Intention to quit or reduce e-cigarettes, cannabis, and their co-use among a school-based sample of adolescents.

INTRODUCTION: Little is known about the prevalence and predictors of adolescents' intention to quit or reduce use of e-cigarettes and/or cannabis. METHODS: Frequencies of intention to change (quit, reduce) e-cigarettes and/or cannabis use were examined among 23,915 surveyed middle and high school students with sole and co-use. Predictors of intention to change were identified via LASSO/multilevel logistic regression. RESULTS: Among those with sole e-cigarette use (n = 543), 40.9 % intended to quit and 24.1 % intended to reduce; non-daily e-cigarette use predicted intention to quit and reduce e-cigarettes (p's < 0.03). Among those with sole cannabis use (n = 546), 10.6 % intended to quit and 25.1 % intended to reduce; absence of cannabis cravings predicted intention to reduce cannabis use (p < 0.01). Among those with co-use (n = 816), 26.2 % intended to either quit or reduce (quit/reduce) both substances, 27.5 % intended to quit/reduce e-cigarettes only, and 6.9 % intended to quit/reduce cannabis only. No predictors emerged for intention to change e-cigarette use among those with co-use (p's > 0.09), but younger age, lack of poly-tobacco use, and lack of cannabis craving predicted intention to quit/reduce cannabis use (p's < 0.04). CONCLUSIONS: More than half of adolescents with past-month e-cigarette use, regardless of concurrent cannabis use, expressed interest in changing their use. However, only heaviness of e-cigarette use emerged as a predictor of intention to change suggesting. While fewer students expressed interest in changing their cannabis use, cannabis cravings and poly-tobacco use predicted intent to change. Overall, findings emphasize the need to tailor interventions towards adolescents engaging in more problematic substance use patterns.

Longitudinal Associations Between Cannabis Use and Cognitive Impairment in a Clinical Sample of Middle-Aged Adults Using Cannabis for Medical Symptoms.

Introduction: Cannabis use to alleviate medical symptoms is increasing in middle-aged and older adults. Cognitive impairment associated with cannabis use may be especially detrimental to these understudied age groups. We hypothesized that among middle-aged and older adults who used cannabis for 12 months, frequent (≥3 days/week) compared with nonfrequent (≤2 days/week) use will be associated with cognitive impairment. Materials and Methods: We performed secondary analysis on data from a clinical trial of cannabis use for medical symptoms. Participants (n=62) were ≥45 years, and completed a baseline and at least one postbaseline visit. Cognitive domains were assessed through the Cambridge Neuropsychological Test Automated Battery. Cannabis use was assessed prospectively through daily smartphone diaries. Frequency of cannabis use was a binary predictor in a mixed-effects logistic regression model predicting cognitive impairment adjusted for baseline cognitive functioning. Results: At baseline, participants were primarily nonfrequent cannabis users; however, in all other time periods, most participants were frequent users (range: 55-58%). Cognitive outcomes did not differ between frequent and nonfrequent cannabis users. However, in sensitivity analyses, respondents with problematic cannabis use scored significantly worse on one cognitive domain compared to those without problematic cannabis use. Conclusions: In a clinical sample of adults aged ≥45 years, no longitudinal associations were found between cannabis use and cognitive functioning. However, a few significant associations were observed between problematic use and cognitive functioning. Further research is needed to assess the impact of cannabis use on adults, particularly those aged ≥65 years, and to investigate potential subtler influences of cannabis use on cognition. ClinicalTrials.gov ID: NCT03224468.

The Cannabis Effects Expectancy Questionnaire-Medical (CEEQ-M): Preliminary psychometric properties and longitudinal validation within a clinical trial.

The use of cannabis for medical symptoms is increasing despite limited evidence for its efficacy. Expectancies-prior beliefs about a substance or medicine-can modulate use patterns and effects of medicines on target symptoms. To our knowledge, cannabis expectancies have not been studied for their predictive value for symptom relief. The 21-item Cannabis Effects Expectancy Questionnaire-Medical (CEEQ-M) is the first longitudinally validated measure of expectancies for cannabis used for medical symptoms. The questionnaire was developed for a randomized clinical trial of the effect of state cannabis registration (SCR) card ownership on symptoms of pain, insomnia, anxiety, and depression in adults (N = 269 across six questionnaire administrations). Item-level analyses (n = 188) demonstrated between-person stability of expectancies and no aggregate, within-person expectancy changes 3 months after individuals gained access to SCR cards. Exploratory factor analysis (n = 269) indicated a two-factor structure. Confirmatory factor analysis at a later timepoint (n = 193) demonstrated good fit and scalar invariance of the measurement model. Cross-lagged panel models across 3 and 12 months (n = 187 and 161, respectively) indicated that CEEQ-M-measured expectancies did not predict changes in self-reported cannabis use; symptoms of pain, insomnia, anxiety, and depression; and well-being. However, greater baseline cannabis use predicted more positive expectancy changes. The findings suggest that the CEEQ-M is psychometrically sound. Future work should clarify at what timescales cannabis expectancies have predictive value and how cannabis expectancies for medical symptoms are maintained and diverge from other substance use expectancies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership.

