Moderated Mediation of the eCHECKUP TO GO College Student Cannabis Use Intervention.

Background: Cannabis use rates are rising among college students, creating a need for effective and accessible intervention options. One such intervention, the Marijuana eCHECKUP TO GO (eCTG) program, has relatively few studies investigating mechanisms of change and related outcomes. This intervention provides users with personalized normative feedback to adjust user's normative perceptions and use patterns. The current study tested moderated mediation of program effects between the eCTG intervention condition and a healthy stress management (HSM) control condition in a college student sample of near-daily cannabis users. Protective behavioral strategies (PBS) were measured among the eCTG conditionMethods: Data were analyzed from a sample of 227 students who were randomly assigned to the eCTG intervention condition or HSM control condition. Change in cannabis use frequency was measured by re-administering the baseline survey at a six-week follow-up. Multi-group moderated mediation path analysis tested the effects of the eCTG intervention on change in cannabis use frequency through PBS, descriptive norms, and injunctive norms, with multi-group categories defined by sex.Results: Direct effects indicated the intervention predicted reduced descriptive norm perceptions and cannabis use frequency. An indirect effect was found for the intervention condition on reducing cannabis use frequency through change in descriptive norms in males. Similarly, an indirect effect was seen for intervention condition on reducing cannabis use frequency through change in injunctive norms for females.Conclusions: Findings suggest changes in descriptive norms played a sex-specific mediating role in the mechanisms of change for the eCTG intervention on reductions in cannabis use frequency.

Mechanisms of change in an adapted marijuana e-CHECKUP TO GO intervention on decreased college student cannabis use.

The objective of this study was to test indirect effects of the Marijuana e-CHECKUP TO GO program on college students' frequent marijuana use through decreased use in specific social and academic activities. This study randomly assigned college students who reported frequent marijuana use (i.e., approximately five times per week) in fall 2016 to receive Marijuana e-CHECKUP TO GO or healthy stress management (HSM) strategies. The final baseline sample included 298 participants. Path analyses tested direct program effects on marijuana use at six-week posttest, as well as the indirect effect via use within four activities frequently participated in by college students: socializing, being physically active, studying, and being in class. Direct Marijuana e-CHECKUP TO GO effects on reductions in frequent use were transmitted by decreased marijuana use while studying and no use while socializing, being physically active, or in class. Marijuana e-CHECKUP TO GO may be most effective at reducing use of marijuana among college students while studying.

Classification trees identify shared and distinct correlates of nonsuicidal self-injury and suicidal ideation across gender identities in emerging adults.

College students have an elevated risk for self-injurious thoughts and behaviours (SITBs), and there are robust differences in prevalence rates for SITBs across gender identities. Although numerous constructs have been implicated as risk factors, researchers have not significantly improved at predicting SITBs, possibly owing to constraints of confirmatory analyses. Classification trees are exploratory, person-centred analyses that enable joint examination of numerous correlates and their interactions. Thus, classification trees may discern previously unstudied risk factors and identify distinct subpopulations with elevated risk for SITBs. We tested classification trees that evaluated 298 potential correlates of nonsuicidal self-injury and suicidal ideation across self-identified women and men. Data came from 5,131 college students who completed the National College Health Assessment, which assesses a wide range of health-related constructs. Models produced parsimonious decision trees that accounted for a substantial amount of outcome variability (38.3-51.5%). Psychopathology, poorer psychological well-being, and other SITBs emerged as important correlates for all participants. Trauma, disordered eating, and heavy alcohol use were salient among women, whereas alcohol use norms were important correlates among men. Importantly, models identified several constructs that may be amenable to intervention. Results support the use of exploratory analyses to explicate heterogeneity among individuals who engage in SITBs and suggest that gender identity is an important moderator for certain risk factors.

Using Classification Trees to Examine Predictors of Marijuana Use Among a Wide Range of Variables.

