Predictors of motives for marijuana use in African American adolescents and emerging adults.

African American adolescents use marijuana at higher rates and may be more vulnerable to psychosocial risk factors for marijuana use, including depression, post-traumatic stress, and having substance-using peers, compared to Caucasian adolescents. Little is known about how these factors contribute to African American adolescents' motives for marijuana use. This study examined the roles of depressive and post-traumatic stress symptoms and substance-using peers on marijuana use motives among African American adolescents and emerging adults and whether these motives predicted marijuana use. Findings suggest that identifying motives for marijuana use may help improve approaches to reduce use among this population.

Marijuana Use and Increases in Use over Time among Young Adult College Students in the State of Georgia: Analyses of Sociocontexual Predictors.

BACKGROUND: While research has assessed correlates of marijuana use, there has been less focus on predictors of differing levels of changes in use during young adulthood, a critical period for use/escalation. OBJECTIVES: We examined changes in marijuana use and related sociocontextual predictors (e.g., earlier-onset substance use, parental use, college type). METHODS: Using data from Georgia college students (ages 18-25 years) in a 2-year, 6-wave longitudinal study (64.6% female, 63.4% White), 2-part random-effects modeling examined use at any assessment and number of days used. RESULTS: Predictors of use status at any assessment included being male (OR = 1.87, 95%CI = [1.28-2.73]), Black (OR = 1.91, 95%CI = [1.15-3.19]), earlier-onset marijuana (OR = 2.63, 95%CI = [1.70-4.06]), cigarette (OR = 2.04, 95%CI = [1.19-3.48]), and alcohol users (OR = 1.49, 95%CI = 1.00-2.22]), parental tobacco (OR = 2.14, 95%CI = [1.18-3.86]) and/or alcohol use (OR = 1.55, 95%CI = [1.09-2.20]), and attending private (vs. public) institutions (OR = 1.68, 95%CI = [1.10-2.59]). Predictors of lower likelihood of use over time included being male (OR = 0.87, 95%CI = [0.77-0.98]), earlier-onset cigarette use (OR = 0.82, 95%CI = [0.68-0.98]), parental alcohol use (OR = 0.86, 95%CI = [0.77-0.97]), and private institution students (OR = 1.17, 95%CI = [1.02-1.34]). Predictors of more days used at baseline included being male (OR = 1.77, 95%CI = [1.40-2.23]), Black (OR = 1.42, 95%CI = [1.04-1.93]), earlier-onset marijuana (OR = 2.32, 95%CI = [1.78-3.01]) and alcohol users (OR = 1.29, 95%CI = [1.01-1.66]), and parental tobacco use (OR = 1.90, 95%CI = [1.32-2.73]). Predictors of fewer days used over time included being older (OR = 0.98, 95%CI = [0.97-1.00]), parental tobacco use (OR = 0.86, 95%CI = [0.78-0.95]), and attending private institutions (OR = 0.89, 95%CI = [0.83-0.93]). CONCLUSIONS: Intervention efforts can be informed by current findings that correlates of baseline use (e.g., being male, attending private institutions) also predicted less use over time, and one's earlier use and parents' use of various substances impacted young adult use.

Experiences of Adverse Childhood Events and Racial Discrimination in Relation to Depressive Symptoms in College Students.

PROBLEM: The college years mark a critical period for experiencing multiple stressors and mental health problems. This study applied minority stress theory to examine adverse childhood events (ACEs) and experiences of racial discrimination, and their relationships to depressive symptoms among racially/ethnically diverse college students. METHODS: We analyzed cross-sectional data from 2,685 college students attending seven colleges/universities in the state of Georgia. Measures included sociodemographics, ACEs, experiences of racial discrimination, and depressive symptoms. RESULTS: Participants' average age was 20.51 (SD=1.94) years; 63.9% were female, 21.9% Black, and 7.8% Hispanic. Multivariable regression indicated that more ACEs predicted more experiences of racial discrimination, and both ACEs and discrimination experiences predicted greater depressive symptoms (p's<.001). Experiencing more ACEs was associated with being older, female, sexual minorities, White (vs. Asian), Hispanic, having less educated parents, and students at public colleges/universities or technical colleges (vs. private colleges/universities, p's<.05). More reports of racial discrimination were associated with being sexual and/or racial/ethnic minorities (p's<.05). Greater depressive symptoms were associated with being younger, female, sexual minorities, White (vs. Black), and students from public (vs. private) colleges/universities (p's<.01). CONCLUSIONS: College campuses should provide resources to address ACEs, racial discrimination, and mental health to support students' academic and psychosocial success.

