Bidirectional relationships between nicotine vaping and maladaptive eating behaviors among young adults.

Background: Past research indicates that young adult cigarette smokers are at risk of engaging in maladaptive eating behaviors (MEBs); however, whether this relationship extends to nicotine vaping is unclear. The current study assessed bidirectional associations between four types of MEBs and nicotine vaping among young adults. Methods: 1,303 young adults (20.5 ± 2.3 years; 63 % female) from a public, urban university were recruited and completed online surveys at six-month intervals from spring 2021 (W1) to spring 2023 (W5). Past 30-day nicotine vaping and four types of MEBs (susceptibility to external cues, emotional eating, routine restraint, and compensatory restraint) were evaluated. Results: Longitudinal cross-lagged models examined the bidirectional relationships between past 30-day nicotine vaping and each type of MEB across five waves. Nicotine vaping predicted both susceptibility to external cues (ß = 0.10, p <.05; Wave 2 to 3) and emotional eating (ß = 0.08, p <.05; Wave 1 to 2). A significant cross-lag regression (Wave 4 to 5) showed nicotine vaping predicted to routine restraint (ß = 0.08, p <.05), and routine restraint predicted to nicotine vaping (ß = 0.12, p <.05). Conclusions: Results indicated that nicotine vaping predicted MEBs; however, the type of MEB differed across waves, which may have been due to the COVID-19 pandemic context. Nicotine vaping predicted to MEBs reflecting vulnerability to the external environment and emotion regulation during a period of heightened restrictions, whereas later when pandemic restrictions had ceased nicotine vaping predicted only to routine restraint. Integrating research and practice on nicotine vaping and MEBs may inform public health efforts to decrease co-occurring health-risks in young adulthood.

Associations of alternative cannabis product use and poly-use with subsequent illicit drug use initiation during adolescence.

RATIONALE: Specific cannabis products may differentially increase risk of initiating non-cannabis illicit drug use during adolescence. OBJECTIVE: To determine whether ever- and poly-use of smoked, vaporized, edible, concentrate, or blunt cannabis products are associated with subsequent initiation of non-cannabis illicit drug use. METHODS: High school students from Los Angeles completed in-classroom surveys. The analytic sample (N = 2163; 53.9% female; 43.5% Hispanic/Latino; baseline M age = 17.1 years) included students who reported never using illicit drugs at baseline (spring, 11th grade) and provided data at follow-up (fall and spring, 12th grade). Logistic regression models assessed associations between use of smoked, vaporized, edible, concentrate, and blunt cannabis at baseline (yes/no for each product) and any non-cannabis illicit drug use initiation-including cocaine, methamphetamine, psychedelics, ecstasy, heroin, prescription opioids, or benzodiazepines-at follow-up. RESULTS: Among those who never used non-cannabis illicit drugs at baseline, ever cannabis use varied by cannabis product (smoked = 25.8%, edible = 17.5%, vaporized = 8.4%, concentrates = 3.9%, and blunts = 18.2%) and patterns of use (single product use = 8.2% and poly-product use = 21.8%). After adjustment for baseline covariates, odds of illicit drug use at follow-up were largest for baseline ever users of concentrates (aOR [95% CI] = 5.74[3.16-10.43]), followed by vaporized (aOR [95% CI] = 3.11 [2.41-4.01]), edibles (aOR [95% CI] = 3.43 [2.32-5.08]), blunts (aOR [95% CI] = 2.66[1.60-4.41]), and smoked (aOR [95% CI] = 2.57 [1.64-4.02]) cannabis. Ever use of a single product (aOR [95% CI] = 2.34 [1.26-4.34]) or 2 + products (aOR [95% CI] = 3.82 [2.73-5.35]) were also associated with greater odds of illicit drug initiation. CONCLUSIONS: For each of five different cannabis products, cannabis use was associated with greater odds of subsequent illicit drug use initiation, especially for cannabis concentrate and poly-product use.

Differential Associations between Weight Status (Obesity, Overweight, and Underweight) and Substance Use in Young Adulthood.

