Momentary Craving, Craving Variability, and Cannabis Use: Associations With THC Concentrates and Sex.

OBJECTIVE: Ecological momentary assessment (EMA) studies are well positioned to assess the impact of craving on cannabis use in real time and may better capture its time-varying nature. The goal of this exploratory study was to examine whether momentary craving and craving variability predict subsequent use of cannabis and how baseline concentrate use status and male sex might affect these relationships. METHOD: College students residing in a state with legal recreational cannabis use who used cannabis twice a week or more completed a baseline interview and signal-contingent EMA for 2 weeks using a smartphone application. Hierarchical (multi-level) regression was used to examine time-lagged associations between craving, craving variability, and subsequent cannabis use. Baseline concentrate use and male sex were examined as moderators. RESULTS: Participants (N = 109) included 59% women, with an average age of 20.2 years, and most using cannabis near-daily or daily. A main effect for craving (within-level effect) on the likelihood of cannabis use at the next EMA instance was found (odds ratio = 1.292, p < .001), although this effect was moderated by concentrate use status. For men, between-level increases in craving led to a greater likelihood of cannabis use at the next instance, but greater craving variability led to a lower likelihood of use. Greater variability in craving was associated with a greater likelihood of cannabis use among those using concentrates. CONCLUSIONS: The experience of craving may differ based on important participant characteristics. More research examining the fluctuating nature of craving and the role of cannabis potency on craving is warranted.

Momentary patterns of alcohol and cannabis co-use in college students: Assessing the temporal association with anxiety.

Using ecological momentary assessment (EMA), we assessed momentary patterns of alcohol and cannabis co-use in college students and whether state-level and baseline reports of anxiety varied based on type of substance(s) consumed. Students (N=109) reporting regular cannabis use completed a baseline assessment and two-week signal-contingent EMA, with three random prompts/day. At each EMA instance, we categorized instances of substance "usage" as: 1) no use, 2) cannabis-only, 3) alcohol-only, or 4) co-use of alcohol and cannabis (i.e., reports of alcohol and cannabis use within the same prompt). Using temporal sequenced data, we explored how state-level anxiety varied before and after usage type using multiple multilevel structural equation models (MSEMs) and whether baseline factors (general anxiety, social anxiety, and sex) influenced the relation between usage type and state-level anxiety. Participants were 63.3% White, 58.7% female, used cannabis near-daily, and commonly reported co-use. Models examining whether usage type predicted subsequent state-level anxiety were predominantly significant, with the majority of relationships being more pronounced for participants with higher baseline general anxiety. In examining whether momentary state-level anxiety predicted usage type, in instances when participants reported higher levels of momentary anxiety, they were more likely to report no use compared to co-use and cannabis-only, with sex moderating some of the relationships. Social anxiety did not moderate any of the within-person associations between state-level anxiety and usage type. This study provides preliminary evidence that report of momentary anxiety varies based on substance type. Future research is needed to establish co-use related synergistic effects and correlates.

Characterizing symptoms of cannabis use disorder in a sample of college students.

Since legalization of marijuana in several U.S. states in 2012, there has been concern about increases in the development of cannabis use disorder (CUD). The current study examined rates of CUD in Colorado college students who reported regular marijuana use and assessed a range of factors associated with CUD symptoms, including coping motives, concentrate/dab use, mental health concerns (depression, anxiety), age of regular marijuana use, and alcohol use. College students were recruited from a mid-sized university and completed a baseline assessment that included a marijuana urine screen. Participants reported a median of five CUD symptoms and 90% met criteria for CUD. After adjusting for covariates, age of regular marijuana use was negatively associated with number of CUD symptoms, while average daily alcohol drinks was positively associated with number of symptoms. Prevention and intervention efforts at the university level should be increased to reduce negative outcomes associated with problem marijuana use.

Feasibility of a combined aerobic and cognitive training intervention on cognitive function in cancer survivors: a pilot investigation.