Minority stress, depression, and cigarette smoking among Chinese gay versus bisexual men: a two-group structural equation model analyses.

BACKGROUND: Literature in the West suggested that bisexual men have a higher smoking rate compared to gay men. Data on patterns of smoking among gay and bisexual men are limited in Eastern Asian countries like China. This study examined the cigarette smoking prevalence for gay versus bisexual men in China and their unique minority stress - smoking pathways. METHODS: Between September 2017 and November 2018, we surveyed a convenience sample of 538 gay men and 138 bisexual men recruited from local sexual minority organizations in four metropolitan cities in China (i.e., Beijing, Wuhan, Nanchang, and Changsha). Measures included sexual orientation, sociodemographics, theory-based minority stressors, depressive symptoms, and past 30-day cigarette smoking. Two-group (gay men vs. bisexual men) structural equation modeling (SEM) was used to test possible distinct mechanisms between theory-based stressors, depressive symptoms, and cigarette smoking among gay men and bisexual men, respectively. RESULTS: The mean age of participants was 26.51 (SD = 8.41) years old and 76.3% of them had at least a college degree. Bisexual men reported a higher rate of cigarette smoking compared to gay men (39.9% vs. 27.3%). Two-group SEM indicated that the pathways for cigarette smoking were not different between gay and bisexual men. Higher rejection anticipation was associated with greater depressive symptoms (standardized ß = 0.32, p < .001), and depressive symptoms were not associated with cigarette smoking. CONCLUSIONS: Minority stress, specifically rejection anticipation, may be critical considerations in addressing depressive symptoms, but not smoking, among both gay and bisexual men in China.

Tobacco Use at the Intersection of Sex and Sexual Identity in the U.S., 2007-2020: A Meta-Analysis.

CONTEXT: A 2009 systematic review synthesized data between 1987 and 2007 and revealed a higher prevalence of smoking among sexual minority populations than among heterosexuals. Subsequently, growing attention to tobacco use among sexual minority populations has spurred more literature on this issue because higher tobacco use prevalence has been found in certain sexual minority subgroups relative to others. However, a population-level synthesis of tobacco use prevalence by sexual minority subgroup has not been done for the past decade. EVIDENCE ACQUISITION: Investigators conducted a meta-analysis by searching MEDLINE, Web of Science, EMBASE, and PsycINFO for U.S.-based studies published between 2007 and 2020 that specifically reported tobacco use prevalence among adults and separated the sexes and gays/lesbians versus bisexuals. Using random-effects models, meta-prevalence estimates, 95% CIs, and heterogeneity (I2) were calculated for each sexual minority subgroup. EVIDENCE SYNTHESIS: A total of 30 studies were included in the meta-analysis. The highest current cigarette use prevalence estimates were found among bisexual women (37.7%), followed by lesbians (31.7%), gay men (30.5%), and bisexual men (30.1%). Heterosexual men (21.0%) and women (16.6%) had the lowest prevalence. CONCLUSIONS: Tobacco use prevalence among sexual minorities during 2007-2020 remained at similarly high levels as those during 1987-2007, and tobacco use disparity between sexual minorities and heterosexuals persisted in the past decade. Significant heterogeneity existed in tobacco use across sexual minority subgroups, with bisexual women having the highest prevalence. These findings are critical for increasing decision maker's awareness and action to address sexual minorities' persistent high prevalence of tobacco use, particularly among bisexual women.

