Introducing a Real-Time Method for Identifying the Predictors of Noncompliance with Event-Based Reporting of Tobacco Use in Ecological Momentary Assessment.

BACKGROUND: Little is known about the factors that bias event-based (i.e., self-initiated) reporting of health behaviors in ecological momentary assessment (EMA) due to the difficulty inherent to tracking failures to self-initiate reports. PURPOSE: To introduce a real-time method for identifying the predictors of noncompliance with event-based reporting. METHODS: N = 410 adults who used both cigarettes and e-cigarettes completed a 1-week EMA protocol that combined random reporting of current contexts with event-based reporting of tobacco use. Each random assessment first asked if participants were currently using tobacco and, if so, the assessment converted into a "randomly captured" event report-indicating failure to self-initiate that report. Multilevel modeling tested predictors of failing to complete random reports and failing to self-initiate event reports. RESULTS: On the person level, male sex, higher average cigarette rate, and higher average cigarette urge each predicted missing random reports. The person-level predictors of failing to self-initiate event reports were older age, higher average cigarette and e-cigarette rates, higher average cigarette urge, and being alone more on average; the moment-level predictors were lower cigarette urge, lower positive affect, alcohol use, and cannabis use. Strikingly, the randomly captured events comprised more of the total EMA reports (28%) than did the self-initiated event reports (24%). These report types were similar across most variables, with some exceptions, such as momentary cannabis use predicting the random capture of tobacco events. CONCLUSIONS: This study demonstrated a method of identifying predictors of noncompliance with event-based reporting of tobacco use and enhancing the real-time capture of events.

This study introduced a real-time method for identifying person- and moment-level predictors of failing to self-initiate tobacco event reports during ecological momentary assessment (EMA), and for capturing a large number of events that would have likely otherwise been missed. The method has implications for behavioral health research more broadly.

The Mood Boost from Tobacco Cigarettes is More Erratic with the Additions of Cannabis and Alcohol.

INTRODUCTION: A large body of literature indicates that nicotine results in an acute mood "boost," including increased positive affect and decreased negative affect. Young adults frequently engage in polysubstance use of cigarettes with cannabis and alcohol-a trend that is likely to accelerate with the expanding legalization of cannabis. However, little is known about whether polysubstance use, defined here as combustible tobacco cigarette use within the same hour as cannabis and alcohol, is associated with changes in the nicotine mood boost. The present study aimed to address this gap. METHODS: Young adults (N = 202, 52% female, mean age = 21 years at time 1) provided ecological moments assessment (EMA) reports of cigarette use over two 7-day bursts spaced 1 year apart. In each report, participants rated mood levels before and after smoking, and indicated cannabis and alcohol use. Mixed-effects location-scale modeling simultaneously tested changes in mood levels and variability related to smoking events with cannabis and/or alcohol compared with smoking-only events. RESULTS: From before to after smoking, positive affect increased and negative affect decreased, on average. Overall, the additions of cannabis and/or alcohol had nonsignificant associations with these mean changes. However, polysubstance use, as well as cigarette-cannabis co-use, were each associated with significantly greater within-person variability in the positive and negative affect changes related to smoking. CONCLUSIONS: The mood benefits associated with smoking were more erratic in the contexts of polysubstance use and cigarette-cannabis co-use. Potential implications for young adults' long-term nicotine use trajectories are discussed. IMPLICATIONS: Among young adults who smoke cigarettes, the mood "boost" from smoking may be more erratic-which is to say, more likely to be either amplified or attenuated-with the additions of cannabis and alcohol together, or cannabis alone. On occasions when young adults seek out cannabis and alcohol to enhance their smoking mood boost, but instead experience a dampening effect, they might consume more nicotine, contributing over time to greater dependence. Future investigation is warranted, with particular attention to nicotine-cannabis co-use.

Religion-Related Child Maltreatment: A Profile of Cases Encountered by Legal and Social Service Agencies.

Religion can foster, facilitate, and be used to justify child maltreatment. Yet religion-related child abuse and neglect have received little attention from social scientists. We examined 249 cases of religion-related child maltreatment reported to social service agencies, police departments, and prosecutors' offices nationwide. We focused on cases involving maltreatment perpetrated by persons with religious authority, such as ministers and priests; the withholding of medical care for religious reasons; and abusive attempts to rid a child of supposed evil. By providing a descriptive statistical profile of the major features of these cases, we illustrate how these varieties of religion-related child maltreatment occur, who the victims and perpetrators are, and how religion-related child abuse and neglect are reported and processed by the social service and criminal justice systems. We end with a call for greater research attention to these important offenses against children.