Background: Young adults have elevated risk for negative marijuana use-related outcomes, and there is heterogeneity among users. Identifying risk factors for marijuana user status will improve understanding of different populations of users, which may inform prediction of individuals most likely to experience negative outcomes. Objectives: To identify predictors of marijuana use initiation in young adults. We simultaneously examined a broad range of potential predictors and all their possible interactions, including constructs that have not been previously studied in substance use initiation research. Methods: Data were repeated cross-sectional survey responses from college students in Colorado (N = 4052, 77% White, 61% female, mean age = 22.77). Measures came from the National College Health Assessment, which assesses numerous health and behavioral constructs. We used recursive partitioning and random forest models to identify predictors of ever having used marijuana out of 206 variables. Results: Classification trees identified engagement in increased alcohol use and sexual behavior as salient correlates of marijuana use initiation. Parsimonious recursive partitioning trees explained a substantial amount of variability in marijuana user status (39% in the full model and 24% when alcohol variables were excluded). Random forest models predicted user status with 74.11% and 66.91% accuracy in the full model and when alcohol variables were excluded, respectively. Conclusions: Results support the use of exploratory analyses to explain heterogeneity among marijuana users and non-users. Since engagement in other health-risk behaviors were salient predictors of use initiation, prevention efforts to reduce harm from marijuana use may benefit from targeting risk factors for health-risk behaviors in general.

Drug overdose and child maltreatment across the United States' rural-urban continuum.

This national study of US counties (n = 2963) investigated whether county-level drug overdose mortality is associated with maltreatment report rates, and whether the relationship between overdose mortality and maltreatment reports is moderated by a county's rural, non-metro or metro status. Data included county-level 2015 maltreatment reports from the National Child Abuse and Neglect Data System, modeled drug-overdose mortality from the Centers for Disease Control, United States Department of Agriculture Rural-Urban Continuum Codes, US Census demographic data and crime reports from the Federal Bureau of Investigation. All data were linked across counties. Zero-inflated negative binomial (ZINB) regression was used for county-level analysis. As hypothesized, results from the ZINB model showed a significant and positive relationship between drug overdose mortality and child maltreatment report rates (χ = 101.26, p < .0001). This relationship was moderated by position on the rural-urban continuum (χ=8.76, p = .01). For metro counties, there was a 1.9% increase in maltreatment report rate for each additional increment of overdose deaths (IRR=1.019, CI=[1.010, 1.028]). For non-metro counties, the rate of increase was 1.8% higher than for metro counties (IRR=1.018, CI=[1.006, 1.030]); for rural counties, the rate of increase was 1.2% higher than for metro counties (IRR=1.012, CI=[0.999, 1.026]). Additional research is needed to determine why the relationship between drug overdose mortality and maltreatment reports is stronger in non-metro and rural communities. One potential driver requiring additional inquiry is that access to mental and physical health care and substance use treatment may be more limited outside of metropolitan counties.

Marijuana eCHECKUPTO GO: Effects of a personalized feedback plus protective behavioral strategies intervention for heavy marijuana-using college students.

BACKGROUND: Marijuana use is common among U.S. college students. Liberalization of marijuana use policies is hypothesized to decrease social norms discouraging use, which protects against marijuana use. This may increase the importance of protective behavioral strategies (PBS) to reduce marijuana use harm. METHODS: This study tested direct and moderated (by sex) program effects of an adapted version of the Marijuana eCHECKUPTO GO, a web-based marijuana use intervention providing university-specific personalized feedback (PF) with normative information and PBS to students attending a university in a state with legalized adult recreational marijuana. Participants were 298 heavy-using college students randomly assigned to receive Marijuana eCHECKUPTO GO or strategies for healthy stress management (HSM). General linear models (GLMs) tested direct program effects on proximal intervention targets, marijuana use, and use consequences. Multi-group GLMs then tested the moderating effect of sex on direct intervention effects. RESULTS: Marijuana eCHECKUPTO GO participants reported decreases in estimated use prevalence (i.e., descriptive norms), self-reported hours high per week, days high per week, periods high per week, and weeks high per month. Sex moderated intervention effects on the use of PBS such that females in the PF condition increased their use of PBS more than males. CONCLUSION: Results demonstrate preliminary support for the adapted Marijuana eCHECKUPTO GO in reducing marijuana use for "heavy college-aged users". Future research should test adapted Marijuana eCHECKUPTO GO sustained effects over time, and examine whether program effects on harm reduction manifest after sustained (e.g., booster) program implementation.

Childhood adversity and the risk of substance use and delinquency: The role of protective adult relationships.