Prescription stimulant use among young adult college students: Who uses, why, and what are the consequences?

OBJECTIVE: To examine prescription stimulant use among college students, particularly use with versus without prescriptions or attention deficit hyperactive disorder (attention-deficit/hyperactivitydisorder (ADHD)) diagnoses. Participants: Data were drawn from a diverse sample of college students from seven colleges/universities in Georgia participating. Methods: Measures assessed ADHD-specific factors, prescription stimulant use, access, motives, side effects, and covariates. Results: Of the 219 students reporting prescription stimulant use (average age 20.72 years, 54.8% female, 82.1% White), 45.7% did not have prescriptions or ADHD diagnoses. Correlates of use without prescriptions/diagnoses included lower parental education, attending private school, not having depression- or anxiety-related diagnoses, and past 30-day marijuana and tobacco use. Those without prescriptions/diagnoses were more likely to use to stay awake longer, to have more enjoyable time, and to party longer; they also reported fewer adverse side effects. Conclusions: Campuses should educate students about ADHD, facilitate screening and treatment, and emphasize adverse consequences of recreational use.

Longitudinal changes in alcohol use and binge-drinking among young-adult college students: Analyses of predictors across system levels.

BACKGROUND: Longitudinal research regarding young-adult college student alcohol use behaviors is needed to identify risk factors and inform interventions, particularly with regard to binge-drinking. METHODS: Data from 3,418 US college students (aged 18-25) in a two-year, six-wave panel study (64.6% female, 63.4% White) were used to examine alcohol use and binge-drinking trajectories, as well as predictors of differing trajectories across individual (sociodemographics, depressive symptoms, ADHD symptoms, early-onset substance use), interpersonal (adverse childhood events, social support, parental substance use), and community factors (college type, rural/urban). RESULTS: Baseline alcohol use was associated with being White, higher parental education, early-onset use of alcohol, cigarettes, and marijuana, greater social support, parental alcohol use, attending private institutions, and rurality (p's < 0.01). Greater alcohol use over time was predicted by being White and attending private institutions (p's < 0.01). Multivariable regression indicated that predictors of binge-drinking at any assessment included older age, sexual minority, greater ADHD symptoms, early-onset substance use, parental alcohol use, attending private institutions, and rurality (p's < 0.01). GMM indicated 4 binge-drinking trajectory classes: Dabblers (89.94% of the sample), Slow decelerators (7.35%), Accelerators (1.86%), and Fast decelerators (0.84%). Fast and Slow decelerators were older; Dabblers and Fast decelerators were more likely female; Accelerators reported more depressive symptoms; Dabblers were less likely early-onset substance users; and those from rural settings were more likely Slow decelerators vs. Dabblers (p's < 0.05). CONCLUSIONS: Intervention efforts should be informed by data regarding those most likely to drink, binge-drink, and escalate use (e.g., Whites, men, early-onset users, parental use, private college students, rural).

Initial use of tobacco or marijuana and later use profiles in young adults.