BACKGROUND: Cancer-related cognitive impairment (CRCI) may negatively affect upwards of 75% of cancer patients. Exercise and cognitive training, independently, may increase functional capacity and aspects of cognitive function. Yet, combined training protocols have not been evaluated in cancer survivor populations. Therefore, the aim of this study was to explore the feasibility of a quasi-randomized, controlled, exploratory, repeated-measures aerobic and cognitive training intervention on cognitive function in participants undergoing treatment for cancer (N = 28). METHODS: Pre- and post-physical and cognitive assessments were administered. A 36-session (approximately 12 weeks) computer-based cognitive (COG), aerobic (AER), cognitive and aerobic (AER + COG), and flexibility (CON) training intervention was completed. Dependent measures t tests and pre- to post percentages were then calculated to address within-group changes for each dependent variable. RESULTS: Within-group measures revealed that the AER logical memory scores (pre- to post mean difference [2.3], 95.0% CI [0.9, 3.7], percentage change [32.7%]), delayed recall scores (pre- to post mean difference [2.1], 95.0% CI [0.3, 3.9], percentage change [27.2%]), block design scores (pre- to post mean difference [1.7], 95.0% CI [0.2, 3.2], percentage change [19.0%]), and letter-number sequencing scores (pre- to post mean difference [1.0], 95.0% CI [0.2, 1.8], percentage change [12.3%]) all increased. Aspects of verbal fluidity scores increased in the CON group. However, all cognitive scores (AER + COG and COG groups) failed to increase. CONCLUSIONS: Aerobic training for CRCI may positively impact cognitive function. Individually, these methods may appropriately address CRCI, but combined training of this nature may be too demanding for patients undergoing treatment for cancer. However, larger randomized trials are needed to substantiate this protocol in large-scale cancer rehabilitation centers.

Does social context matter? An ecological momentary assessment study of marijuana use among college students.

INTRODUCTION: Past research has shown that marijuana use occurs commonly in social situations for young adults, though few studies have examined the association between immediate social context and marijuana use patterns and associated problems. The current study examined the impact of demographics, marijuana use and problem use, alcohol use, craving, and social context on the likelihood of using marijuana with others via ecological momentary assessment (EMA). METHODS: College-student marijuana users (N=56) were recruited and completed a baseline assessment and training on the two-week signal-contingent EMA protocol. Participants were sent text messages three times per day randomly for two weeks. RESULTS: Of the 1131 EMA instances during which participants reported using marijuana, 862 (76.22%) were labeled as being with others. Forty-five participants (80.36%) reported marijuana use with others present during at least half of the times they used marijuana. Findings from a multilevel logistic regression model showed a significant positive association between the probability of using with others and minutes spent using marijuana (b=0.047, p<0.001), social facilitation (b=0.138, p<0.001), and DSM-IV diagnosis (dependence versus no diagnosis, b=1.350, p=0.047). CONCLUSIONS: Cannabis dependence, more time using marijuana in the moment, and using for social facilitation purposes were positively associated with using marijuana in the context of being with others. Daily users had more variability in terms of the social context of their use. This study illustrates the complex relationship between social context and marijuana use.

Marijuana use and associated motives in Colorado university students.

BACKGROUND AND OBJECTIVES: Marijuana is the most commonly used illicit drug among college students, with heavy use leading to negative outcomes. Use of marijuana for medical and recreational purposes in select U.S. states has been controversial, with concerns surrounding increased prevalence rates and harm. The current exploratory study aimed to assess marijuana use in college students in Colorado, demographic differences in frequency of use, and motives for using. METHODS: College students (N = 300; 61% female) were recruited through introductory psychology courses and completed a series of questionnaires and a marijuana urine screen. RESULTS: Almost three-fourths of the sample reported lifetime use of marijuana. Sixty-five percent used marijuana within the last year and 29% tested positive on the urine screen. Hurdle Poisson regression models with a subset of participants (n = 117) showed non-Greek and freshman status were associated with increased number of days participants used marijuana in the last month. Problem marijuana use was positively associated with a range of motives-of note-motives focused on coping, boredom, alcohol, and food. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Prevalence rates of marijuana use were high in this sample of college students in a state with legal recreational marijuana use. Particular students (eg, students who use marijuana to cope) may be at higher risk for problem marijuana use. Developing effective, tailored interventions for university students is warranted. (Am J Addict 2017;26:830-837).

