Sexual minority status, illicit drug use, and depressive symptoms.

Youth who are lesbian, gay, bisexual, and who identify with other sexual orientations (LGB+) are at higher risk for illicit drug use and have higher rates of mental illness. The current study examined the prevalence of illicit drug use among LGB+ persons and assessed the moderating effect of mental illness. Cross-sectional data from the 2015, 2017, and 2019 Youth Risk Behavioral Surveillance System were aggregated. The outcome was any reported use of cocaine, inhalants, heroin, methamphetamines, ecstasy, or hallucinogens. The primary exposure was self-reported sexual orientation category (i.e., heterosexual, gay/lesbian, bisexual, not sure). Self-reported depressive symptoms were tested as a moderator. Logistic regression models assessed main and interactive effects. Gay or lesbian students [AOR=1.87 95%CI: 1.45,2.43], bisexual students [AOR=2.07 95%CI: 1.77,2.42], and those unsure of their sexual orientation [AOR=1.99 95%CI: 1.65,2.39] had increased odds of illicit drug use. Odds were higher among LGB+ youth who did not have depressive symptoms (p<0.001). Odds of illicit substance use was significantly greater in youth identifying as gay and lesbian, bisexual, and students who were not sure about their sexual orientation and among LGB+ youth without depressive symptoms. Targeted, but non-stigmatizing, prevention programs are needed.

Driving after substance use in Rhode Island adolescents: A cross-sectional analysis of surveillance data.

OBJECTIVE: Existing literature on driving under the influence during adolescence is sparse, especially for driving after the use of non-medical prescription drugs (DAP). This study examines the prevalence of driving after use of alcohol (DAA), cannabis (DAC), and DAP, and examines the role of several potential risk and protective factors. METHODS: This was a secondary analysis of the 2022 Rhode Island Study Survey, a cross-sectional survey of middle and high school students. Separate multivariable regressions were conducted for each outcome among lifetime users for each substance, controlling for current substance use, individual-, perceived parental-, and perceived friend-substance use risk perception, age, sexual/gender minority (SGM) status, race, ethnicity, school level, and town poverty level. RESULTS: Among lifetime users of alcohol (n = 3849), cannabis (n = 2289), and non-medical prescription drugs (n = 611), the prevalence of DAA, DAC, and DAP was 4.9, 14.3, and 16.9%, respectively. Current substance use, high individual risk perception, being nonwhite, and being Hispanic were risk factors for DAA while perceiving parent's risk perception as negative and being heterosexual cisgender-female were protective. Current substance use, negative individual risk perception, and being nonwhite were risk factors for DAC while perceiving parent's risk perception as negative and being in high school were protective. Current substance use and older age were risk factors for DAP while perceiving parent's risk perception as negative and perceiving friend's risk perception as negative were protective. CONCLUSIONS: Driving under the influence is a concern among adolescent substance users. Current substance use and perceived parental risk perception as negative are common risks and protective factors, respectively. Findings suggest substance-specific, heterogeneous interventions are needed. For example, interventions focusing on peer perceptions are most relevant for DAP, while shifting personal perceptions of harm are most relevant for DAC.

Internet, App-Based, and Casino Gambling: Associations Between Modality, Problem Gambling, and Substance Use.

Technology-based gambling prevalence is not well understood since relevant questions are not included in health and disease surveillance studies. The current study sought to estimate the prevalence of internet-based and smartphone app-based gambling, along with casino gambling, in a sample of U.S. young adults and determine if gambling modality was associated with problem gambling symptoms or substance use. The 2022 Rhode Island Young Adult Survey included N = 1,022 students between the ages of 18 to 25 years old who had lived in Rhode Island, with n = 414 lifetime gamblers (40.5%) included in this study. Odds of gambling via a smartphone app and on the internet, respectively, were greater in heterosexual cis-males compared to heterosexual cis-females (OR[95%CI] = 3.14 [1.25,7.91]; OR[95%CI] = 6.30 [2.05,19.3]). Internet gambling amongst employed students was less common than among those who were not a student and not employed (OR[95%CI] = 0.25 [0.06,1.00]). Odds of problem gambling symptoms were higher among those who gambled via a smartphone app (OR[95%CI] = 3.23 [1.21,8.60]). All forms of gambling were associated with alcohol consumption, although the strength of the association was stronger in app and internet gamblers. Casino gamblers were more likely to be high risk marijuana and illicit drug users. The rising availability of app gambling coupled with its social, psychological, and cultural context may presents an alternative pathway to problem gambling. Bans on internet gambling and/or strict guidelines on the frequency of wagers and cash placed per wager, should be considered as viable methods to mitigate associated consequences.

