS: Selection of comparison conditions, types of social relationships, and types of occupations considered by the IDS and ORS make it possible to develop culture-sensitive and cohort-specific measures of interpersonal distance and occupational restrictiveness that can be used to compare the level and type of stigma associated with different conditions and to monitor changes in stigma over time.

Associations between major depressive symptoms and drinking onset: Do sex and age matter?

BACKGROUND: There has been mixed evidence about whether major depression predicts drinking onset. Empirical evidence about whether the heterogeneity of major depressive symptoms differentially predicts drinking onset is scarce, and potential sex- and age-variations have not been fully studied. In this study, we estimate sex- and age-specific relationships linking (a) depressed mood and/or anhedonia with drinking onset among all 'at-risk' individuals and (b) three latent depressive constructs, manifested by 13 clinical features, with drinking onset among individuals with depressed mood and/or anhedonia. METHODS: Study population was non-institutionalized civilian residents 12 years of age and older living in the United States. Major depressive symptoms and drinking onset were assessed via audio-computer-assisted self-interviews. Logistic regressions and structural equation modeling were used for analysis. RESULTS: Among all 'at risk' individuals, depressed mood or anhedonia strongly predicted early-adolescent drinking onset, whereas they did not predict at-age drinking onset. Among individuals with depressed mood or anhedonia, a 3-factor model provided a good fit to the data for all sex- and age-subgroups. With the exception of early-adolescent boys, neurovegetative symptoms and suicide-related symptoms tended to positively predict underage drinking onset, whereas Low mood or energy tended to inversely predict underage drinking onset; limited evidence was found for at-age and post-21 drinking onset. LIMITATIONS: The observational nature precludes causal inference. Few people initiated alcohol drinking later than 21 years of age, which resulted in less precise estimates. CONCLUSIONS: Strengths and directions of major depressive symptoms predicting drinking onset vary across age, sex, and depressive symptoms.

Breast cancer survival and the expression of genes related to alcohol drinking.

Breast cancer is the leading cause of cancer-related disease in women. Cumulative evidence supports a causal role of alcohol intake and breast cancer incidence. In this study, we explore the change on expression of genes involved in the biological pathways through which alcohol has been hypothesized to impact breast cancer risk, to shed new insights on possible mechanisms affecting the survival of breast cancer patients. Here, we performed differential expression analysis at individual genes and gene set levels, respectively, across survival and breast cancer subtype data. Information about postdiagnosis breast cancer survival was obtained from 1977 Caucasian female participants in the Molecular Taxonomy of Breast Cancer International Consortium. Expression of 16 genes that have been linked in the literature to the hypothesized alcohol-breast cancer pathways, were examined. We found that the expression of 9 out of 16 genes under study were associated with cancer survival within the first 4 years of diagnosis. Results from gene set analysis confirmed a significant differential expression of these genes as a whole too. Although alcohol consumption is not analyzed, nor available for this dataset, we believe that further study on these genes could provide important information for clinical recommendations about potential impact of alcohol drinking on breast cancer survival.

Female-male differences in prescription pain reliever dependence levels: Evidence on newly incident adolescent and young adult users in the United States, 2002-2014.

BACKGROUND: A comprehensive epidemiology of dependence on prescription opioid pain relievers requires evidence about age-specific female-male differences, possibly manifest during adolescent and early adult years. In this study, we identified newly incident extra-medical users of prescription pain relievers (EMPPR), all observed with onsets before the 22nd birthday. We then quantified female-male differences in clinical features or manifestations of opioid dependence (OD), devised a measurement-equivalent OD dimension, and estimated age-specific female-male differences in OD levels. METHOD: The population under study included 12-to-21-year-old non-institutionalized civilian community residents of United States sampled for recent nation-scale surveys. Confidential computer-assisted self-interviews identified newly incident EMPPR users (n = 10,188). Analysis-weighted estimation procedures yielded cumulative incidence proportions for each OD feature, evaluated measurement non-equivalence across subgroups, and estimated female-male differences age-by-age. RESULTS: (1) Tolerance and salience ('spending a lot of time') are most common OD features. (2) Measurement non-equivalence (bias) was found across sex- and onset-age groups. (3) With biasing features removed, we can see elevated OD levels for female new initiates, age-by-age. Subsidiary analyses suggested possibly accelerated progression toward higher OD levels when extra-medical PPR use starts before age 18. CONCLUSIONS: Dimensional approaches to OD and other drug use disorders have gained popularity but can be fragile when differential measurement biases are left uncontrolled. This study's bias-corrected dimensional view of female-male differences shows elevated OD levels among newly incident female EMPPR users relative to new male initiates. Future studies can check for accelerated progression to higher OD levels when EM use starts before age 18 years.

Nation-scale primary prevention to reduce newly incident adolescent drug use: the issue of lag time.