Youth involved in the child welfare system experience multiple early adversities that can contribute to increased risk of substance use and delinquency. Although adverse childhood experiences (ACEs) have been associated with poorer behavioral outcomes among youth, less is known about the possible protective factors that may influence the relationship between early adversity and risk-taking behavior. This study examined whether protective adult relationships moderated the link between cumulative ACEs and substance use and delinquency after controlling for demographic characteristics in child welfare-involved youth. The sample included 1054 youth, ages 11-17, from the National Survey of Child and Adolescent Well-Being II who were in the first wave of data collection. Results showed that protective adult relationships moderated the relationship between ACEs and substance use, but not for delinquency. Specifically, under lower levels of protective adult relationships, cumulative ACEs related to increased substance use among youth. Implications for child welfare practices to target youths' support systems are discussed.

Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department.

Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19-29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED.

Sociodemographic and drug use severity differences between medical marijuana users and non-medical users visiting the emergency department.

BACKGROUND AND OBJECTIVES: The purpose of this study is to extend what is known about medical marijuana and non-medical marijuana users who visit the emergency department (ED) by exploring differences in their sociodemographic characteristics and their drug-related problem severity. METHODS: Of 292 consecutively enrolled exclusive marijuana-only users visiting the ED for any reason, 37% (n = 107) reported using marijuana on the advice of a medical doctor, and 63% (n = 185) reported that they did not use it under the advice of a medical doctor (ie, non-medical user). Participants denied using any other drug with the exception of alcohol. Participants completed the Addiction Severity Index-Lite which provided composite and individual items related to drug use problems, psychiatric problems, medical problems, and alcohol use problems. Self-efficacy for avoiding drug use and sociodemographic characteristics were also collected. RESULTS: In a multivariate model, compared to non-medical marijuana users, medical users reported a higher frequency of days of use, more money spent on marijuana, and lower readiness to change use of marijuana, yet lower frequency of drug problems and tended to be low-risk versus moderate-severe risk users. Medical marijuana use was associated with a greater number of days of psychological problems. DISCUSSION AND CONCLUSIONS: Results for medical marijuana users might be interpreted as consistent with that of routine, self-administered treatment for medical or psychological problems. SCIENTIFIC SIGNIFICANCE: Results suggest behavioral health interventions in acute care settings should consider treating non-medical marijuana users differently than medical users due to the greater drug-related problems associated with non-medical use. (Am J Addict 2016;25:385-391).

Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BACKGROUND: Although screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals. METHODS: A total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite. RESULTS: Of 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12). CONCLUSIONS: In this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome. TRIAL REGISTRATION: ClinicalTrials.gov NCT01683227.

Self-Reported Age of Onset and Telescoping for Cigarettes, Alcohol, and Marijuana Across Eight Years of the National Longitudinal Survey of Youth.

Smoking, drinking, and illicit drug use are leading causes of morbidity and mortality, both during adolescence as well as later in life. Although for some adolescents, substance use may last for only a brief period of experimentation, use of these substances in adolescence may have negative consequences. The determination of how well national and local policy and intervention efforts address teen substance use depends largely on the collection of valid and accurate data. Assessments of substance use rely heavily on retrospective self-report measures. The reliability and validity of self-reported substance use measures, however, may be limited by various sources of measurement error. This study utilizes four waves of data from the National Longitudinal Survey of Youth spanning eight years. Our wave-to-wave analyses examined the accuracy of self-reported age of onset for cigarette, alcohol and marijuana users. Findings indicate that approximately one-fourth of cigarette users, one-fifth of alcohol users and one-third of marijuana users reported their age of onset exactly the same across waves. Of those who reported the age of onset inaccurately, the error tended to be in the direction of reporting their age of onset as older at a latter wave relative to what was reported previously, known as forward telescoping. Results from multiple linear regression analyses showed that the single most consistent variable associated with telescoping was the number of years since the substance was first reported. Time since first report was the single consistent and strongly associated with telescoping in each wave-to-wave comparison for all three substances under study. Implications for policy and research are discussed.

Drinking plans and drinking outcomes: examining young adults' weekend drinking behavior.

This study examined relationships among drinking intentions, environments, and outcomes in a random sample of 566 undergraduate college students. Telephone interviews were conducted with respondents before and after a single weekend assessing drinking intentions for the coming weekend related to subsequent drinking behaviors. Latent class analyses found evidence for four distinct drinking environments distinguished by private/public setting and presence of few/many intoxicated people. There was evidence that the drinking environment mediated the relationship between drinking intentions and heavy episodic drinking in this young adult sample. Future research might focus on examining person/environment interactions as they relate to heavy episodic drinking.