Digital alcohol and cannabis ads, consumption frequency, and driving under the influence.

OBJECTIVE: Little is known about the consequences of substance-related advertising on driving under the influence of alcohol (DUIA) or cannabis (DUIC). This study seeks to estimate associations between substance-related digital advertising exposures and DUIA and DUIC, respectively, in a sample of young adults. METHOD: The Rhode Island Young Adult Survey 2022 was a cross-sectional web-based survey of N=1,022 adults aged 18-25 years. Analyses were conducted among lifetime alcohol users (n=824) and lifetime cannabis users (n=471). Prevalence of past 30-day digital ad exposure to alcohol and cannabis, respectively, was assessed, as well as prevalence of past month DUIA and DUIC. Multivariable logistic regressions examined the association between digital ad exposure and substance use among lifetime users, and ad exposure and DUI among current users. RESULTS: 54.4% of participants reported past 30-day exposure to digital alcohol advertising, and 33.5% reported exposure to digital cannabis advertising. Exposure to social media alcohol advertising was associated with higher odds of DUIA after adjustment for sociodemographic variables (OR[95%CI]=2.14[1.07,4.28]), but not after accounting for frequency of use. Odds of DUIC remained significantly higher for those exposed to app-based cannabis advertising after adjusting for sociodemographic variables (OR[95%CI]=4.36[1.76,10.8]) and frequency of use (OR[95%CI]= 3.96[1.53,10.2]). CONCLUSIONS: Since social media alcohol ad exposure may be indirectly linked with DUIA and app-based cannabis ad exposure may be directly linked to frequency of use and DUIC, legislators should consider comprehensive substance-related ad regulations and bans.

Impact of alcohol home delivery and other methods of obtaining alcohol in young adults.

AIMS: To estimate the use of home alcohol delivery and other methods of obtaining alcohol, rates of ID checking for home alcohol delivery purchases, and associations with alcohol-related consequences. METHODS: Surveillance data from 784 lifetime drinkers participating in the 2022 Rhode Island Young Adult Survey were used. The method of obtaining alcohol (e.g. type of purchase, gifted, theft) was assessed. The Alcohol Use Disorders Identification Test, Brief Young Adults Alcohol Consequences Questionnaire, and a drinking and driving question were used to measure high-risk drinking behaviors, experiencing negative alcohol questions, and history of drinking and driving. Logistic regression models adjusting for sociodemographic variables were used to estimate main effects. RESULTS: About 7.4% of the sample purchased alcohol through a home delivery or to-go purchase; 12.1% of participants who obtained alcohol this way never had their ID checked during the purchase attempt, and 10.2% of these purchases were completed by participants under the legal purchase age. Home delivery/to-go purchases were associated with high-risk drinking. Alcohol theft was associated with high-risk drinking, experiencing negative alcohol consequences, and drinking and driving. CONCLUSIONS: Home alcohol delivery and to-go purchases may provide an opportunity for underage access to alcohol, but their current use as a method of obtaining alcohol is rare. Stronger ID checking policies are needed. Alcohol theft was linked to several negative alcohol outcomes, and home-based preventive interventions should be considered.

The Mental Health Consequences of Losing a Loved One to COVID-19.