BACKGROUND: There is limited evidence about the effects of United States (US) nation-level policy changes on the incidence of alcohol drinking and tobacco smoking. To investigate the potential primary prevention effects on precocious drug use and to clarify lag-time issues, we estimated incidence rates for specified intervals anticipating and lagging after drug policy enactment. Our hypotheses are (a) reductions in underage drinking or smoking onset and (b) increases of incidence at the legal age (i.e., 21 for drinking and 18 for smoking). METHODS: The study population is 12-23-year-old non-institutionalized US civilian residents. Estimates are from 30 community samples drawn to be nationally representative for the US National Surveys on Drug Use and Health 1979-2015. Estimates were year-by-year annual incidence rates for alcohol drinking and tobacco smoking by 12-23-year-olds, age by age. Meta-regressions estimate age-specific incidence over time. RESULTS: Incidence of underage alcohol drinking declined and followed a trend line that started before 1984 enactment of the National Minimum Drinking Age Act, but increased drinking incidence for 21 year olds was observed approximately 10 years after policy enactment. Eight years after the Synar amendment enactment, evidence of reduced smoking incidence started to emerge. Among 18 year olds, a slight increase in tobacco smoking incidence occurred about 10 years after the Synar amendment. CONCLUSION: Once nation-level policies affecting drug sales to minors are enacted, one might have to wait almost a decade before seeing tangible policy effects on drug use incidence rates.

E-cigarette use and onset of first cigarette smoking among adolescents: An empirical test of the 'common liability' theory.

Background: E-cigarettes have become the most commonly used tobacco products among youth in the United States (US) recently. It is not clear whether there is a causal relationship between e-cigarette use and the onset of cigarette smoking. The "common liability" theory postulates that the association between e-cigarette use and cigarette smoking can be attributed to a common risk construct of using tobacco products. This study aims to investigate the relationship between ever e-cigarette use and cigarette smoking onset in the US using a structural equation modeling approach guided by the "common liability" theory. Methods: The study population is non-institutionalized civilian adolescents living in the US, sampled in the longitudinal Population Assessment of Tobacco and Health study. Information about tobacco product use was obtained via confidential self-report. A structural equation modeling approach was used to estimate the relationship between e-cigarette use at wave 1 and the onset of cigarette smoking at wave 2 after controlling for a latent construct representing a "common liability to use tobacco products." Results:  After controlling for a latent construct representing a "common liability to use tobacco products", ever e-cigarette use does not predict the onset of cigarette smoking (ß=0.10, 95% CI= -0.09, 0.29, p=0.299). The latent "common liability to use tobacco products" is a robust predictor for the onset of cigarette smoking (ß=0.42; 95% CI=0.08, 0.76; p=0.015). Conclusions: Findings from this study provide supportive evidence for the 'common liability' underlying observed associations between e-cigarette use and smoking onset.

Incidence of nonmedical use of OxyContin and other prescription opioid pain relievers before and after the introduction of OxyContin with abuse deterrent properties.

OBJECTIVES: There is an epidemic of nonmedical and extra-medical use opioid abuse, addiction, and overdose. Extended-release oxycodone (OxyContin®), a prescription opioid pain reliever, was reformulated in 2010 to deter its abuse. The aim of this study was to assess changes in the onset of abuse of OxyContin and other opioids among young people and adults after reformulation of OxyContin with abuse-deterrent properties. METHODS: The study population was U.S. residents ≥ 12 years sampled in National Surveys on Drug Use and Health (NSDUH), 2004 to 2015, with subsample of 12-21-year-olds. Nonmedical and extra-medical use is the NSDUH proxy for abuse. Confidential audio-computer-assisted self-interviews were assessed. Age-specific incidence of nonmedical and extra-medical use of OxyContin and other prescription opioids were estimated year by year. Interrupted-time-series and age-period-cohort analyses were analyzed. RESULTS: Interrupted-time-series analysis showed a lower incidence of OxyContin nonmedical and extra-medical use after 2010 reformulation compared to the counterfactual predicted by the trend before 2010. No such difference was seen for other prescription opioids for all ages, although a lower incidence was also observed for other prescription opioids among 12-21-year-olds. Among 12-21-year-olds, a robustly lower incidence was found in 2012 compared to 2010 for OxyContin after holding constant age and cohort effects, whereas no robust difference was observed for other prescription opioids. The results showed 137,500 fewer newly incident cases of OxyContin nonmedical and extra-medical use per year. CONCLUSIONS: This study provides evidence supporting the role of OxyContin reformulation in the reduction of onset of OxyContin nonmedical and extra-medical use.

Male-female differences in the onset of heavy drinking episode soon after first full drink in contemporary United States: From early adolescence to young adulthood.

