Feasibility of remote self-collection of dried blood spots, hair, and nails among people with HIV with hazardous alcohol use.

BACKGROUND: The use of biomarkers in behavioral HIV research can help to address limitations of self-reported data. The COVID-19 pandemic forced many researchers to transition from standard in-person data collection to remote data collection. We present data on the feasibility of remote self-collection of dried blood spots (DBS), hair, and nails for the objective assessment of alcohol use, antiretroviral therapy adherence, and stress in a sample of people with HIV (PWH) who are hazardous drinkers. METHODS: Standardized operating procedures for remote self-collection of DBS, hair, and nails were developed for an ongoing pilot study of a transdiagnostic alcohol intervention for PWH. Prior to each study appointment, participants were mailed a kit containing materials for self-collection, instructions, a video link demonstrating the collection process, and a prepaid envelope for returning samples. RESULTS: A total of 133 remote study visits were completed. For DBS and nail collection at baseline, 87.5% and 83.3% of samples, respectively, were received by the research laboratory, of which 100% of samples were processed. Although hair samples were intended to be analyzed, most of the samples (77.7%) were insufficient or the scalp end of the hair was not marked. We, therefore, decided that hair collection was not feasible in the framework of this study. CONCLUSION: An increase in remote self-collection of biospecimens may significantly advance the field of HIV-related research, permitting the collection of specimens without resource-intensive laboratory personnel and facilities. Further research is needed on the factors that impeded participants' ability to complete remote biospecimen collection.

Sexual Assault, Mental Health, and Alcohol Use in College Women: The Role of Resilience and Campus Belonging.

Understanding the mental health outcomes of sexual assault among college women is a public health priority. Although research has identified risk factors for the development of mental health problems following an assault, few studies have utilized a strengths-based approach to identify personal and social resources that may mediate the sexual assault-mental health link. Prior studies allude to the role of resilience and perceived campus belonging in explaining the relationship between sexual assault and mental health. This study represents the first application of the stress process model using a large sample of college women to examine (a) the association between sexual assault and mental health (i.e., psychological distress, suicidality, self-harm) and alcohol use problems and (b) the role of resilience and perceived campus belonging as partial mediators of these associations. Data were collected as part of the Spring 2021 American College Health Association National College Health Assessment (ACHA-NCHA; n = 31,328, Mean age = 20.26, SD = 1.64, 58.8% White), a cross-sectional, online survey that samples college students from 143 self-selected United States colleges. To test our primary hypothesis, a structural regression model was conducted, which included a latent sexual assault predictor, manifest resilience and campus belonging mediators, a latent mental health outcome, and a manifest alcohol use problems outcome. Mental health and alcohol use problems were positively associated with sexual assault and negatively associated with resilience and campus belonging. Resilience partially mediated the association between sexual assault and mental health. Campus belonging partially mediated the association between sexual assault, mental health, and alcohol use problems. This model explained 23.2% of the variance in mental health and 5.9% of the variance in alcohol use. Resilience and campus belonging may represent modifiable factors that can be targeted in trauma-focused interventions in efforts to improve victimized college women's mental health.

Non-daily Cigarette Smoking: Stability and Transition to Abstinence in Young Adults.