OBJECTIVES: This study examined the association between loss of a loved one to COVID-19 and depression, anxiety and suicide ideation among Rhode Island young adults. METHODS: The 2022 Rhode Island Young Adult Survey recruited 1,022 young adults aged 18-25 years who lived in Rhode Island. Logistic regression models were used to estimate the odds of depression, anxiety, and suicide ideation due to experiencing a loss due to COVID-19. RESULTS: The odds of anxiety and suicide ideation were 57% (OR[95% CI] = 1.57 [1.13, 2.18]) and 79% (OR[95% CI] = 1.79 [1.19, 2.70]) greater among participants who lost a close friend or family member due to COVID-19. CONCLUSIONS: Losing a loved one to COVID-19 increases the risk of anxiety or suicide ideation among young adults in RI. Prevention measures such as screening for mental health symptoms and incorporating mental health awareness into college, university and workplace settings should be instituted.

Brain Injury and Substance Use in Young Adults: The Need for Integrating Care.

OBJECTIVES: This study examined sociodemographic disparities in traumatic brain injury (TBI), and the association between TBI and substance misuse among young adults in Rhode Island. METHODS: Among this sample of N=1,022 from the 2022 Rhode Island Young Adult Survey, multivariable logistic regressions were used to examine both study objectives. RESULTS: Black, Asian, and Hispanic young adults had 77% (95%CI: 26%, 93%), 79% (95%CI: 32%, 94%), and 58% (95%CI: 31%, 75%) lower odds of brain injury, respectively, compared to White, non-Hispanic young adults. Those having experienced brain injury were more likely to engage in hazardous alcohol use (p = 0.003), hazardous marijuana use (p < 0.001), and illicit drug use (p = 0.003), but not OTC or prescription drug misuse. CONCLUSIONS: There is a pressing need for integrated, large-scale, multidisciplinary programs with a well-trained workforce to address TBI and substance misuse in various medical settings for behavioral health and emergency care.

The Mental Health Burden of Racial Discrimination in Young Adults in Rhode Island.

OBJECTIVES: This study examined the association between racial discrimination and depressive symptoms among Rhode Island young adults. METHODS: The 2022 Rhode Island Young Adult Survey recruited 1,022 young adults aged 18-25 years who lived in Rhode Island for at least part of the year. Multivariable logistic regression for depressive symptoms controlled for sexual and gender identity, race/ethnicity, social status, age, employment, and student status. RESULTS: 23.6% of young adults reported experiencing racial discrimination in childhood and/or adulthood. Odds of depressive symptoms increased for experiences of childhood racial discrimination (+70%; 95%CI: 14%, 155%) and any racial discrimination (+56%; 95%CI: 6%, 130%), but not for racial discrimination in adulthood (+38%; 95%CI: -8%, 108%). CONCLUSIONS: Experiences of racial discrimination increase odds of depressive symptoms among young adults. Prevention measures such as universal screening for childhood adversity, incorporating antiracism education into all institutional settings, and continued nondiscrimination policy and enforcement should be employed.

Pornography: A Concealed Behavior with Serious Consequences.

OBJECTIVES: The purpose of the current study was to estimate prevalence of pornography use and addiction in Rhode Island young adults, identify sociodemographic disparities, and determine if use and addiction were associated with mental illness. METHODS: Data from n=1022 participants of the Rhode Island Young Adult Survey were used. Pornography use and addiction, depression, anxiety, and suicide ideation were assessed. Multivariable logistic regressions controlled for age, social status, sex, gender, sexual orientation, and race/ethnicity. RESULTS: 54% indicated pornography use; 6.2% met the criteria for addiction. Odds of pornography use were 5 times higher (95%CI=3.18,7.71), and addiction 13.4 times higher (95%CI=5.71,31.4) among heterosexual cis-males. Pornography addiction was associated with increased odds of depression (OR=1.92, 95%CI=1.04,3.49) and suicide ideation (OR=2.34, 95%CI=1.24,4.43). CONCLUSIONS: Pornography use is highly prevalent, and addiction may be associated with mental illness. New screenings, media literacy training, and developing new therapeutic interventions should be considered.

Risk Factors for Suicide Ideation Among Rhode Island College Students.