INTRODUCTION: Given the relatively limited literature regarding risk factors for progression of alternative tobacco and marijuana use, this study examined initially-used tobacco or marijuana products and psychosocial risk factors such as adverse childhood events (ACEs), mental health (depression, ADHD), and parental substance use, in relation to young adult lifetime and current (past 30-day) tobacco and marijuana use. METHODS: Using cross-sectional data from a 2014-2016 study of 3418 young adult college students in Georgia, we analyzed lifetime and current use of various tobacco products (cigarettes, cigar products, smokeless tobacco, e-cigarettes, hookah) and marijuana among lifetime tobacco or marijuana users (N=1451) in relation to initially-used product as well as sociodemographic characteristics and psychosocial risk factors. RESULTS: Multivariable analyses indicated that more products ever used correlated with cigarettes being first used (vs cigars, B=-0.66; e-cigarettes, OR=-1.33; hookah, B=-0.99; and marijuana, B=-1.05; p<0.001), as well as being older (B=0.06), male (B=-0.72) and White (vs Black, B=-0.30; or Asian, B=-0.60), more adverse childhood events (ACEs, B=0.07), and parental marijuana use (B=0.47; p<0.05). Currently-used products correlated with cigarettes being first used (vs cigars, B=-0.18; e-cigarettes, B=-0.37; and hookah, B=-0.18; p<0.05), being younger (B=-0.04), male (B=-0.15), more depressive symptoms (B=0.01), and parental marijuana use (B=0.40; p<0.05). Current cigarette, smokeless tobacco, hookah and marijuana use demonstrated specificity to initially-used products. CONCLUSIONS: Initially-used products, specifically cigarettes, with well-documented and communicated risks, correlated with using more products subsequently among young adults, underscoring needed research on such risks and risk communication, and early intervention strategies.

Tobacco Use Trajectories in Young Adults: Analyses of Predictors Across Systems Levels.

INTRODUCTION: Research is needed to examine trajectories of tobacco use beyond cigarette smoking, particularly during emerging middle young adulthood, and to identify distinct multilevel influences of use trajectories. AIMS AND METHODS: We examined (1) tobacco use trajectories over a 2-year period among 2592 young adult college students in a longitudinal cohort study and (2) predictors of these trajectories using variables from a socioecological framework, including intrapersonal-level factors (eg, sociodemographics, psychosocial factors [eg, adverse childhood experiences, depressive symptoms, and attention-deficit hyperactivity disorder symptoms], early-onset substance use), interpersonal factors (eg, social support, parental substance use), and community-level factors (eg, college type, rural vs. urban). RESULTS: About 64.5% were female and 65.0% were white. From age 18 to 26, 27%-31% of participants reported past 30-day use of any tobacco product. We identified four trajectory classes: Abstainers/Dabblers who never or infrequently used (89.2%); Adult users who began using frequently around age 20 and continued thereafter (5.9%); College Smokers who began using before 19 but ceased use around 25 (2.5%); and Teenage users who used during their teenage years but ceased use by 22 (1.9%). Multinomial regression showed that, compared to Abstainers/Dabblers, significant predictors (p < .05) of being (1) Adult users included being male, earlier onset marijuana use, attending public universities or technical colleges (vs. private universities), and living in urban areas; (2) College users included being male, earlier onset marijuana use, and parental alcohol or marijuana use; and (3) Teenage users included only earlier onset marijuana use. CONCLUSION: Distinct prevention and intervention efforts may be needed to address the trajectories identified. IMPLICATIONS: Among young adult college students, the largest proportion of tobacco users demonstrate the risk of continued and/or progression of tobacco use beyond college. In addition, specific factors, particularly sex, earlier onset marijuana use, parental use of alcohol and marijuana, and contextual factors such as college setting (type of school, rural vs. urban) may influence tobacco use outcomes. As such, prevention and cessation intervention strategies are needed to address multilevel influences.

Maturing Out of Alcohol Use in Young Adulthood: Latent Class Growth Trajectories and Concurrent Young Adult Correlates.