BACKGROUND: Past evidence suggests obesity co-occurs with tobacco/nicotine, cannabis, and alcohol use in young adulthood, but whether this relationship extends to nicotine or cannabis vaping is unclear. Furthermore, differential relationships between substance use and specific weight status categories (obesity, overweight, and underweight) have not been assessed. This study assessed prevalence of tobacco/nicotine, cannabis, and alcohol use by weight status categories in young adulthood. METHODS: Of the 1322 young adults (18-29 years; 20.5 ± 2.3 years; 63% female; 42% Hispanic/Latino/a/x, 30% Asian-American/Asian, 18% Caucasian/White, 7% Multiracial, and 2% African-American/Black) from a public, urban university were surveyed on their health-risk behaviors in the spring and fall of 2021. RESULTS: Multinomial logistic regression models assessed six-month follow-up substance use prevalence (never, lifetime but no past 30-d use, and past 30-d use) by baseline weight status (obese, overweight, underweight; reference: healthy weight). Obesity predicted lower odds of past 30-d nicotine vaping (aOR [95% CI] = 0.27 [0.08-0.92]). Overweight predicted higher odds of lifetime combustible cannabis (aOR [95% CI] = 1.58 [1.08-2.30]) and past 30-d binge drinking (aOR [95% CI] = 1.79 [1.12-2.85]). Underweight was associated with lower odds of lifetime cannabis vaping (aOR [95% CI] = 0.35 [0.12-0.99]) and combustible cannabis (aOR [95% CI] = 0.38 [0.16-0.87]). CONCLUSIONS: Differential relationships between obesity and overweight on tobacco/nicotine, cannabis, and alcohol use suggest greater specificity is needed when evaluating relationships between higher weight status and substance use. It appears that overweight young adults may be at higher risk of substance use than obese young adults. Greater efforts to consider multiple weight status groups, not just obese, may have significant implications for tobacco/nicotine prevention and intervention efforts targeting vulnerable populations.

Weighing the Risk: Developmental Pathways and Processes Underlying Obesity to Substance Use in Adolescence.

Research on co-occurring obesity and substance use in adolescence has grown substantially in the past decade, but questions on the pathways and processes underlying co-occurrence remain. This review first synthesizes empirical findings on the relationship between obesity and substance use (e.g., alcohol, cannabis, tobacco use). Multidisciplinary theoretical frameworks referencing behavioral medicine, neuroscience, psychology, and public health are then used to inform an interdisciplinary, conceptual model focused on pathways and processes by which obesity increases risk of substance use. Recommendations for future research underscore the importance of prospective studies that encompass multiple domains of development. Recommendations for practice include family-based interventions that promote adaptive self-regulation, targeted antibullying or victimization interventions, and increased attention by health professionals on risky behavior associated with adolescent obesity.

Tobacco and cannabis poly-substance and poly-product use trajectories across adolescence and young adulthood.

Tobacco and cannabis poly-substance and poly-product use is common in adolescents and young adults (AYAs), but few studies have examined developmental trajectories of poly-use. This study characterized the prevalence, patterns, and racial/ethnic and sex differences of developmental trajectories of use and poly-use of 8 different widely-marketed tobacco and cannabis products across adolescence and young adulthood. 3322 AYAs from Los Angeles, California completed 5 surveys from fall of 11th grade (2015) to 1-2 years post-high school (2018-2019). Self-reported past 30-day use of three tobacco (nicotine vaping, cigarette, hookah) and five cannabis (combustible, blunt, edible, vaping, dabbing) products were analyzed using parallel growth mixture modeling to identify tobacco and cannabis use and poly-use trajectories; racial/ethnic and sex differences were evaluated as correlates of trajectory membership. Five trajectories were identified: Non-Users (58.6%); Young Adult-Onset Poly-Substance/Poly-Product Users (15.8%); Decreasing Moderate Poly-Substance/Poly-Product Users (9.8%); Increasing Predominant Cannabis Poly-Product Users (8.3%); and Chronic Poly-Substance/Poly-Product Users (7.3%). Within trajectories, developmental patterns of each tobacco and cannabis product were similar. Non-Hispanic White (vs. non-NH White) participants had higher odds of belonging to the Chronic Poly-Substance/Poly-Product Users (vs. Non-Users) trajectory (aOR = 2.24[1.37,3.67]); females (vs. males) had higher odds of belonging to the Young Adult-Onset Poly-Substance/Poly-Product Users (vs. Non-Users) trajectory (aOR = 1.30[1.02-1.66]). Tobacco and cannabis poly-substance use patterns, including use of various products, appear to be a common developmental trajectory during some point in adolescence and young adulthood. The interplay of tobacco and cannabis poly-substance/poly-product use merit attention in prevention and regulatory policies to protect AYA health.