INTRODUCTION: There is increasing recognition that non-daily cigarette smoking is common in early adulthood but less is known about its stability over time, or what influences transitions to heavier or nonsmoking. We examined the stability of non-daily smoking in a sample of young adults, and tested whether social and cognitive factors predicted transitions to other smoking patterns over time. AIMS AND METHODS: Participants were 579 young adults (18-24 years old at enrollment, 52% male) who were non-daily and never-daily cigarette smokers and California residents. Participants completed 13 waves of assessment over 3 years. We used descriptive statistics to evaluate the frequency of consistent abstinence, defined as no cigarette use at two consecutive waves and no cigarette use at any subsequent waves. Cox and logistic regression were used to test predictors of consistent abstinence. RESULTS: We found that 55% of participants smoked intermittently throughout the study, while 43% were consistently abstinent by the end of the study; few transitioned to daily smoking. Stopping smoking was associated with having fewer smoking friends, smoking less in social situations, having lower positive reinforcement expectancies for smoking, and having stronger intent to quit. Post hoc analyses indicated those who stopped smoking tended to report reductions in positive reinforcement expectancies and increased intent to quit in the 6 months before stopping. CONCLUSIONS: Findings suggest a substantial minority of young adult non-daily smokers may stop on their own, but that the majority continue smoking and may require intervention. Interventions for this population should address social motives and reinforcement expectancies. IMPLICATIONS: The majority of young adults who are non-daily cigarette smokers appear to maintain this habit over an extended period and may require intervention. Interventions that focus on reducing expectancies for positive effects of and social motives for cigarette use and on increasing intent to quit smoking may be most effective.

Post-legalization changes in marijuana use in a sample of young California adults.

INTRODUCTION: Increasing marijuana use among young adults is a concern due to substantial acute and chronic health risks. More widespread use of marijuana may also lead to increased use of nicotine and tobacco products. California legalized commercial sales of marijuana for recreational use as of January 2018. To our knowledge no studies to date have examined subsequent changes in marijuana use. The goal of this study was to test the hypothesis that marijuana use frequency increased following legalization of recreational sales. We also hypothesized that increased marijuana frequency would predict greater frequency of nicotine/tobacco consumption. METHODS: The study was a secondary analysis of a longitudinal study of tobacco use among non-daily cigarette smokers. Participants were 563 young adults (aged 18-24) enrolled in 2015-16 and followed quarterly for 3 years. RESULTS: A piecewise multilevel regression model indicated that marijuana use frequency did not change over time, including following legalization. More frequent use was associated with younger age and identifying as white (ps < 0.001, which did not change after legalization. Marijuana frequency was moderated by sex (p < .001), with women reporting increasing and men decreasing use over time. It was also associated with tobacco use, and particularly with e-cigarette use following legalization (ps < 0.05). CONCLUSIONS: Findings suggest legalization of recreational marijuana sales had a negligible overall impact on days of use among young adults, but may have prompted increased interest in marijuana among some, particularly women and e-cigarette users. The continuously evolving landscape around these products indicates that ongoing surveillance is critical.

Co-occurring Use of Cannabis and Tobacco and the Presence of Acute Respiratory Symptoms among Young Adult Light and Intermittent Smokers.

BACKGROUND: Cannabis use and intermittent smoking are becoming increasingly prevalent among young adults. Thus, identifying health consequences of co-occurring use of these substances represents an emerging research priority. Purpose/Objectives: This study evaluated the relationship between tobacco/cannabis co-use and acute symptoms of respiratory illness among young adult intermittent smokers. We hypothesized that tobacco/cannabis co-use would be more strongly associated with respiratory symptoms relative to use of neither or one product. Methods: A secondary analysis of a three-year observational study was conducted. Non-daily smokers (n = 563) aged 18-24 were recruited via social media and completed electronic surveys at baseline and annually for two years, producing three total assessments. Past-two-week use of tobacco and cannabis was measured at each assessment, as was severity of six acute respiratory symptoms. The respiratory measure was dichotomized to indicate the presence or absence of symptoms. Results: Tobacco/cannabis co-use decreased from 54.8% at baseline to 43.4% at year two (p < .001). Mean respiratory symptoms also declined significantly over time (ps < .05). At each timepoint, co-use was more strongly associated with presence of respiratory symptoms than the use of neither product (aORs = 2.73-4.39, ps ≤ .013). Co-users were also 38%-183% more likely to endorse the presence of respiratory symptoms than single product users at each timepoint (aORs = 1.38-2.83, ps = .023-.212). Conclusions/Importance: Although co-occurring use of tobacco and cannabis by young adults may represent experimental use of multiple substances, it may also promote or exacerbate acute symptoms of respiratory illness. Further exploration with more granular patterns of co-use and across different routes of administration is warranted.