Background: Evidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use. Objective: To prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use. Methods: This observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period. Results: After 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency. Conclusions: Frequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.

Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults: A Randomized Clinical Trial.

Importance: Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet a strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown. Objective: To evaluate the effect of obtaining a medical marijuana card on target clinical and cannabis use disorder (CUD) symptoms in adults with a chief concern of chronic pain, insomnia, or anxiety or depressive symptoms. Design, Setting, and Participants: This pragmatic, single-site, single-blind randomized clinical trial was conducted in the Greater Boston area from July 1, 2017, to July 31, 2020. Participants were adults aged 18 to 65 years with a chief concern of pain, insomnia, or anxiety or depressive symptoms. Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). Randomization was stratified by chief concern, age, and sex. The statistical analysis followed an evaluable population approach. Interventions: The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. Participants could continue their usual medical or psychiatric care. Main Outcomes and Measures: Primary outcomes were changes in CUD symptoms, anxiety and depressive symptoms, pain severity, and insomnia symptoms during the trial. A logistic regression model was used to estimate the odds ratio (OR) for CUD diagnosis, and linear models were used for continuous outcomes to estimate the mean difference (MD) in symptom scores. Results: A total of 186 participants (mean [SD] age 37.2 [14.4] years; 122 women [65.6%]) were randomized and included in the analyses. Compared with the delayed card acquisition group, the immediate card acquisition group had more CUD symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001); fewer self-rated insomnia symptoms (MD, -2.90; 95% CI, -4.31 to -1.51; P < .001); and reported no significant changes in pain severity or anxiety or depressive symptoms. Participants in the immediate card acquisition group also had a higher incidence of CUD during the intervention (17.1% [n = 18] in the immediate card acquisition group vs 8.6% [n = 7] in the delayed card acquisition group; adjusted odds ratio, 2.88; 95% CI, 1.17-7.07; P = .02), particularly those with a chief concern of anxiety or depressive symptoms. Conclusions and Relevance: This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms. Further investigation of the benefits of medical marijuana card ownership for insomnia and the risk of CUD are needed, particularly for individuals with anxiety or depressive symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT03224468.

A neural habituation account of the negative compatibility effect.

The negative compatibility effect (NCE) is the finding of slower reaction times (RTs) to report the direction of a target arrow following a subliminal prime arrow pointed in the same direction. The NCE is commonly thought to reflect automatic response inhibition, and on this assumption, it has recently been used to assess various motor disorders. Here we propose a fundamentally different account of the NCE: one that relates the NCE to a broader class of paradigms that reveal behavioral deficits with repetition priming. We propose that the NCE is a "cognitive aftereffect," as explained with the neural habituation model of Huber and O'Reilly (2003). To identify the underlying perceptual dynamics by reducing the role of response preparation, we developed a novel variant of the NCE task with threshold accuracy rather than RT as the dependent measure. This revealed a transition from positive to negative priming as a function of prime duration, and a second experiment ruled out response priming. The perceptual dynamics of the neural habituation model were fit to these results and then fixed in applying the model to the NCE literature. Application of the model to RTs added a response layer that accumulates response information throughout the trial. With this addition, the model captured results found in the NCE literature that are inconsistent with a response inhibition account. Situations that produce a positive compatibility effect, rather than an NCE, were explained as response priming, whereas NCE effects were explained as a cognitive aftereffect, rooted in perceptual dynamics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Connecting the dots without top-down knowledge: Evidence for rapidly-learned low-level associations that are independent of object identity.