OBJECTIVES: This study aimed to identify individual and relational risk factors for suicide ideation among students enrolled in 2- and 4-year colleges. METHODS: A cross-sectional analysis was conducted using N=685 college students from the 2022 Rhode Island Young Adult Survey. RESULTS: 13.7% (N = 94) reported suicide ideation, 7.6% (N = 52) reported making a suicide plan, and 3.2% (N = 22) reported at least one suicide attempt. Sexual and gender minorities had 300% (95%CI: 47%, 987%) increased odds relative to cisgender heterosexual males, students living on campus had 56% (95%CI: 79%, 10%) lower odds compared to those living off campus with a parent, and students with insomnia had 156% (57%, 320%) increased odds of suicide ideation. CONCLUSIONS: Interventions to 1) cultivate identity- affirming communities for sexual and gender minority students, 2) create a sense of belonging for students living off campus, and 3) improve sleep health are needed.

Smartphone Addiction and Mental Illness In Rhode Island Young Adults.

BACKGROUND: Smartphone addiction is a rising problem in the United States. The current study estimated the prevalence of smartphone addiction in Rhode Island young adults and its associations with mental illness. METHODS: The 2022 Rhode Island Young Adult Survey measured smartphone addiction, depression, anxiety, and suicide ideation. Covariates included age, sex/gender minority status, race/ethnicity, and social status. RESULTS: The prevalence of smartphone addiction was 34%. Odds of experiencing depression (OR[95%CI]=2.69 [2.05,3.52]), anxiety (OR[95%CI]=2.06 [1.58,2.69]), and suicide ideation (OR[95%CI]=1.55 [1.08,2.20]) were greater in participants with smartphone addiction. The relationship between smartphone addiction and depression was strongest in heterosexual cis-males (OR[95%CI] = 8.45 [3.53, 20.3]). DISCUSSION: Smartphone addiction is prevalent among Rhode Island's young adults and may be associated with depression, anxiety, and suicide ideation. Heterosexual cis-males may be particularly vulnerable. Screening programs and interventions to reduce smartphone use for all young adults, and particularly young men, should be considered.

Depressive and anxiety symptoms in first generation college students.

Objectives: Depression and anxiety contribute to the burden of disease among college students. The current study determined if depressive and anxiety symptoms were more prevalent in first generation students and if social and emotional support moderated this relationship. Methods: Depressive and anxiety symptoms were measured in 432 U.S. college students via an online survey. Single items determined student generation status and available social support. The CES-D10 and GAD-7 measured depression and anxiety, respectively. Structural equation modeling was used to identify significant effects. Results: First generation status was associated with increased cognitive-emotional (p = 0.036) and somatic (p = 0.013) anxiety symptoms, but not depression. High social and emotional support appeared to suppress somatic anxiety symptoms experienced by first generation students (p = 0.004). Conclusions: Greater anxiety symptoms in first generation students may be due to increased general and acculturative stress, although more research is needed. Large national surveys of college students should consider adding a question about first generation status.

Correlates of gambling and gambling problems among Rhode Island young adults: a cross-sectional study.

BACKGROUND: Numerous states in the USA have legalized sports betting due to recent legal decisions by the US Supreme Court. Here, sociodemographic correlates of current gambling and specific gambling activities associated with symptoms of gambling problems were identified. METHODS: Cross-sectional data were obtained from the 2020 Rhode Island Young Adult Survey (RIYAS). RIYAS participants (n = 540) were a convenience sample of 18 to 25 year olds who lived in Rhode Island for at least part of 2020. Data were collected from May to October 2020. Four gambling activities were assessed (i.e. sports betting; betting on races; gaming tables at a casino; poker machines at a casino). Logistic regression models assessed main effects. RESULTS: 22.4% engaged in one or more gambling activities. 11.5% of participants had any gambling problems. Odds of gambling activities were higher among men; Black, Indigenous, People of Color; older young adults; and essential workers. Odds of gambling problems were 2.4 times higher among participants who engaged with sports betting. CONCLUSIONS: Gambling activities are common among several population subgroups, and participation in sports betting may be a risk factor for the development of problem gambling. Comprehensive prevention policies are needed.

Effect of COVID-19 Lockdown on Substance Use Among Middle School and High School Students: A Natural Experiment.