Associations Between Self-Reported and Biological Measures of Nicotine Consumption Among Young Adult Nondaily Cigarette Smokers.

BACKGROUND AND OBJECTIVES: Intermittent, dual use of cigarettes and e-cigarettes is a common pattern among youth and young adults. However, little is known about the validity of self-report measures of nicotine consumption in these populations. The goal of the present study was to examine associations between self-reported frequency of cigarette and e-cigarette use and nicotine levels in hair samples at two assessments 1 year apart. METHODS: Participants (n = 90; 65% female) were 19- to 25-year-old intermittent cigarette smokers recruited from the community for a longitudinal study of tobacco use. They submitted hair samples via mail, 1 and 2 years after enrollment in the parent study. RESULTS: Findings indicated that days of use of both cigarettes and e-cigarettes in the past 30 days independently predicted hair nicotine in the full sample, and when examining only timepoints at which any cigarette use was reported. Timepoints when any e-cigarette use was reported, hair nicotine was positively associated with e-cigarette but not cigarette frequency. DISCUSSION AND CONCLUSIONS: Data suggest that self-report measures are valid methods of assessing intermittent use of both cigarettes and e-cigarettes. Findings also suggest that dual users may tend to consume more nicotine and thus be at greater risk for dependence than single product users. SCIENTIFIC SIGNIFICANCE: These results are among the first to indicate that hair analysis can be used to detect intermittent nicotine exposure via both cigarettes and e-cigarettes. (Am J Addict 2020;29:471-475).

Polytobacco use among young adult smokers: prospective association with cigarette consumption.

BACKGROUND: The risks of polytobacco use among young adults are unclear because we know relatively little about the consistency of multiproduct patterns over time and how these patterns impact cigarette smoking. The purpose of this study was to examine changes in multiple tobacco product use over time and associations with cigarette smoking quantity. METHODS: Participants (n=335; 55% male) were 18-24 years old non-daily cigarette smokers living in California. Polytobacco use patterns were assessed quarterly for 2 years. RESULTS: Transition analyses showed that while the number of products that had been used recently was volatile, the most common pattern was stability between timepoints. A longitudinal negative binomial regression model indicated that those who used more non-cigarette products also reported greater cigarette quantity. The strength of this relationship increased over time. CONCLUSIONS: Findings suggest that individuals who use more tobacco products are at greater risk for increased cigarette smoking and maintaining a multiple product use pattern.

Expectancies and reasons for use of e-cigarettes among young adults: A longitudinal analysis.

Use of electronic cigarettes, or e-cigarettes, has increased exponentially in recent years. Mechanisms that might underlie this increase include expectancies and reasons for e-cigarette use. This study was designed to identify and evaluate changes in expectancies and reasons for e-cigarette use among young adults over time and to determine whether such changes were associated with changes in e-cigarette use. Data for these analyses were collected from a sample of 137 young adult e-cigarette users who completed electronic surveys 5 times over a 12-month period. Results yielded five e-cigarette use expectancy and reason factors: Affect-Related Reasons, Social Reasons, Positive Social Expectancies, Positive Internal Expectancies, and Negative Expectancies. Linear mixed models showed that Negative Expectancies significantly increased over time (p = .004), whereas Affect-Related Reasons significantly decreased over time (p = .001). Additional linear mixed models indicated that, whereas both frequency and quantity of e-cigarette use decreased over time, changes in Positive Internal Expectancies were positively associated with changes in frequency of e-cigarette use (p = .032) and changes in Positive Social Expectancies were positively associated with changes in both frequency (p = .007) and quantity (p = .026) of e-cigarette use. These findings suggest that young adults' expectancies and reasons for using e-cigarettes fluctuate over time, and changes in expectancies seem to be longitudinally associated with changes in e-cigarette use. Positive expectancies for e-cigarette use represent targets for clinical, prevention, and intervention efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relationship between family history of tobacco use and progression to tobacco use among young adult e-cigarette users.