Marijuana use, craving, and academic motivation and performance among college students: An in-the-moment study.

INTRODUCTION: Marijuana is the most commonly used illicit substance in the U.S., with high rates among young adults in the state of Colorado. Chronic, heavy marijuana use can impact cognitive functioning, which has the potential to influence academic performance of college students. It is possible that craving for marijuana may further contribute to diminished cognitive and affective functioning, thus leading to poor outcomes for students. METHODS: College student marijuana users (n=57) were recruited based on heavy use and completed ecological momentary assessment (EMA) via text-messaging. The association between marijuana use and craving in a college setting was explored, as well as how these variables might relate to academic motivation, effort and success. The participants were sent text messages for two weeks, three times per day at random times. RESULTS: A temporal association between craving and marijuana use was found, where momentary craving positively predicted greater marijuana use. Similarly, as craving levels increased, the number of minutes spent studying decreased at the next assessment point. A negative association between momentary craving for marijuana and academic motivation was found in the same moment. Greater academic self-efficacy positively predicted cumulative GPA, while average minutes spent smoking marijuana was negatively related. CONCLUSIONS: Using EMA, marijuana craving and use were significantly related. These findings provide further evidence that heavy marijuana use is negatively associated with academic outcomes.

Early mobility in the intensive care unit: Standard equipment vs a mobility platform.

BACKGROUND: Despite the general belief that mobility and exercise play an important role in the recovery of functional status, mobility is difficult to implement in patients in intensive care units. OBJECTIVES: To compare a mobility platform with standard equipment, assessing efficiency (decreased time and staff required to prepare patient), effectiveness (increased activity time), and safety (no falls, unplanned tube removals, or emergency situations) for intensive care patients. METHODS: This observational study was approved by the institutional review board, and informed consent was obtained from the patient or the medical decision maker. Intensive care patients were assigned to a room in the usual manner, with platforms in odd-numbered rooms and standard equipment in even-numbered rooms. Standardized data collection tools were designed to collect data for 24 hours for each patient. The nurses caring for the patients completed the data collection tools in real time during the activity. The stages of activity and the physiological states that would preclude mobility were very specifically defined for the research study. RESULTS: Data were collected for a total of 71 patients and 238 activities. Important (although not significant) descriptive statistics regarding early mobility in the intensive care unit were discovered. The unintended result of the research study was a change in the culture and practice regarding early mobility in the intensive care unit. CONCLUSIONS: Early mobility can be implemented in intensive care units. Standard equipment can be used to mobilize such patients safely; however, for patients who ambulate, a platform may increase efficiency and effectiveness.

GMM logistic regression models for longitudinal data with time-dependent covariates and extended classifications.

When analyzing longitudinal data, it is essential to account both for the correlation inherent from the repeated measures of the responses as well as the correlation realized on account of the feedback created between the responses at a particular time and the predictors at other times. As such one can analyze these data using generalized estimating equation with the independent working correlation. However, because it is essential to include all the appropriate moment conditions as you solve for the regression coefficients, we explore an alternative approach using a generalized method of moments for estimating the coefficients in such data. We develop an approach that makes use of all the valid moment conditions necessary with each time-dependent and time-independent covariate. This approach does not assume that feedback is always present over time, or if present occur at the same degree. Further, we make use of continuously updating generalized method of moments in obtaining estimates. We fit the generalized method of moments logistic regression model with time-dependent covariates using SAS PROC IML and also in R. We used p-values adjusted for multiple correlated tests to determine the appropriate moment conditions for determining the regression coefficients. We examined two datasets for illustrative purposes. We looked at re-hospitalization taken from a Medicare database. We also revisited data regarding the relationship between the body mass index and future morbidity among children in the Philippines. We conducted a simulated study to compare the performances of extended classifications.