Predictors of partying prior to bar attendance and subsequent BrAC.

Pre-drinking (e.g., pre-gaming, pre-loading) occurs frequently among young adult and college-aged drinkers and is associated with increased intoxication as well as alcohol-related problems. The purpose of the following study was to examine pre-drinking behaviors in situ, and to test whether drinking intentions mediate the relationship between heavy episodic drinking history and pre-drinking behaviors. We randomly selected a sample of 1040 young adults bar patrons at 32 bars in a major metropolitan city in Southern California and asked participants to complete an interview concerning drinking behavior as well as provide a breath sample used to measure breath alcohol concentration. We used multilevel path analysis to test two meditational models. Results showed drinking intentions mediated the relationship between heavy episodic drinking history and pre-drinking behavior as well as the relationship between heavy episodic drinking history and level of pre-drinking intoxication. Gender did not moderate these meditational relationships suggesting similar pre-drinking behaviors for both men and women. Potential methods to prevent pre-drinking behaviors in this population of young people are discussed.

Typologies of recanting of lifetime cigarette, alcohol and marijuana use during a six-year longitudinal panel study.

AIM: To identify if there are different typologies for adolescent self-reporters and recanters for alcohol, cigarette and marijuana use. METHODS: This study is a secondary data analysis and utilized four waves of the National Longitudinal Survey of Youth child panel data. The study included adolescents aged ten and older who self-reported ever use of cigarettes (n=872), marijuana (n=854) or alcohol (n=837). Consistent responders were those who reported lifetime use of a specific substance and continued to report such use at each latter wave of data collection. Latent class analyses were utilized to investigate if there are different types of self-reporters for each substance class. RESULTS: Three unique groups for each substance was identified. The first group of users, who had a late age of onset, tended to be consistent self-reporters across waves. Those who were early onset users of cigarettes and marijuana tended to recant their use while early onset alcohol users were consistent reporters. Those with moderate ages of onset had no consistent recanting patterns. The highest degree of recanting was found among the early onset marijuana users. CONCLUSIONS: The results suggest that youth who begin their use at an earlier age may not be as reliable reporters as youth who initiate use at later ages. Our results suggest that the veracity of prevalence estimates for licit and illicit substances could be different depending on the age of the respondent.

Testing the length of time theory of recall decay: examining substance use report stability with 10 years of national longitudinal survey of youth data.

AIM: This article examines whether the proportion of recanters increases (or decreases) as a function of time o test length of time theory. SAMPLE: 2,221 US respondents in the National Longitudinal Survey of Youth child data. Bivariate and logistic regression analyses were used. RESULTS: Among recanters, 50% of cigarette and alcohol users recanted use by 4 years, and 50% of marijuana users recanted by 3 years. Predictors of recanting was being Black or Hispanic and younger age. The theory was not supported. Further research is needed to identify potential reasons why adolescents recant their use is such a short time span. The study's limitations are noted.

The Stability of Self-Reported Marijuana Use Across Eight Years of the National Longitudinal Survey of Youth.

INTRODUCTION: This study examined teen marijuana report stability over eight years. The stability of self-reports refers to the consistency of self-reported use across several years. METHOD: This study used fives waves of data across eight years from the National Longitudinal Survey of Youth. Analyses were conducted to examine the internal or within wave consistency as well as external or across waves consistency for self-reported marijuana use. Further tests were conducted to identify if there were any differences for age, ethnicity and sex for report consistency. RESULTS: Report stability was higher for lifetime use reports than the age of onset reports. Wave-by-wave differences revealed stability remained at acceptable levels in nearly all comparisons at agreement being about 75%. Overall, report agreement was higher for females, older adolescents, and Non-Hispanic/Non-Black youth in bivariate analyses. However, only older chronological age remained consistently significantly associated with better report stability in multiple logistic regression models. Implications regarding misclassification of users for prevention programs and measurement issues are discussed.

The relationship between alcohol consumption and past-year smoking initiation in a sample of undergraduates.