Family history of tobacco use and use of e-cigarettes have both been associated with increased tobacco use among young adults. However, to our knowledge, these variables have not been considered simultaneously. This study was designed to evaluate the hypothesis that family history of tobacco use would predict tobacco product use over time among young adult e-cigarette users with limited combustible tobacco use experience. A sample of 124 participants were recruited online from across the United States, completed five surveys over 12 months, and reported use of nicotine and tobacco products over the previous two weeks at each survey. Family history of nicotine and tobacco use was reported at the 6-month assessment, and data were collected in 2017 and 2018. Regression models indicated that family history was associated with likelihood of cigarette use (odds ratio = 1.02 [95% confidence interval = [1.00, 1.04]). Significant interactions between family history and linear (OR = 1.05 [1.01, 1.10]) and quadratic (OR = 0.99 (0.98, 1.00)] time terms indicated that the association between family history and likelihood of combustible product use shifted over time. In both cases, more extensive family histories predicted greater use frequency, and follow-up analyses showed that more extensive family history was associated with greater combustible tobacco product use 3, 6, and 9 months following baseline. Family history of nicotine/tobacco use may promote initiation of tobacco use among e-cigarette users. These results suggest family history of tobacco use may comprise a risk factor for combustible tobacco use within the evolving tobacco product landscape.

Marijuana use among young adult non-daily cigarette smokers over time.

Recent data regarding growth in concurrent use of nicotine and marijuana have raised concern that reductions in legal restrictions on marijuana use may increase risk for tobacco-related harms. Previous studies have shown cross-sectional links between use of both substances, but less is known about associations over time. The goal of the present study was to test the hypothesis that there is a bidirectional relationship between use of marijuana and use of tobacco products over time, such that increasing use of either substance would predict increasing use of the other. Participants (n = 391, 52% male) were 18-24 year-old Californians who were non-daily cigarette smokers at enrollment and had never been daily smokers. They reported nicotine/tobacco and marijuana use quarterly over 2 years. Longitudinal negative binomial and logistic regression models indicated that each additional timepoint at which participants reported recent marijuana use predicted 9-11% increases in tobacco quantity and frequency. Additionally, each additional timepoint at which cigarette or tobacco use was reported predicted 19-22% greater marijuana frequency. Data suggest that young adults who use marijuana more frequently are likely at risk for greater tobacco exposure, and vice versa. These findings suggest a need for preventive measures that focus on concurrent use of both substances rather than either individually.

Impulsivity and tobacco product use over time.

Impulsivity has been consistently associated with greater likelihood and intensity of cigarette smoking, but most studies have been cross-sectional. Additionally, while some initial studies are suggestive, less is known about links between impulsivity and use of e-cigarettes or hookah tobacco. The goal of the present study was to test the hypothesis that the urgency and sensation seeking aspects of impulsivity would be prospectively associated with patterns of cigarette, e-cigarette, and hookah tobacco use over time. Young adults (n = 335; 56% male) aged 18-24 who were non- and never-daily cigarette smokers at baseline completed 9 online assessments of tobacco product use over two years. Longitudinal negative binomial regression models were used to evaluate relationships between impulsivity components and product use. Frequency of use of all three products declined over time. Higher levels of positive urgency (cigarette), negative urgency (hookah), and lack of premeditation (e-cigarette, hookah) were associated with smaller reductions in frequency of specific products. Additionally, higher negative urgency predicted greater quantity of cigarettes consumed, and higher sensation seeking was associated with more frequent e-cigarette use. Findings suggest impulsivity components differentially predict tobacco use over time, indicating that motives and/or risk factors for tobacco use may be product-specific.