BACKGROUND: The purpose of this study was to evaluate intraindividual variation in "maturing out" of alcohol use by using latent class growth trajectories of alcohol use from adolescence (age 17 years) through young adulthood (age 33 years). We also modeled trajectory group differences with regard to concurrent, age-relevant domains of substance use, health (e.g., physical health rating, sleep problems), interpersonal functioning (e.g., conflict with partner), and occupational functioning (e.g., intrinsic motivation). METHODS: Growth mixture modeling was used with a sample of 1,004 adolescents/young adults, and 3 trajectory groups were identified as follows: (i) a Normative Use group (n = 646) with low alcohol use remaining stable from adolescence to young adulthood; (ii) a Moderate Increase group (n = 300) with moderate alcohol use increasing slowly from adolescence to emergent adulthood (age 23 years) and then decreasing slightly from emergent adulthood to young adulthood (age 33 years); and (iii) a High Increase group (n = 58) with a high, increasing pattern of alcohol use from adolescence to emergent adulthood and then a small decrease in use from emergent adulthood to young adulthood. RESULTS: At age 33 years, trajectory groups differed, with High and Moderate Increase groups differing significantly from the Normative Use group in current alcohol and other substance use and other risk factors (e.g., friends' alcohol use). Furthermore, the High and Moderate Increase groups differed from the Normative Use group on indicators of health (poorer sleep and more sleep problems), social functioning (higher partner and work-family conflict), and occupational functioning (lower intrinsic work motivation). CONCLUSIONS: These findings suggest that trajectory group membership in alcohol use from adolescence to young adulthood is associated with the domains of substance use, health, and social and occupational functioning. Furthermore, the findings suggest that maturing out applies primarily to a subset of those individuals at moderate to higher levels of alcohol use.

Motives for Alcohol and Marijuana Use as Predictors of Use and Problem Use Among Young Adult College Students.

This study examined (a) differences between alcohol-only users and alcohol-marijuana co-users and (b) motives for use in relation to alcohol and marijuana use and problem use. Spring 2016 data among 1,870 past 4-month alcohol users (63.6% female, 69.1% White) from seven Georgia colleges/universities were analyzed cross-sectionally and with regard to problem use measured 4 months later. Correlates of co-use (n = 345; vs. alcohol-only use, n = 1,525) included greater alcohol and marijuana use frequency, problem drinking and marijuana use, and alcohol use motives (p's < .05). Controlling for covariates, alcohol use frequency correlated with greater marijuana use frequency and Coping and Self-enhancement alcohol use motives, but lower Conformity alcohol use motives (p's < .001); greater Coping and Self-enhancement alcohol use motives (p's < .01) predicted problem alcohol use. Marijuana use frequency correlated with greater Coping and Expansion marijuana use motives (p's < .05); greater Expansion marijuana use motives (p = .005) predicted problem marijuana use. College-based substance use interventions should target Coping and Self-enhancement alcohol use motives and Expansion marijuana use motives.

Sex differences in substance use from adolescence to young adulthood: Tests of increases in emergent adulthood and maturing out in later young adulthood.

INTRODUCTION: This study evaluated sex differences in substance use changes across two transitions: from adolescence (age 17 yrs.) to emergent adulthood (age 23 yrs.), and maturing out from emergent to later young adulthood (ages 28 and 33 yrs.). METHODS: Four-wave longitudinal data (N = 1004) from adolescence to young adulthood were used and five substance outcomes were assessed (cigarette, alcohol, and marijuana use, heavy drinking episodes (HDEs), and alcohol problems). A longitudinal mixed model tested Sex × Time interactions to determine if sex moderated changes in substance outcomes. RESULTS: Findings supported both increases in substance outcomes from adolescence to emergent adulthood and decreases in substance outcomes from emergent adulthood to later young adulthood. Sex moderated these relationships, with males increasing their use of substances more than females across the transition from adolescence to emergent adulthood. Findings were partially robust across substance outcomes, although sex specificity was indicated for some substance outcomes (e.g., males' greater acceleration than females for HDEs) for the adolescent to emergent adult interval (from ages 17-23 years) and sex differences in maturing out for some outcomes (e.g., females' matured out earlier than males for cigarette and marijuana use). CONCLUSIONS: These findings provide support for developmental changes associated with significant increases in substance use during the early twenties and decreases (maturing out) in the late twenties and early thirties. Sex moderated the strength of these relationships and these sex differences may be associated with changes in young adult social roles (e.g., marriage, parenting, and occupational roles).

Developmental Changes in Sexual Risk and Substance Use Among African American Females: an Integrated Data Analysis Approach Using Time-varying Effect Models.