Sociodemographic differences in young adults' recall of tobacco and cannabis marketing online and in television/film.

Young adults (YA) who report viewing pro-tobacco and cannabis marketing are at increased risk for using tobacco and cannabis. However, there is a growing diversity of tobacco and cannabis products on the market, as well as methods for marketing them. Prevalence of, and sociodemographic differences in, YA's recall of various types of tobacco and cannabis marketing is not well-characterized. Data were from a cohort of YA (mean age: 19.8) from Southern California in 2019. Respondents were asked whether they recalled having seen two types of marketing (online advertisements and portrayals of product use in TV/movies) for 5 tobacco and 3 cannabis products among never-users of tobacco (N = 954) and cannabis (N = 1,046), respectively. Sociodemographic differences in marketing recall were subsequently assessed. Among tobacco-naïve respondents, 31.3% and 49.3% recalled seeing online advertisements and tobacco use in TV/movies, respectively. Among cannabis-naïve respondents, 18.7% and 31.0% recalled seeing online advertisements and cannabis use in TV/movies, respectively. Overall, respondents recalled seeing tobacco and cannabis products on TV/movies at higher rates than seeing online advertisements, with the exception of electronic cigarettes, for which online advertisements were seen at higher rates. Women (vs. men) had higher odds of seeing tobacco (aOR = 1.9) and cannabis use in TV/movies (aOR = 1.4) and cannabis marketing online (aOR = 1.4). LGB (vs. straight) respondents had higher odds of seeing cannabis marketing online (aOR = 1.7). Efforts to regulate exposure to tobacco and cannabis marketing among young women and LGB people merit further consideration.

Trajectories of Nicotine and Cannabis Vaping and Polyuse From Adolescence to Young Adulthood.

Importance: Little is known about cannabis vaping trajectories across adolescence and young adulthood or the co-occurrence with nicotine vaping. Objective: To evaluate nicotine vaping and cannabis vaping trajectories from late adolescence to young adulthood (≥18 years of age) and the extent of polysubstance vaping. Design, Setting, and Participants: In this prospective cohort study, 5 surveys (including information on substance vaped) were completed at 10 high schools in the Los Angeles, California, metro area. Students were surveyed at 6-month intervals from fall of 11th grade (October to December 2015; wave 5) through spring of 12th grade (March to June 2017; wave 8) and again approximately 1 to 2 years after high school (October 2018 to October 2019; wave 9). Exposures: Past 30-day nicotine and cannabis vaping frequency across 5 waves. Main Outcomes and Measures: Self-reported frequency of nicotine vaping and cannabis vaping within the past 30 days across 5 time points from late adolescence to young adulthood. Trajectories were measured with these past 30-day use frequencies at each wave. Parallel growth mixture modeling estimated conditional probabilities of polysubstance vaping. Results: The analytic sample included 3322 participants with at least 1 time point of data (mean [SD] age, 16.50 [0.42] years at baseline; 1777 [53.5%] female; 1573 [47.4%] Hispanic or Latino). Growth mixture modeling identified the 5-trajectory model as optimal for both nicotine vaping and cannabis vaping. Trajectories for nicotine and cannabis vaping were similar (nonusers: 2246 [67.6%] nicotine, 2157 [64.9%] cannabis; infrequent users: 566 [17.0%] nicotine, 608 [18.3%] cannabis; moderate users: 167 [5.0%] nicotine, 233 [7.0%] cannabis; young adult-onset frequent users: 213 [6.4%] nicotine, 190 [5.7%] cannabis; adolescent-onset escalating frequent users: 131 [3.9%] nicotine, 134 [4.0%] cannabis). Males had greater odds of belonging to the adolescent-onset escalating frequent users nicotine (adjusted odds ratio, 2.88; 95% CI, 1.58-5.23; P < .01) and cannabis (adjusted odds ratio, 1.95; 95% CI,1.03-3.66; P < .05) vaping trajectories compared with nonusers. Polysubstance vaping was common, with those in trajectories reflecting more frequent nicotine vaping (adolescent-onset escalating frequent users and young adult-onset frequent users) having a high probability of membership (85% and 93%, respectively) in a cannabis-use trajectory. Conclusions and Relevance: In this cohort study, the prevalence and type of nicotine vaping and cannabis vaping developmental trajectories from late adolescence to young adulthood were similar. Polysubstance vaping was common from late adolescence to young adulthood, particularly among those reporting more frequent vaping use. The findings suggest that public health policy and clinical interventions should address polysubstance vaping in both adolescence and young adulthood.