Cancer type does not affect exercise-mediated improvements in cardiorespiratory function and fatigue.

PURPOSE: Despite mounting evidence indicating that exercise training has a positive effect on cancer recovery, the influence of cancer type on the response to exercise training remains uncharacterized. Therefore, the adaptations to exercise training were compared between groups composed of 7 different forms of cancer. METHODS: A total of 319 cancer survivors completed fatigue inventories and participated in assessments of cardiorespiratory function, which encompassed aerobic capacity (VO2 peak), pulmonary function (forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1]), and resting blood pressure and heart rate. Participants were divided into 7 groups based on cancer type, including breast cancer (BC, n = 170), prostate cancer and other male urogenital neoplasia (PC, n = 38), hematological malignancies (HM, n = 34), colorectal cancer (CC, n = 25), gynecological cancers (GC, n = 20), glandular and epithelial neoplasms (GEN, n = 20), and lung cancer (LC, n = 12). All participants completed an individualized, multimodal exercise intervention consisting of cardiorespiratory, flexibility, balance, and muscular strength training 3 days per week for 3 months. Following the intervention, all subjects were reassessed. Generalized Estimating Equations with exchangeable working correlation structure was used to model each response; the group by time interaction effect represented the effect of cancer type on exercise-associated improvements. RESULTS: No significant (P > .05) group by time interaction effects were observed between different types of cancer for any parameter. Pre- to postexercise contrasts revealed significant improvements in VO2 peak in BC, PC, HM, and GEN at the Bonferroni adjusted significance level (.00714). Heart rate was significantly lowered in the BC and CC groups. Mean fatigue indices decreased by at least 17% in all groups, but these changes were only significant in the BC, HM, CC, and GC groups. Systolic blood pressure decreased significantly in BC and GC, and diastolic blood pressure decreased significantly only in the BC group while pulmonary function remained unchanged in all cancer types. CONCLUSION: Although trends toward improved cardiorespiratory and fatigue parameters only reached significance in some groups, there were no significant differences between cancer types. This suggests that cardiorespiratory and fatigue improvements following rehabilitative exercise are not dependent on cancer type. Further research investigating alternative physiological parameters are needed to confirm the relationship between cancer type and exercise-mediated rehabilitation.

Feasibility of text messaging for ecological momentary assessment of marijuana use in college students.

Measuring self-reported substance use behavior is challenging due to issues related to memory recall and patterns of bias in estimating behavior. Limited research has focused on the use of ecological momentary assessment (EMA) to evaluate marijuana use. This study assessed the feasibility of using short message service (SMS) texting as a method of EMA with college-age marijuana users. Our goals were to evaluate overall response/compliance rates and trends of data missingness, response time, baseline measures (e.g., problematic use) associated with compliance rates and response times, and differences between EMA responses of marijuana use compared to timeline followback (TLFB) recall. Nine questions were texted to participants on their personal cell phones 3 times a day over a 2-week period. Overall response rate was high (89%). When examining predictors of the probability of data missingness with a hierarchical logistic regression model, we found evidence of a higher propensity for missingness for Week 2 of the study compared to Week 1. Self-regulated learning was significantly associated with an increase in mean response time. A model fit at the participant level to explore response time found that more time spent smoking marijuana related to higher response times, while more time spent studying and greater "in the moment" academic motivation and craving were associated with lower response times. Significant differences were found between the TLFB and EMA, with greater reports of marijuana use reported through EMA. Overall, results support the feasibility of using SMS text messaging as an EMA method for college-age marijuana users.