Knowing the identity of an object can powerfully alter perception. Visual demonstrations of this-such as Gregory's (1970) hidden Dalmatian-affirm the existence of both top-down and bottom-up processing. We consider a third processing pathway: lateral connections between the parts of an object. Lateral associations are assumed by theories of object processing and hierarchical theories of memory, but little evidence attests to them. If they exist, their effects should be observable even in the absence of object identity knowledge. We employed Continuous Flash Suppression (CFS) while participants studied object images, such that visual details were learned without explicit object identification. At test, lateral associations were probed using a part-to-part matching task. We also tested whether part-whole links were facilitated by prior study using a part-naming task, and included another study condition (Word), in which participants saw only an object's written name. The key question was whether CFS study (which provided visual information without identity) would better support part-to-part matching (via lateral associations) whereas Word study (which provided identity without the correct visual form) would better support part-naming (via top-down processing). The predicted dissociation was found and confirmed by state-trace analyses. Thus, lateral part-to-part associations were learned and retrieved independently of object identity representations. This establishes novel links between perception and memory, demonstrating that (a) lateral associations at lower levels of the object identification hierarchy exist and contribute to object processing and (b) these associations are learned via rapid, episodic-like mechanisms previously observed for the high-level, arbitrary relations comprising episodic memories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Suggestibility is associated with alcohol self-administration, subjective alcohol effects, and self-reported drinking behavior.

BACKGROUND: Suggestibility, defined as an individual's inclination to accept and internalize messages, has not been studied in relation to alcohol use. Peer conformity, a component of suggestibility, may be related to alcohol use, as peer groups show similarities in patterns of alcohol use. Few studies have assessed how suggestibility and peer conformity relate to alcohol self-administration or to reinforcing effects of alcohol. AIMS: This study assessed whether suggestibility and peer conformity were associated with drinking behavior, alcohol self-administration, subjective response to alcohol, and drinking motives and expectancies. METHODS: Study 1 participants were alcohol drinkers (n=20), who completed a laboratory study of free-access intravenous alcohol self-administration. Study 2 participants were adolescents and young adults, age 14-25 (n=150), with lifetime alcohol use. Participants completed surveys of suggestibility and drinking patterns (Study 1 and 2), subjective alcohol effects (Study 1 only), and alcohol motives and expectancies (Study 2 only). RESULTS/OUTCOMES: In Study 1, participants with higher levels of suggestiblity self-administered more alcohol, and reported greater subjective alcohol effects. Peer conformity, though correlated with suggestibility, was not related to these measures. In Study 2, participants with higher suggestiblity reported more alcohol consumption, higher drinking motives and alcohol expectancies. Peer conformity was not related to alcohol consumption, but was related to coping and enhancement drinking motives, and all expectancies measures. CONCLUSIONS/INTERPRETATION: Results indicate that suggestibility, beyond peer conformity, may be a critical factor to study when examining alcohol consumption behavior, and may provide insight into the development of alcohol use disorder.

Recognition memory shielded from semantic but not perceptual interference in normal aging.

Normal aging impairs long-term declarative memory, and evidence suggests that this impairment may be driven partly by structural or functional changes in the medial temporal lobe (MTL). Theories of MTL memory function therefore make predictions for age-related memory loss. One theory - the Representational-Hierarchical account - makes two specific predictions. First, recognition memory performance in older participants should be impaired by feature-level interference, in which studied items contain many shared, and thus repeatedly appearing, perceptual features. Second, if the interference in a recognition memory task - i.e., the information that repeats across items - resides at a higher level of complexity than simple perceptual features, such as semantic gist, older adults should be less impacted by such interference than young adults. We tested these predictions using the Deese-Roediger-McDermott paradigm, by creating feature-level (i.e., perceptual) interference with phonemically/orthographically related word categories, and higher-level associative interference with semantically related word categories. We manipulated category size in order to compare the effect of less versus more interference (i.e., small versus large category size), which served to (1) avoid potential item confounds arising from systematic differences between words belonging to perceptually- versus semantically-related categories, and (2) ensure that any effect of interference was due to information encoded at study, rather than pre-experimentally. Further, we used signal detection theory (SDT) to interpret our data, rather than examining false alarm (FA) rates in isolation. The d' measure derived from SDT avoids contamination of the memory measure by response bias, and lies on an interval scale, allowing memory performance in different conditions to be compared without violating assumptions of the statistical tests. Older participants were relatively more impaired by perceptual interference and less impaired by semantic interference than young adults. This pattern is at odds with many current theories of age-related memory loss, but is in line with the Representational-Hierarchical account.

Does inhibition cause forgetting after selective retrieval? A reanalysis and failure to replicate.