Young adult e-cigarette use: A latent class analysis of device and flavor use, 2018-2019.

OBJECTIVE: The myriad of e-cigarette devices and flavors used by young adults (YAs) complicates identification of the particular e-cigarette products that are associated with more frequent tobacco use and merit consideration for regulation. The current study used latent class analysis to identify distinct patterns of e-cigarette device and flavor use and evaluate their association with vaping and smoking frequency. METHODS: Cross-sectional survey data (2018-2019) from a Southern California cohort were analyzed. YAs reporting past 30-day nicotine vaping (N = 550; M age = 19.2 years) self-reported e-cigarette device type/brand and flavor. Six device (e-cig/vape pen, mech mod, box mod, JUUL, non-JUUL pod, disposable) and three flavor (tobacco, mint/menthol, sweet/fruit) indicators were included in a latent class analysis. Past 30-day nicotine vaping and cigarette smoking frequency were assessed as correlates of device and flavor class membership. RESULTS: Three classes were identified: Any Pod-Mint/Menthol or Sweet/Fruit Flavor Users (prevalance:47%); Non-JUUL-Sweet/Fruit Flavor Users (28%); and Poly-Device-Poly-Flavor Users (25%). Greater frequency of vaping and smoking were associated with higher odds of belonging to the Poly-Device-Poly-Flavor Users class vs. the Any Pod-Mint/Menthol or Sweet/Fruit Flavor Users (vaping: aOR[95%CI] = 1.36[1.16, 1.59], p < .001; smoking: aOR[95%CI] = 1.25[1.02, 1.54], p = .03) and Non-JUUL-Sweet/Fruit Flavor Users (vaping: aOR[95%CI] = 1.30[1.10, 1.53], p < .01; smoking: aOR[95%CI] = 1.42[1.07, 1.88], p = .02) classes. CONCLUSIONS: Although YAs that predominately used pod devices alongside non-tobacco flavors were most common, YAs characterized by a proclivity toward using many different devices and flavors were appreciably prevalent and smoked and vaped more frequently. Regulations targeting a wide spectrum of vaping products may be optimal in protecting YA health.

E-cigarette use among young adults: A latent class analysis examining co-use and correlates of nicotine vaping.