OBJECTIVE: Research on COVID-19's effect on substance use is mixed, and few studies have focused on adolescents. We assessed whether implementation of the COVID-19 lockdown affected substance use and changed perceptions of psychoactive substance availability in middle and high school students. METHODS: We assessed self-reported use and perceived availability of alcohol, tobacco cigarettes, electronic cigarettes, marijuana, synthetic marijuana, nonprescribed prescription drugs, and illicit drugs (heroin, inhalants) among middle and high school respondents aged 11-18 years to the Rhode Island Student Survey (N = 17 751). An administrative pause because of COVID-19 lockdowns allowed us to divide results into surveys completed before (January through March 2020; n = 13 259) and after (November 2020 through May 2021; n = 4492) the lockdown implementation. We determined the effects of the COVID-19 lockdown using logistic regression models, adjusting for age, gender/sexual orientation, middle/high school level, and city/town classification. RESULTS: After the COVID-19 lockdown implementation, the odds of respondents using psychoactive substances decreased, with the largest decreases occurring for prescription drugs (odds ratio [OR] = 0.39; 95% CI, 0.28-0.54) and inhalants (OR = 0.37; 95% CI, 0.26-0.53). The odds of respondents perceiving difficulties in obtaining psychoactive substances significantly increased after lockdown implementation, with the largest increases occurring for prescription drugs (OR = 1.53; 95% CI, 1.39-1.69) and illicit drugs (OR = 1.65; 95% CI, 1.44-1.88). CONCLUSIONS: COVID-19 lockdown implementation was associated with a decreased perception of availability of psychoactive substances and use of psychoactive substances. Decreases in substance use may be because of decreased perceived availability and increased parental support and oversight. Interventions that focus on parental oversight and strengthened policies to disrupt the licit and illicit drug markets are needed.

Secondary analysis of one State's Youth Risk Behavior Surveillance System (YRBSS) data by Individualized Education Program (IEP) status.

BACKGROUND: Children with disabilities may be at increased risk for engaging in health risk behaviors compared to their peers without disabilities. OBJECTIVE: This secondary analysis aims to assess if Individualized Education Program (IEP) status, a proxy for having a disability, is a risk factor for youth to engage in health risk behaviors such as alcohol use, marijuana use, other substance use, bullying or cyberbullying victimization, and sexual activity. METHODS: Data from Connecticut Youth Risk Behavior Surveillance System (YRBSS) 2013, 2015, 2017, and 2019 were combined for a representative sample of 9243 students, 850 reporting having an IEP. Having a disability was measured by an item that asked if participants received special education services as part of an IEP. Logistic regression that accounted for the YRBSS sample design was used to assess main effects. RESULTS: Having an IEP significantly predicted the likelihood of being bullied (OR = 1.81), cyberbullied (OR = 1.49), and other drug use (OR = 1.65), but did not predict engaging in sexual activity. CONCLUSIONS: Students with disabilities in CT, as defined by the receipt of special education services as specified on an IEP, are at increased risk to engage in health risk behaviors than are students without disabilities during their high school years. Further analyses and comparisons across sites, years, and type of disability are limited as there is no current item on the national YRBSS questionnaire that measures a participant's special education status or disability status.

Exposure to Alcohol Marketing and Alcohol-Related Consequences in Young Adults.

BACKGROUND: Exposure to alcohol marketing is positively associated with alcohol consumption. However, few research studies have tested alcohol marketing's effect on other alcohol-related outcomes. Consequently, the current study sought to identify associations between exposure to alcohol marketing and alcohol-related consequences in young adults. Methods: A secondary analysis of the 2020 Rhode Island Young Adult Survey was conducted. Participants were lifetime drinkers (n = 390) who were 18 to 25 years old and lived in Rhode Island for at least part of 2020. Past 30 day exposure to 6 forms of alcohol marketing was assessed. Alcohol consequences were measured using 8 items from the Brief Young Adult Alcohol Consequences Questionnaire. Logistic regression models were adjusted for AUDIT score, age, race/ethnicity, gender, sexual orientation, employment status, and enrollment in school. Results: 92.3% of participants reported past 30 days exposure to any form of alcohol marketing. 43.6% of participants reported experiencing any alcohol-related consequence. Exposure to any form of alcohol marketing was positively associated with experiencing alcohol-related consequences (OR[95% CI] = 3.35 [1.19, 9.44]). After disaggregation by marketing type, only television exposure remained significantly associated with alcohol-related consequences (OR[95% CI] = 1.85 [1.06, 3.24]). Conclusions: Exposure to alcohol advertising on television may be positively associated with experiencing negative alcohol consequences in young adults. If confirmed, the findings may renew interest in strengthening alcohol marketing guidelines and regulations.