The aim of this study was to describe age-related changes in sexual risk and substance use using existing data from three HIV/sexually transmitted infection (STI) prevention trials conducted in Atlanta, Georgia, that enrolled young African American women. We used two novel analysis methods: integrative data analysis (IDA) and time-varying effect models (TVEM). Each trial collected self-reported behavioral data and vaginal swab specimens assayed for chlamydia, gonorrhea, and trichomonas. Baseline data from all participants and follow-up data from participants not randomized to an active intervention arm were integrated in a pooled dataset using an IDA approach. The pooled dataset included observations for 1974 individuals, aged 14-25 years for behavioral outcomes and 16-25 years for STI outcomes. We used TVEM to model age-related changes in sexual risk and substance use behaviors and STI acquisition, adjusting for trial as a fixed effect. Coital frequency and condomless sex increased through the early 20s while multiple partnerships remained fairly steady. Alcohol use and cigarette smoking increased through about age 24 years before declining. Marijuana use peaked at age 16-17 years and thereafter generally declined. STI acquisition was highest at age 16 years. This study demonstrates the feasibility and utility of innovative methodological techniques to address novel questions related to adolescent development using existing data from multiple trials. The results suggest that mid-adolescence and the early 20s may be periods of particular risk. The findings may be useful for timing culturally and developmentally relevant prevention interventions for young African American women.

Comparisons of Types of Exposure to Violence Within and Across Contexts in Predicting the Perpetration of Dating Aggression.

It is widely accepted that adolescents exposed to violence are more likely to become perpetrators of dating aggression. However, it remains unclear whether the effects of exposure to violence on later perpetration of dating aggression vary based on the nature of the violence exposure (e.g., witnessing versus being a victim) and the contexts of exposure to violence. Thus, the relationships between two types of exposure to violence (witnessing and victimization) in early adolescence and perpetrating dating aggression in late adolescence were compared within and across three social contexts: the home, the community, and the school. Participants included 484 youth (51% females; 81% African-Americans, 18% European-Americans, 1% Hispanic or Other). Information on exposure to violence were collected at Waves 1 and 2 during early adolescence (Wave 1: M = 11.8 years old; Wave 2: M = 13.2 years old) and dating aggression data were collected during late adolescence (Wave 3: M = 18.0 years old). The results showed that across all contexts witnessing violence was a more consistent predictor of later dating aggression relative to victimization. Being exposed to violence in the home either via observation or victimization was a stronger predictor of physical dating aggression and threatening behaviors compared to being exposed to violence in the school. These findings provide a deeper understanding of the roles of various forms of exposure to violence during early adolescence in perpetrating dating aggression later in the life course.

Tobacco Abstinence Motives in Young Adult College Students: Scale Development and Validation.

Objectives: Our objective was to develop a scale to assess motives for abstaining from tobacco use among young adults. Methods: We analyzed 2016 survey data from 2094 US college students (ages 18-25) who reported no past-4-month tobacco use. We developed a 10-item scale and examined its reliability and validity, specifically in relationship to future use intentions; perceived addictiveness, health risks, and social acceptability of tobacco use; and tobacco product use at 4-month follow-up. Results: Factor analysis identified 2 factors: Social Concerns and Instrumental Concerns. Bivariate analyses regarding convergent and discriminant validity indicated that both subscales were associated with lower future tobacco use intentions; greater perceived addictiveness and harm to health; and lower likelihood of follow-up use across products (ps < .05). Social Concerns scores were associated with all psychosocial factors; Instrumental Concerns scores were not associated with perceived social acceptability or parental tobacco use. Multivariable logistic regression indicated that lower Social Concerns scores predicted any follow-up tobacco use (p = .027); lower Instrumental Concerns scores predicted follow-up e-cigarette use (p = .037). Additionally, Tobacco Abstinence Motives scores contributed significantly to each model. Conclusions: This scale demonstrated good psychometric properties and identi- fied social and instrumental concerns as potential intervention targets to promote young adult abstinence.