INTRODUCTION: Although a significant proportion of young adults report e-cigarette use (nicotine vaping), little is known about co-use with other substances, including correlates that predict co-use. The current study aimed to identify co-occurring substance use patterns and evaluate multiple correlates in a college student sample. METHODS: 435 participants (21.4 ± 2.9 years; 57% women; 41% Hispanic/Latina/o, 29% Asian-American/Pacific Islander, 17% Caucasian/White, 6% Multiracial, and 5% African-American/Black) from a large, urban university were recruited in-person and completed an online survey in the fall of 2018 and the spring of 2019. RESULTS: Using latent class analysis (LCA), four substance use patterns were identified: Binge Drinkers (7%); e-cigarette Users (8%); Cannabis Users (14%); and Low Substance Users (71%). The e-cigarette Users class was characterized by moderate or greater use (>5 days of nicotine vaping in past 30-days) as well as past 30-day binge drinking and cannabis use. Higher levels of deviant peer affiliation (aOR = 1.28[1.11-1.47], p < .01), impulsivity-lack of premeditation (aOR = 1.36[1.05-1.78], p < .05), and lower levels of social anxiety (aOR = 0.94[0.88-0.99], p < .05), predicted membership in the e-cigarette Users class. CONCLUSIONS: The most pervasive co-occurring substance use was observed among the e-cigarette Users class. Young adults reporting moderate or greater levels of nicotine vaping tended to engage in binge drinking and cannabis use, which may ultimately increase risk of deleterious health outcomes. Deviant peer affiliation and impulsivity-lack of premeditation (but not internalizing symptoms) predicted membership in the e-cigarette Users class; consequently, public health efforts may benefit from increased selectivity in targeting young adults for e-cigarette prevention and intervention services.

Parenting With a Substance Abuse History: The Moderating Role of Parenting Behaviors on Obesity and Internalizing Symptoms in Adolescence.

Although numerous studies have shown that child obesity is associated with internalizing symptoms, relatively few studies have examined the role of parenting behaviors on this relationship. Youth meeting obesity status may be at higher risk of psychosocial maladjustment when exposed to more vulnerable parenting contexts. The current study interviewed mothers with a history of substance abuse to assess whether parenting behaviors moderated the relationship between obesity and internalizing symptoms among adolescents (N = 160; 51% girls; M = 12.76 years). Hierarchical regression analyses identified physical discipline as a moderator; girls meeting obesity status displayed higher levels of internalizing symptoms when exposed to higher versus lower levels of physical discipline. Prevention/intervention efforts targeting mothers with substance abuse histories should aim to not only improve physical and emotional health but also highlight the connections between physical and emotional health and the influence of parenting behaviors on associations.

Alcohol use, mental health, and parenting practices among HIV-positive mothers.

Mothers living with HIV (MLH) must balance childcare, their illness, and oftentimes other mental health problems/stressors. It is important to understand how a maladaptive coping strategy, (alcohol use) is linked to poorer parenting practices. We assessed the relationship between mental health/coping (anxiety, depression, alcohol use, social support) and parenting/family dimensions (communication, parenting style/stress, family routines/cohesion) among 152 MLH. Mothers reporting more psychiatric symptoms and less social support also reported poorer parenting practices and interactions. Further, MLH who used more alcohol reported less parenting involvement and fewer family interactions. Alcohol use, even at subclinical levels, can negatively impact the parent-child relationship.

A Peek Past the Vape Clouds: Vape Shop Decline in Long Beach, California during 2015-2018.

OBJECTIVES: The current study adds to the literature on vape shops by evaluating vape shop growth in an urban community over a 3-year period, assessing similarities and differences across the vape shop context, and addressing whether socialization spaces within vape shops are associated with a vape shop's ultimate success - remaining operational. As e-cigarette/vaping use enters its second decade in the US market, its regulation and status as a novel form of substance use is evolving; accordingly, it is unknown whether the presence of vape shops has changed as well. METHODS: In this study, we tracked and observed 19 vape shops over a 3-year period in Long Beach, California. RESULTS: Vape shop presence declined by 53% between September 2015 and September 2018. A comparison of vape shops remaining open versus those closing in the 3-year period indicated that shops with designated socialization spaces (lounges/tasting bars) were more likely to remain operational. CONCLUSIONS: The substantial decline in vape shop presence in this community may reflect an entrepreneurial response to increased regulation, as well as a dynamic market for e-cigarette/vape products. Findings suggest vape users support Electronic Nicotine Delivery Systems (ENDS) retailers that promote community-building or recreational activity.