The role of decision-making in cannabis-related problems among young adults.

BACKGROUND: Deficits in decision-making and episodic memory are often reported among heavy cannabis users, yet little is known on how they influence negative consequences from cannabis use. Individual differences in decision-making may explain, in part, why some individuals experience significant problems from their cannabis use whereas others do not. We hypothesized that poor decision-making would moderate relationships between amount of cannabis use and problems from cannabis use whereas episodic memory performance would not. METHOD: Young adult cannabis users (n=52) with cannabis as their drug of choice and with minimal comorbidities completed semi-structured interviews, self-report questionnaires, and measures of neurocognitive functioning, with decision-making accessed via the Iowa Gambling Task (IGT), episodic memory via the Hopkins Verbal Learning Test - Revised (HVLT) and problems from cannabis use with the Marijuana Problems Scale. RESULTS: Strong relationships were observed between amount of cannabis use (lifetime, 12-month, and 30-day) and problems reported from use, but only among participants with low (impaired) decision-making (R(2)=.39 to .51; p<.01). No significant relationships were observed among those with better (low average to high average) decision-making performance (p>.05). In contrast, episodic memory performance was not a significant moderator of the relationship between amount of cannabis use and cannabis problems (p>.05). CONCLUSIONS: Cannabis users with poor decision-making may be at greater risk for experiencing significant negative consequences from their cannabis use. Our results lend further support to emerging evidence of decision-making as a risk factor for addiction and extend these findings to cannabis users.

Performance of young adult cannabis users on neurocognitive measures of impulsive behavior and their relationship to symptoms of cannabis use disorders.

Recent studies suggest that abstinent cannabis users show deficits on neurocognitive laboratory tasks of impulsive behavior. But results are mixed, and less is known on the performance of non-treatment-seeking, young adult cannabis users. Importantly, relationships between performance on measures of impulsive behavior and symptoms of cannabis addiction remain relatively unexplored. We compared young adult current cannabis users (CU, n = 65) and nonusing controls (NU, n = 65) on several laboratory measures of impulsive behavior, as well as on a measure of episodic memory commonly impacted by cannabis use. The CU group performed more poorly than the NU group on the Hopkins Verbal Learning Test-Revised Total Immediate Recall and Delayed Recall. No significant differences were observed on the measures of impulsive behavior (i.e., Iowa Gambling Task, IGT; Go-Stop Task; Monetary Choice Questionnaire; Balloon Analogue Risk Task). We examined relationships between neurocognitive performance and symptoms of cannabis use disorder symptoms (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, DSM-IV CUD) among the CU group, which revealed that poorer IGT performance was associated with more symptoms of DSM-IV CUD. Our results show poorer memory performance among young adult cannabis users than among healthy controls, but no differences on measures of impulsive behavior. However, performance on a specific type of impulsive behavior (i.e., poorer decision making) was associated with more cannabis use disorder symptoms. These results provide preliminary evidence to suggest that decision-making deficits may be more strongly associated with problems experienced from cannabis use, rather than solely being a consequence of cannabis use, per se.

Recruitment and retention of adolescents in a smoking trajectory study: who participates and lessons learned.

Recruitment of adolescents into tobacco use research is often challenging. This study reports on the predictors of recruitment and retention in a longitudinal study of adolescent smoking behavior. In 2000, 8th and 10th grade students at 18 schools (N = 5,298) in the Chicago metropolitan area completed brief screening surveys; 1457 students (ranging from susceptible nonsmokers to regular smokers) were invited to participate in a longitudinal study, and 48.9% agreed. Chi-square analyses revealed that female and white students were more likely to participate than male and nonwhite students. Recruitment rates did not vary by parental smoking status, students' experience with smoking, or student grade. Multivariate analyses revealed that overall, gender and race were significant predictors of participation. Chi-square and multivariate analyses revealed no significant differences in retention on the demographic, smoking experience, or psychosocial variables measured. Implications of the results and study limitations are discussed.

Human participants challenges in youth tobacco cessation research: researchers' perspectives.

Recruiting adolescents into smoking cessation studies is challenging, particularly given institutional review board (IRB) requirements for research conducted with adolescents. This article provides a brief review of the federal regulations that apply to research conducted with adolescents, and describes researchers' experiences of seeking IRB approval for youth cessation research. Twenty-one researchers provided information. The most frequently reported difficulty involved obtaining parental consent. Solutions to commonly reported problems with obtaining IRB approval are also identified. Waivers of parental consent can facilitate recruitment of youths into studies; however, researchers must ensure that their protocols comply with federal regulations when requesting a waiver.