BACKGROUND: Globally, there is a male excess in the occurrence of heavy drinking once alcoholic beverages are consumed and some new evidence that this 'gender gap' might be null among underage drinkers. Here, we estimate age-specific male-female differences in heavy drinking episode (HDE) incidence across the first eight calendar-quarters after first full drink. METHODS: Study population is non-institutionalized civilians in the United States (2006-2014). Standardized audio computer-assisted self-interviews were used to assess the date of first full drink and the date of first HDE (i.e., 5+ drinks on one occasion) among ∼33,000 12-to-21-year-old newly incident drinkers (all with 1st full drink and HDE evaluated within 24 months of drinking onset). Time-to-HDE survival analyses are used to estimate age-specific male-female ratios in the hazard of HDE onset. RESULTS: We found that among early adolescent new drinkers (drinking onset at age 11-14), the newly incident drinking females progress to HDE more quickly than males (HR = 1.3, 95% CI = 1.1, 1.6). In contrast, male excess risk is observed when drinking starts at or after age 15 years. For underage drinkers, age-specific hazard ratios (HR) depend upon age at first full drink. CONCLUSIONS: Based on recent survey data from the US, this study's survival analyses support early adolescent female excess in the onset of HDE. When drinking starts at or after age 15 years, a male excess becomes apparent within two years since first full drink. Future studies may probe any sex-specific mechanisms toward the rapid onset of HDE at different age groups.

Female-male differences in alcohol dependence levels: Evidence on newly incident adolescent and young-adult drinkers in the United States, 2002-2014.

OBJECTIVE: In this study of newly incident drinkers (NIDs), we (a) investigate and calibrate measurement equivalence of 7 clinical features of an alcohol dependence syndrome (ADS) across sex and age-of-onset subgroups and (b) estimate female-male differences in ADS levels soon after taking the first full drink, with focus on those with first full drink before the 24th birthday. METHODS: The study population is 12- to 23-year-old NIDs living in the United States (n = 33,561). Calibrated for measurement equivalence, male-female differences in levels of newly incident ADS are estimated for 6 age-of-onset subgroups. RESULTS: Measurement equivalence is achieved by dropping the "difficulty cutting down" item. Then, among early-adolescent-onset NID, females have higher ADS levels (for 12- to 13-year-old NID: ß = .25; 95% CI [0.05, 0.45]). In contrast, when drinking onset is delayed to adulthood, males have higher ADS levels (e.g., for 18- to 19-year-old NID: ß = -.27; 95% CI [-0.52, -0.02]; for 20- to 21-year-old NID: ß = -.38; 95% CI [-0.65, -0.12]). CONCLUSIONS: In the United States, there is female excess in ADS levels measured soon after drinking onset in early adolescence. The traditional male excess is seen when drinking onset occurs after mid-adolescence. Evidence from other countries will be useful.

Age of onset or age at assessment-that is the question: Estimating newly incident alcohol drinking and rapid transition to heavy drinking in the United States, 2002-2014.

Age-specific incidence estimates are important and useful facts in psychiatric epidemiology, but incidence estimation can be challenging. Methods artifacts are possible. In the United States, where the minimum legal drinking age is 21 years, recent cross-sectional field research on 12- to 25-year-olds applied conventional "age-at-assessment" approaches (AAA) for incidence estimation based on 12-month recall. Estimates disclosed unexpected nonlinear patterns in age-specific incidence estimates for both drinking onset and for transitioning from first drink to heavy drinking. Here, our aim is to draw attention to an "age of onset" (AOO) alternative to AAA approaches and to verify whether the AOO approach also discloses nonlinearity. Yearly data are from U.S. nationally representative samples drawn and assessed for National Surveys on Drug Use and Health, 2002-2014, with standardized audio computer-assisted self-interview assessments for drinking outcomes. Both AAA and AOO approaches show nonlinearities, with an unexpected dip in drinking incidence rates after age 18 and before the age 21 minimum legal drinking age. The AOO and the AAA approaches disclosed similar age-specific patterns. We discuss advantages of the AOO approach when nonlinear incidence patterns can be anticipated, but we conclude that the AAA approach has not created an artifactual nonlinear pattern.

Newly incident cannabis use in the United States, 2002-2011: a regional and state level benchmark.