Gambling: A Ubiquitous Behavior Among Rhode Island's Young Adults.

OBJECTIVES: Gambling is a prevalent behavior associated with numerous consequences. The purpose of the current study was to assess the prevalence of gambling and problem gambling in Rhode Island young adults and to identify sociodemographic correlates of gambling. METHODS: Data from n=546 participants of the Rhode Island Young Adult Survey were used. Twelve types of gambling behaviors, and problem gambling, were assessed. Sociodemographic variables included age, race/ethnicity, gender, sexual orientation, social status, education, employment, and essential worker status. RESULTS: The prevalence of any gambling was 62.3%, and odds of any gambling was 57% higher (95%CI = 1.08,2.27) among essential workers. The prevalence of problem gambling was 11.4%, and the odds were 3.6 times higher (95%CI = 1.32, 9.86) among persons who are transgender. CONCLUSIONS: The prevalence of gambling and problem gambling are high among Rhode Island's young adults. Implementing programmatic and regulatory measures to prevent and treat problem gambling are vital.

Eliminating Disparities in Young Adult Tobacco Use: The Need for Integrated Behavioral Healthcare.

OBJECTIVES: There is limited data available specific to young adult tobacco use in Rhode Island. This study examines whether young adult cigarette and e-cigarette use varies by sociodemographics, mental health, and use of other substances. METHODS: This cross-sectional web-based survey was administered during the COVID-19 pandemic, from May to October 2020. RESULTS: A total of 12.9% of young adults reported current cigarette or e-cigarette use. Young adults who currently used cigarettes or e-cigarettes were more likely to be white, non-Hispanic, younger, and have depressive symptoms, a depression diagnosis, suicide ideation, engage in harmful drinking, alcohol dependence, current marijuana use, and frequent marijuana use. CONCLUSIONS: To address the needs of disproportionately affected young adults, steps must be taken to integrate comprehensive, barrier-free, widely promoted coverage of tobacco cessation treatment in all behavioral healthcare settings.

Breaking Down Barriers: Young Adult Interest and Use of Telehealth for Behavioral Health Services.

OBJECTIVES: Use of telehealth for behavioral health services has increased since the start of the COVID-19 pandemic. This study examines which young adults in Rhode Island were using these telehealth services and are interested in its use. METHODS: This cross-sectional web-based survey was administered in the midst of the COVID-19 pandemic, from May to October 2020. RESULTS: Results suggest sexual and gender minorities and those with low social status were more likely to access these services, highlighting its effectiveness at reaching disadvantaged young adults. Those with mental health symptoms were more likely to utilize telehealth, but those with substance use were not. CONCLUSIONS: There is a missed opportunity to target substance use telehealth services to this willing and interested population. Continued coverage and use of telehealth for mental health and substance use services is essential in breaking down barriers to care for young adults in Rhode Island.

Inequities Laid Bare: The Mental Health of Young Adults in Rhode Island During the COVID-19 Pandemic.

This study documents disparities in the mental health burden of young adults in Rhode Island during the COVID-19 pandemic as it pertains to essential worker status, sexual orientation, gender identity, and childhood trauma. A cross-sectional web-based survey of young adults aged 18 to 25 years conducted between May and October of 2020 assessed anxiety symptoms, depressive symptoms, and thoughts of suicide. In fully adjusted regression models, (n =528 young adults) being an essential worker, a sexual minority, having lower relative SES, and having more adverse childhood experiences were significantly associated with negative mental health outcomes. In models adjusted for individual ACEs, exposure to mental illness in the household, physical violence between adults in the household, emotional abuse, and sexual abuse were independently associated with all three outcomes. Young adults most vulnerable and stigmatized in the community are also those who are most severely affected in terms of mental health.