BACKGROUND: Although most young people begin smoking before the age of 18, the results of a growing number of recent studies have shown a sizable minority of college students initiate smoking while in college. Moreover, the use of alcohol by college students has been linked to smoking initiation in some studies in the literature. OBJECTIVES: The purpose of this study was to examine the association between past-year drinking frequency and past-year smoking initiation among a sample of college students. METHODS: A total of 1,523 undergraduate students attending a large urban university in the southwestern United States were invited to participate in an Internet study examining college student lifestyles and behaviors. RESULTS: The results of a logistic regression analysis indicated a significant association between past-year alcohol consumption and the likelihood of past-year smoking initiation after controlling for respondent race, the past-year use of marijuana, illicit drug use, and prescription drug use. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: These results suggest alcohol consumption may serve as an influence on smoking initiation among some college students. These results provide additional support to a growing literature linking alcohol use to smoking initiation in college student populations. Additional research is needed to determine the mechanisms that explain this relationship.

Cigarette smoking and subsequent hospitalization in a cohort of young U.S. Navy female recruits.

INTRODUCTION: Tobacco use is of particular concern to the U.S. Department of Defense because the military historically has had higher and heavier rates of tobacco use than civilians. Few prospective studies have examined the association of cigarette smoking with medical outcomes, particularly among initially healthy female military personnel. METHODS: This prospective cohort study followed over 5,000 young U.S. Navy female recruits varying in their smoking status at entry into the Navy and collected their subsequent hospitalization data (i.e., International Classification of Diseases, Ninth Revision codes) for up to 7-8 years of service. RESULTS: Results indicated that after adjusting for differences in time at risk and sociodemographic variables, daily smokers (compared with never-and other smokers) had higher rates of hospitalization for any reason and for musculoskeletal conditions. Daily smokers also had higher rates than never- and other smokers for non-pregnancy-related hospitalizations and for mental disorders, although only the daily/other differences reached statistical significance. Daily smokers' average number of days hospitalized was significantly longer than that of never- and other smokers. DISCUSSION: Results suggest that young women do not have to wait decades to experience the harmful effects of smoking. A recent history of cigarette smoking is an important determinant of hospitalization risk for even young healthy women in the U.S. Navy.

Predictors of error in estimates of blood alcohol concentration: a replication.

OBJECTIVE: To identify predictors of error in estimated blood alcohol concentration (eBAC) in a sample of bar patrons. METHOD: Six hundred sixty-six patrons (43.6% female) were randomly sampled from 32 bars. Patrons were asked to provide a breath sample into a handheld breath alcohol concentration test unit upon entrance and exit from the bar. Patrons also completed a brief survey at entrance and exit. For analyses, this sample was stratified by whether patrons consumed alcohol before attending the bar. Estimates of BAC were calculated using Matthews and Miller's formula (1979). A three-category dependent variable was created based on the estimation accuracy of eBAC relative to breath alcohol concentration: accurate (within .02), underestimate of BAC, and overestimate of BAC. RESULTS: Of those that drank before arriving at the bar, 29% of eBACs were accurate, 32.3% were underestimates, and 38.8% were overestimates. For those who drank only at the bar, 42.0% were accurate, 20.8% were underestimates, and 37.7% were overestimates. Among those who drank before attending the bar, the number of drinks consumed before attending the bar was significantly related to eBAC underestimate. Among those who drank only at the bar, predictors of overestimate included being female, drinking more, and drinking longer. CONCLUSIONS: The accuracy of eBAC is poor at best. In an earlier study of parties, eBACs were often underestimated; in the bar setting, eBACs were often overestimated. More research is needed to understand the role of setting on eBAC calculations.

Blood alcohol concentrations among bar patrons: A multi-level study of drinking behavior.

This paper presents data from a study that collected observational data, survey data, and breath samples to estimate blood alcohol concentrations (BrAC) from patrons attending 30 bars. The study examines: (1) drinking behavior and settings prior to going to a bar; (2) characteristics of the bar where respondents are drinking; (3) person and environmental predictors of BrAC change (entrance to exit). Purposive sampling of bars that cater to young adults gave a sample of 30 bars. Patrons were randomly selected from bars (n=839). Approximately half of the sample was female (48.7%). Nearly three-quarters of participants reported drinking before attending the bar. Serving practices of the bars were observed; majority of bars served excessive amounts of alcohol in short periods of time. On average, those who drank before attending the bar had BrACs at approximately half the legal limit. Implications for responsible beverage service coupled with law enforcement strategies are discussed.