Retrieval practice can produce forgetting, but it remains unclear using only behavioral data whether this forgetting is caused by targeted inhibition versus interference. Therefore, Wimber et al. (2015) used pattern classifier analyses of fMRI data to track individual memories in a novel variant of retrieval induced forgetting. After initial learning, people recalled target images across selective retrieval practice trials, and cortical activity patterns gradually became more similar to those evoked by the target pictures (i.e., pattern enhancement) and less similar to those evoked by competing pictures (i.e., pattern suppression). The key question was whether this inhibition of competing memories would cause forgetting. Wimber et al. found a significant forgetting effect (p<.01) on a subsequent forced choice picture recognition test, with lower accuracy for competitors than for baseline items. Because fMRI data is correlative, a causal interpretation of the data would require, at a minimum, more forgetting following cortical pattern suppression (as occurred for competitors) than cortical pattern enhancement (as occurred for targets). The interaction necessary to reach this conclusion was significant (p=.041). However, reanalyzing the original data revealed that the interaction depended on the decision to code missing responses as equivalent to choosing the wrong picture. Even if missing trials reflected memory failures, at worst they would produce 50/50 guessing, rather than an error every time. Treating these trials as missing, or setting them to chance performance, resulted in no reliable forgetting difference between competitors and targets. Because this might reflect inadequate statistical power, we undertook two replication attempts of the behavioral paradigm, failing both times to observe more forgetting for competitors than targets. In fact, we failed to find any forgetting at all. We conclude that the study of Wimber et al. does not support the conclusion that forgetting is caused by targeted inhibition.

The elimination of positive priming with increasing prime duration reflects a transition from perceptual fluency to disfluency rather than bias against primed words.

With immediate repetition priming of forced choice perceptual identification, short prime durations produce positive priming (i.e., priming the target leads to higher accuracy, while priming the foil leads to lower accuracy). Many theories explain positive priming following short duration primes as reflecting increased perceptual fluency for the primed target (i.e., decreased identification latency). However, most studies only examine either accuracy or response times, rather than considering the joint constraints of response times and accuracy to properly address the role of decision biases and response caution. This is a critical oversight because several theories propose that the transition to negative priming following a long duration prime reflects a decision strategy to compensate for the effect of increased perceptual fluency. In contrast, the nROUSE model of Huber and O'Reilly (2003) explains this transition as reflecting perceptual habituation, and thus a change to perceptual disfluency. We confirmed this prediction by applying a sequential sampling model (the diffusion race model) to accuracy and response time distributions from a new single item same-different version of the priming task. In this way, we measured strategic biases and perceptual fluency in each condition for each subject. The nROUSE model was only applied to accuracy from the original forced-choice version of the priming task. This application of nROUSE produced separate predictions for each subject regarding the degree of fluency and disfluency in each condition, and these predictions were confirmed by the drift rate parameters (i.e., fluency) from the response time model in contrast to the threshold parameters (i.e., bias).

Computed tomography (CT)-guided versus laparoscopic radiofrequency ablation: a single-institution comparison of morbidity rates and hospital costs.

BACKGROUND: Computed tomography (CT)-guided radiofrequency ablation (RFA) is presumed to be less morbid and less costly than laparoscopic RFA. This analysis investigates the 30-day morbidity, hospital cost, and reimbursement for CT-guided RFA versus laparoscopic RFA used to manage hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM). METHODS: A retrospective review was performed for all patients with CRLM or HCC who underwent CT-guided RFA or laparoscopic RFA between January 2002 and August 2008. Demographics, risk stratification, and procedural data were analyzed. Hospital financial data were queried for total cost, reimbursement, and itemized departmental charges. The CRLM and HCC patients were evaluated separately. RESULTS: The study analyzed 18 RFA procedures for the treatment of HCC (8 CT-guided RFA; 10 laparoscopic RFA) and 25 RFA procedures for the treatment of CRLM (6 CT-guided RFA; 19 laparoscopic RFA). Immediate local failures were reported for 33.3% and 12.5% of the CT-guided RFA procedures for CRLM and HCC and for 5.2% and 0.0% of the laparoscopic RFA procedures for CRLM and HCC, respectively. The mean hospital cost was higher for the patients who underwent laparoscopic RFA ($11,808.70 ± $7,238.90 for HCC vs $9,882.40 ± $1,926.90 for CRLM) than for those who underwent CT-guided RFA ($7,186.10 ± $3,899.60 for HCC vs $5,767.50 ± $2,869.00 for CRLM). The mean reimbursement was lower than the mean hospital cost for the patients who underwent CT-guided RFA for CRLM ($4,329.10 vs $5,767.50). CONCLUSION: Although CT-guided RFA is less expensive, it is poorly reimbursed. Also, CT-guided RFA is associated with a higher immediate local failure rate for both CRLM and HCC and a higher complication rate for patients with CRLM. For patients with HCC, CT-guided RFA is associated with a lower complication rate. Our data suggest that laparoscopic RFA should be used for most patients with CRLM and only selectively for patients with HCC.