A Silver Lining: The Role of Ethnic Diversity on Co-Occurring Trajectories of Weight Status and Peer Victimization Across Early Adolescence.

PURPOSE: Although it is well-established that higher weight status youth are at greater risk of peer victimization, it is unknown how weight status and victimization develop concurrently; thus, the current study examined the co-occurrence of weight status and victimization trajectories across early adolescence. Furthermore, the role of ethnicity, including a novel measure of individual-level ethnic diversity exposure at school, was evaluated. METHODS: Participants included 5,991U.S. boys and girls (52% female; 32% Latino; 20% white; 14% East/Southeast Asian; 12% African-American/black) from 26 urban middle schools. Participants self-reported height and weight as well as peer victimization across four timepoints from sixth to eighth grade. Survey data was collected between 2009 and 2014. RESULTS: Growth mixture modeling identified five weight status groups (Low, Moderate, High, Decreasing, and Increasing) and four victimization groups (Low, High, Decreasing, and Increasing) trajectories. Parallel growth mixture modeling indicated that adolescents in the moderate weight status trajectory experienced the least amount of victimization; adolescents in the high weight status trajectory reported the highest levels of increasing and stable-high victimization. Moreover, higher weight status youth exposed to greater ethnic diversity at school were more likely to experience low victimization. CONCLUSIONS: The study highlights the importance of belonging to a normative weight status trajectory for experiencing low peer victimization, yet also shows the large variability in the victimization experiences of higher weight status youth. Greater exposure to ethnic diversity at school appears to play a significant role in offsetting risk of victimization among higher weight status adolescents.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma

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Electronic Nicotine Delivery Systems (E-cigarette/Vape) use and Co-Occurring Health-Risk Behaviors Among an Ethnically Diverse Sample of Young Adults.

BACKGROUND: Prevalence rates of electronic nicotine delivery systems (ENDS; i.e., e-cigarette/vape) use has grown exponentially in the past few years. College students present a particularly vulnerable group for ENDS use. The current study sought to expand the literature by examining the context in which college students use ENDS, co-occurring health risks beyond traditional tobacco use, and the role of ethnicity in ENDS use. METHODS: Health-risk behavior survey data was collected from 452 undergraduates attending a large, public urban university during the 2015-2016 academic year. Ever ENDS users vs. non-ENDS users were compared across potential demographic, health-risk, and other health-related correlates. RESULTS: Almost 40% of participants reported lifetime use of ENDS. No ethnic or sex differences were found. The primary source for obtaining ENDS was friends and ENDS were most often used with friends vs. alone or with others not considered friends. Participants engaging in risky alcohol use and cigarette smoking had a higher likelihood of endorsing ENDS use. Conclusions/Importance: The current study indicated that a large proportion of college students have tried ENDS irrespective of ethnicity or sex. An increasingly normative social context may inform the popularity of ENDS use across ethnicity and sex, but additional research using ethnically diverse samples is warranted. Risky alcohol use appears to be a significant correlate of ENDS use, even after accounting for the robust relationship between ENDS use and cigarette smoking. The robust relationship between alcohol and tobacco use likely extends to ENDS use.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

Obesity and Cigarette Smoking: Extending the Link to E-cigarette/Vaping Use.

OBJECTIVES: In recent years, electronic tobacco (e-cigarette/vaping) use among young adults has grown exponentially. Given past research linking obesity and cigarette smoking, assessing whether this relationship extends to electronic tobacco use is warranted. The current study examined weight status as a correlate of substance use patterns reflecting electronic tobacco use. METHODS: Survey data were collected from a convenience sample of 452 (59% female) undergraduates attending a large, public university during the 2015-2016 academic year. Latent class analysis (LCA) was conducted to identify substance use classes and examine weight status as a covariate of class membership. RESULTS: LCA analyses identified 4 classes: High Substance Use (19%), Risky Alcohol Use (14%), Cigarette/Electronic Tobacco Use (17%), and Low Substance Use (50%). Both obesity status and greater deviation from one's group body mass index (BMI) norm were associated with a higher likelihood of belonging to the Cigarette/Electronic Tobacco Use class. CONCLUSIONS: Findings suggest that electronic tobacco use may fit well into previously established relationships between higher weight status and tobacco use. Future research should examine the longitudinal processes and pathways underlying the relationship between weight status and electronic tobacco use.