BACKGROUND: Cannabis use and cannabis regulatory policies recently re-surfaced as noteworthy global research and social media topics, including claims that Mexicans have been sending cannabis and other drug supplies through a porous border into the United States. These circumstances prompted us to conduct an epidemiological test of whether the states bordering Mexico had exceptionally large cannabis incidence rates for 2002-2011. The resulting range of cannabis incidence rates disclosed here can serve as 2002-2011 benchmark values against which estimates from later years can be compared. METHODS: The population under study is 12-to-24-year-old non-institutionalized civilian community residents of the US, sampled and assessed with confidential audio computer-assisted self-interviews (ACASI) during National Surveys on Drug Use and Health, 2002-2011 (aggregate n âˆ¼ 420,000) for which public use datasets were available. We estimated state-specific cannabis incidence rates based on independent replication sample surveys across these years, and derived meta-analysis estimates for 10 pre-specified regions, including the Mexico border region. RESULTS: From meta-analysis, the estimated annual incidence rate for cannabis use in the Mexico Border Region is 5% (95% CI [4%-7%]), which is not an exceptional value relative to the overall US estimate of 6% (95% CI [5%-6%]). Geographically quite distant from Mexico and from states of the western US with liberalized cannabis policies, the North Atlantic Region population has the numerically largest incidence estimate at 7% (95% CI [6%-8%]), while the Gulf of Mexico Border Region population has the lowest incidence rate at 5% (95% CI [4%-6%]). Within the set of state-specific estimates, Vermont's and Utah's populations have the largest and smallest incidence rates, respectively (VT: 9%; 95% CI [8%-10%]; UT: 3%; 95% CI [3%-4%]). DISCUSSION: Based on this study's estimates, among 12-to-24-year-old US community residents, an estimated 6% start to use cannabis each year (roughly one in 16). Relatively minor variation in region-wise and state-level estimates is seen, although Vermont and Utah might be exceptional. As of 2011, proximity to Mexico, to Canada, and to the western states with liberalized policies apparently has induced little variation in cannabis incidence rates. Our primary intent was to create a set of benchmark estimates for state-specific and region-specific population incidence rates for cannabis use, using meta-analysis based on independent US survey replications. Public health officials and policy analysts now can use these benchmark estimates from 2002-2011 for planning, and in comparisons with newer estimates.

Relationship of drinking motives with alcohol consumption and alcohol-related problems identified in a representative community-based study from Ningxia, China.

BACKGROUND: Drinking motives have been linked to alcohol consumption and drinking-related problems in western countries, but evidence about this relationship is largely lacking for Asian countries. We aim to assess the relationship between drinking motives and drinking-related outcomes in China, where alcohol use disorders are an increasingly important contributor to the overall burden of illness. METHODS: Validated Chinese versions of the Drinking Motives Questionnaire-Revised (DMQ-R) and the Alcohol Use Disorder Identification Test (AUDIT) were used to assess drinking motives and drinking-related outcomes among 612 current drinkers identified from a cross-sectional survey of a representative sample of 2425 adults living in Ningxia Province in 2013. Structural equation modeling was used to estimate the relationships linking specific drinking motives ('enhancement', 'conformity', 'social' and 'coping') to drinking-related outcomes ('level of alcohol consumption', 'alcohol dependence' and 'adverse consequences'). FINDINGS: The enhancement motive is significantly associated with the level of alcohol consumption (ß=0.52, 95% CI=0.27, 0.78). The conformity motive is associated with higher levels of alcohol dependence (ß=0.74, 95% CI=0.50, 0.98) and adverse consequences of drinking (ß=0.43, 95% CI=0.04, 0.81). The social motive and drinking to cope motive are not significantly associated with any of the three drinking outcomes. INTERPRETATION: The relationships between drinking motives and drinking-related outcomes in China are quite different from those reported in western countries. This study highlights the need to consider local context when adapting prevention or intervention strategies developed in western countries to address the problem of the harmful use of alcohol in China.

Prevalence, correlates, comorbidity, and age of onset of alcohol use disorders in adult males from five provinces in China.

BACKGROUND: This study integrates data from high-quality mental health surveys in five provinces in China to examine the prevalence, demographic correlates, age of onset, and comorbidity of alcohol use disorder (AUD). METHODS: The five cross-sectional surveys initially screened a representative sample of 74,752 community-living adults (94% response rate) from a sampling population including over 12% of China's adult population. Psychiatrists then administered a detailed diagnostic exam to an enriched sample of 21,015 respondents (95% response rate). The prevalence of AUD in females in China is below 0.5%, so we limited our analysis to 9619 males who completed the diagnostic interview. RESULTS: Using meta-analyses to summarize estimates across the five locations, the current (30-day) prevalence of AUD among adult Chinese males was 9.8% (95% CI=5.7-16.9%), but there was wide cross-province variation. After adjusting for age and other demographic variables, the prevalence of AUD was significantly lower in single men than in married men (OR=0.4, CI=0.2-0.7), lower in men who were not currently working than in men who were currently working (OR=0.7, CI=0.5-0.96), and lower in men with comorbid mental disorders than in men without comorbid mental disorders (OR=0.4, CI=0.2-0.8). The risk of developing AUD peaked at 30 years of age. CONCLUSIONS: Substantial differences in the demographic correlates and age of onset of AUD in men in China compared to those reported in other countries highlight the importance of understanding the country-specific and region-specific profile of AUD before developing intervention and prevention strategies.