Age-related associations between substance use and sexual risk behavior among high-risk young African American women in the South.

BACKGROUND: We assessed age-related associations between substance use and sexual risk behavior using data from three HIV prevention trials that enrolled young African American women. METHODS: We used integrative data analysis to pool data from 1862 individuals aged 16-25 years. We used time-varying effect models to examine associations between substance use (alcoholic drinks per month, recent marijuana use, cigarettes smoked per day) and sexual risk behaviors (monthly frequency of vaginal sex, multiple sex partners, condomless sex), adjusting for the fixed effect of trial. RESULTS: In models that included all three substances, cigarette smoking was not associated with any outcome. Alcohol quantity was associated with greater frequency of sex at all ages, an increased likelihood of having multiple sex partners from about age 17-24 years, and an increased likelihood of condomless sex after about age 18.5 years. Associations between alcohol quantity and sex frequency were relatively stable; associations with having multiple sex partners and condomless sex increased beginning at about age 22 years. Marijuana use was associated with greater sex frequency at approximate ages 16.5-24 years and an increased likelihood of having multiple sex partners at ages 18-24 years. Associations with sex frequency were relatively stable; associations with having multiple sex partners increased from about age 18 and peaked at about age 23 years. CONCLUSIONS: We observed developmentally-dependent relationships between both alcohol and marijuana and sexual risk behavior. The findings underscore the need to address substance-related sexual risk among young African American women and may inform optimal timing of intervention.

Psychological Risk Factors for Alcohol, Cannabis, and Various Tobacco Use among Young Adults: A Longitudinal Analysis.

BACKGROUND: Alcohol, cannabis, and tobacco use are prevalent in young adults and may be differentially related to psychological symptoms characterized as externalizing or internalizing. OBJECTIVES: This study examined the use of alcohol, cannabis, and various tobacco products in relation to externalizing (ADHD) versus internalizing factors (depression, anxiety), hypothesizing alcohol and cannabis use are associated with externalizing factors whereas tobacco use is related to internalizing factors. METHODS: Data from a 2-year longitudinal study of 2,397 US college students (aged 18-25) launched in 2014 were analyzed. Adult ADHD Self-Report Scale, Patient Health Questionnaire-9 item (assessing depressive symptoms), and the Zung Self-Rating Anxiety Scale scores were examined in relation to subsequent past 30-day use of alcohol, cannabis, and tobacco products (cigarettes, little cigars/cigarillos, smokeless tobacco, e-cigarettes, hookah), as well as nicotine dependence per the Hooked on Nicotine Checklist. RESULTS: Participants were 20.49 (SD = 1.93) years old, 64.7% female, and 65.5% White. In multivariable analyses, greater ADHD symptoms predicted alcohol and cannabis use (p = .042 and p = .019, respectively). Cigarette and little cigar/cigarillo use were predicted by greater depressive (p = .001 and p = .002, respectively), and anxiety symptoms (p = .020 and p = .027, respectively). Nicotine dependence was correlated with greater anxiety symptoms (p = .026). Counter to hypotheses, smokeless tobacco use was predicted by greater ADHD symptoms (p = .050); neither e-cigarette nor hookah use were predicted by these psychological symptoms. Conclusions/Importance: Research examining risk factors for tobacco use must distinguish among the various tobacco products. Moreover, interventions may need to differentially target use of distinct substances, including among the range of tobacco products.

A systematic review of selected human rights programs to improve HIV-related outcomes from 2003 to 2015: what do we know?