Is Obesity Associated With School Dropout? Key Developmental and Ethnic Differences.

BACKGROUND: We aimed to expand the literature on child obesity and school outcomes by examining associations between obesity and high school dropout, including the role of obesity onset and duration as well as ethnicity. METHODS: Data on 5066 children obtained between 1986 and 2010 from the child cohort of the 1979 National Longitudinal Study of Youth (NLSY79) were analyzed. Group-based trajectory analysis identified obesity trajectories from 6 to 18 years. School completion information from age 14 into young adulthood was used to calculate school dropout. Chi-square and pairwise comparison tests were used to identify significant associations between obesity trajectories and school dropout. RESULTS: Adolescents belonging to an increasing trajectory (adolescent-onset obesity) had a higher likelihood of dropping out of high school compared with those belonging to chronic, decreasing (childhood-only obesity), and nonobese trajectories. This association was particularly salient among white adolescents. CONCLUSIONS: Obesity onset during early adolescence increased risk of high school dropout. White adolescents were particularly vulnerable. Given that early adolescence is marked by significant biological and social changes, future research should seek to identify the underlying processes linking adolescent obesity and school dropout to decrease school dropout risk among this vulnerable population.

Adolescent obesity and future substance use: Incorporating the psychosocial context.

A growing body of work has shown that obese adolescents are at risk of engaging in problematic substance use, but mixed findings highlight the complexity of the relationship. Incorporating the psychosocial context into this research may inform past discrepancies. The current study assessed whether obese adolescents had a higher likelihood of experiencing a psychosocial context that predicted problematic substance use in young adulthood. Latent class analysis on 10,637 adolescents from The National Longitudinal Study of Adolescent to Adult Health (Add Health) identified four psychosocial classes in adolescence: Adjusted, Deviant Peer/Victimization, Moderate Depression, and Maladjusted. Obese adolescents were more likely to belong to the Maladjusted class, characterized by higher levels of depression and deviant peer affiliation. Those in the Maladjusted class had the second highest levels of cigarette smoking and marijuana use in young adulthood. Obese adolescents' psychosocial context should be considered in future research linking obesity and substance use.

Maternal mental health and children's internalizing and externalizing behaviors: Beyond maternal substance use disorders.

Maternal substance abuse and mental disorders can have adverse impacts on child development. We investigated the impact of maternal mental health on child behaviors based on a long-term follow-up study of mothers and their children approximately 10 years after mothers' admission to drug abuse treatment. Mothers (n=396) were assessed at admission to drug treatment during 2000 to 2002, and at follow-up in 2010-2011. At follow-up, each mother was asked to assess one target child using the Child Behavior Checklist for ages 6-18 (CBCL). Mothers' mental disorder diagnoses were obtained from records maintained by the California Department of Mental Health in 2009. About 46% of mothers had comorbid mental disorders; 27% had depressive disorder, 15% bipolar disorder, 15% adjustment disorder, 13% anxiety disorder, and 6% psychotic disorder. Of these mothers, more than half had two or more mental disorder diagnoses. The average age of the target child was approximately 10 years old (range 6 to 17). Relative to children of mothers without comorbid mental disorders, children were more likely to demonstrate internalizing behaviors if their mothers had comorbid depression/anxiety disorders (OR=2.0, 95%CI:1.0-4.0) or severe mental disorders (psychoses, bipolar) (OR=3.4, 95%CI:1.5-7.6). For externalizing behaviors, family problems was the only significant predictor (OR=3.2, 95%CI:1.7-6.0 for children of mothers with depression/anxiety disorders, OR=3.9, 95%CI:1.9-7.8 for severe mental disorders). Addressing maternal mental disorders (particularly severe mental disorders) and family problems are important for child well-being as these factors were significantly related to emotional and problem behaviors of children.