BACKGROUND: Repressive legal environments and widespread human rights violations act as structural impediments to efforts to engage key populations at risk of HIV infection in HIV prevention, care, and treatment efforts. The identification and scale-up of human rights programs and rights-based interventions that enable coverage of and retention in evidence-based HIV prevention and treatment approaches is crucial for halting the epidemic. METHODS: We conducted a systematic review of studies that assessed the effectiveness of human rights interventions on improving HIV-related outcomes between 1/1/2003-28/3/2015 per PRISMA guidelines. Studies of any design that sought to evaluate an intervention falling into one of the following UNAIDS' key human rights program areas were included: HIV-related legal services; monitoring and reforming laws, policies, and regulations; legal literacy programs; sensitization of lawmakers and law enforcement agents; and training for health care providers on human rights and medical ethics related to HIV. RESULTS: Of 31,861 peer-reviewed articles and reports identified, 23 were included in our review representing 15 different populations across 11 countries. Most studies (83%) reported a positive influence of human rights interventions on HIV-related outcomes. The majority incorporated two or more principles of the human rights-based approach, typically non-discrimination and accountability, and sought to influence two or more elements of the right to health, namely availability and acceptability. Outcome measures varied considerably, making comparisons between studies difficult. CONCLUSION: Our review revealed encouraging evidence of human rights interventions enabling a comprehensive HIV response, yet critical gaps remain. The development of a research framework with standardized indicators is needed to advance the field. Promising interventions should be implemented on a larger scale and rigorously evaluated. Funding for methodologically sound evaluations of human rights interventions should match the demand for human rights-based and structural approaches to protect those most vulnerable from HIV infection.

From Epidemiologic Knowledge to Improved Health: A Vision for Translational Epidemiology.

Epidemiology should aim to improve population health; however, no consensus exists regarding the activities and skills that should be prioritized to achieve this goal. We performed a scoping review of articles addressing the translation of epidemiologic knowledge into improved population health outcomes. We identified 5 themes in the translational epidemiology literature: foundations of epidemiologic thinking, evidence-based public health or medicine, epidemiologic education, implementation science, and community-engaged research (including literature on community-based participatory research). We then identified 5 priority areas for advancing translational epidemiology: 1) scientific engagement with public health; 2) public health communication; 3) epidemiologic education; 4) epidemiology and implementation; and 5) community involvement. Using these priority areas as a starting point, we developed a conceptual framework of translational epidemiology that emphasizes interconnectedness and feedback among epidemiology, foundational science, and public health stakeholders. We also identified 2-5 representative principles in each priority area that could serve as the basis for advancing a vision of translational epidemiology. We believe an emphasis on translational epidemiology can help the broader field to increase the efficiency of translating epidemiologic knowledge into improved health outcomes and to achieve its goal of improving population health.

Partner Conflict and Support as Moderators of Alcohol Use on Alcohol Problems and Marital Satisfaction in Young Adult Marital Dyads.

BACKGROUND: This cross-sectional study used data from 483 young adult marital dyads to evaluate conflict-with-partner and support-from-partner as moderators of alcohol use on 2 outcomes: alcohol problems and marital satisfaction. A path analytic modeling approach was used to test stress-exacerbating and stress-buffering hypotheses, and to accommodate the interdependent nature of the dyadic data. METHODS: This cross-sectional sample was selected from an adolescent-to-young adult longitudinal study in which spouses were recruited into the study during a later young adult assessment when the sample was, on average, 32.5 years old. Individual interviews using computerized technology were conducted with participants. RESULTS: Findings for the outcome of alcohol problems indicated stress exacerbation in that higher conflict by each partner in interaction with higher alcohol use was associated with more alcohol problems for wives. Husbands' and wives' alcohol problems were lower when higher partner support buffered the association between alcohol use and alcohol problems. For the outcome of marital satisfaction, higher support-from-partner buffered the association between alcohol use and marital satisfaction. Finally, the combination of alcohol use and conflict-with-partner had more adverse implications for women's alcohol problems relative to men's alcohol problems. CONCLUSIONS: These findings highlight that interactions between interpersonal dimensions of romantic relationships and alcohol use by both partners contribute to our understanding of their associations with alcohol problems and marital satisfaction within the marital relationship. Furthermore, there was some sex specificity in that some interactions were more prominently associated with alcohol problems for wives than husbands.