Young Adult Depression and Cannabis Use: Associations Before and After Recreational Legalization.

INTRODUCTION: The co-occurrence of depression with cannabis use worsens both mood and substance use disorder outcomes, with young adults particularly at risk of co-occurrence. This research investigates whether the association of state-level prevalence rates of young adult (age 18-25) depression and cannabis use in the U.S. changed following enactment of recreational (adult use) cannabis legalization between 2008 and 2019. METHODS: Annual, state prevalence data on past-year major depressive episode (hereafter, depression) and past-month cannabis use were extracted from the National Survey on Drug Use and Health (N=600 state-year observations). Moderated regression models tested whether the association of depression with cannabis use differed before versus after recreational legalization by comparing prevalence rates of depression and cannabis use in states that enacted recreational legalization to those that did not, while fixing state, year, and medical legalization effects. Data were accessed and analyzed in 2023. RESULTS: Prevalence rates of both depression and cannabis use increased throughout the study period. The positive statistical effect of depression on cannabis use more than doubled in magnitude after legalization (ß=0.564, 95% CI=0.291, 0.838) as compared to before (ß=0.229, 95% CI=0.049, 0.409), representing a significant change (ß=0.335, 95% CI=0.093, 0.577). CONCLUSIONS: These results suggest that the association between prevalence rates of young adult depression and cannabis use strengthened following recreational legalization in the U.S. This is potentially due to increases in cannabis accessibility and the acceptance of the health benefits of cannabis, which may enhance the use of cannabis as a coping mechanism among young adults with depression.

Responsiveness to mHealth Intervention for Cannabis Use in Young Adults Predicts Improved Outcomes.

Mobile health (mHealth) interventions have proliferated rapidly in part because of their advantages in reducing consumer and provider burden, but less attention has been paid to participant responsiveness to mHealth programs and how this may affect outcomes. This study adds to that literature by examining whether participant responsiveness to a text messaging-delivered intervention was predictive of treatment outcomes over baseline levels of the outcome. We analyzed data from a pilot-randomized controlled trial of a text messaging-intervention to treat young adults with cannabis use disorder (treatment arm, N = 47), examining three indicators of responsiveness (two behavioral: treatment completion and booster message participation; and one subjective: perceived helpfulness of treatment) on abstinence from cannabis use and use-related problems measured at 3-month follow-up. With the exception of completion, the indicators were positively correlated with each other. Each of the indicators was predictive of better treatment outcomes above and beyond baseline risk. Treatment completion and booster participation-measured via technical data captured during intervention administration-appeared to be stronger predictors of improved outcomes than self-reported perceived helpfulness. Results suggest that behavioral and subjective responsiveness measures appear to be valid indicators of treatment response to mHealth interventions for substance use. Responsiveness measured via technical data captured during intervention administration may be a stronger and more efficient strategy for monitoring continued engagement. We discuss implications of these findings for deploying mHealth interventions at scale and monitoring responsiveness.

Relational victimization and peer affiliate prosocial behaviors in African American adolescents: Moderating effects of gender and antisocial behavior.

INTRODUCTION: Experiencing relational victimization (e.g., peer exclusion, untrue rumors) during adolescence can have negative social-emotional consequences, including increased antisocial behavior and substance use. The negative impact of relational victimization may be lessened by spending time with supportive, prosocial peers. METHODS: This study examined the concurrent and predictive associations between relational victimization and peer affiliates' prosocial behaviors in 244 predominately African American adolescents (ages 13-14) living in U.S. urban neighborhoods. Questionnaires were collected every six months for two years. Overt victimization was controlled for in the analysis and the moderation of gender and antisocial behaviors were tested. RESULTS: Peer affiliates' prosocial behavior was stable across the two years. Relational victimization was not associated with peers' prosocial behavior at baseline or across time. Gender did not moderate the association between relational victimization and peers' prosocial behavior. Moderating effects were found for antisocial behavior; relational victimization was positively associated with peer affiliates' prosocial behavior but only for adolescents who were low on antisocial behavior at baseline. CONCLUSIONS: For African American youth, efforts to reduce relational aggression and increase peer support in prosocial activities prior to adolescence may be useful for preventing social-emotional problems.

Who responds best to text-delivered cannabis use disorder treatment? A randomized clinical trial with young adults.

Young adults ages 18 to 25 have the highest percentage (5%) of cannabis use disorder (CUD) among all age groups, and are the least likely to receive treatment compared with other age groups. Because this population is in need of creative approaches for treatment engagement, we tested Peer Network Counseling-txt (PNC-txt), a 4-week, automated text-delivered cannabis treatment that focuses on close peer relations with 96 treatment seeking young adults. Participants meeting CUD criteria were randomized to PNC-txt, or assessment only control condition and followed for 3-months. At 3-months, the PNC-txt group reduced number of heavy cannabis-use days and relationship problems due to cannabis use compared with controls. Subgroup analyses were conducted with cases having more and fewer CUD symptoms than the full sample. For cases with fewer symptoms, but not for those with more, PNC-txt reduced past 30-day use, urges to use, memory problems, and relationship problems due to cannabis use compared with controls. Treatment satisfaction data from the full sample indicated that participants thought the intervention texts helped them reduce or manage their cannabis use and increased their understanding of the negative relational effects associated with ongoing cannabis use. Findings provide evidence of the efficacy of PNC-txt in treating CUD in young adults, support clinically targeting peer relations, and suggest that PNC-txt may be most helpful for those with mild to moderate CUD severity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A pilot trial of text-delivered peer network counseling to treat young adults with cannabis use disorder.

Approximately 1.8 million young adults aged 18 to 25 had a Cannabis Use Disorder (CUD) in the past year. Unfortunately, engaging young adults in treatment is very challenging. Creative approaches to treat cannabis disorders such as integrating mobile technology with evidence-based treatments are warranted. In light of these challenges, we developed a text message-delivered version of Peer Network Counseling (PNC-txt), which is a substance use intervention that focuses on peer relations. PNC-txt engages participants in 16 automated, personalized text interactions over 4weeks. We conducted a randomized controlled trial to test the efficacy of PNC-txt against a waitlist control group with 30 treatment seeking young adults (ages 18-25) who met DSM-5 criteria for CUD. Self-report and urine analyses were used to test outcomes at the three-month follow-up. The PNC-txt group significantly reduced their cannabis use related problems as well as cannabis cravings, compared to the control group. PNC-txt participants also had a significantly greater percentage with urines negative for cannabis metabolites compared to controls. Moderation analysis showed that CUD severity level moderated treatment, suggesting that PNC-txt is more effective for participants with medium and high levels of CUD severity. All effect sizes ranged from medium to large. Results from this pilot trial are promising and warrant further research on PNC-txt for addressing cannabis use disorder.

A longitudinal study predicting adolescent tobacco, alcohol, and cannabis use by behavioral characteristics of close friends.

Few studies have examined in detail how specific behaviors of close friends put adolescents at risk for specific types of substance use. Using a prospective, longitudinal design, we examined how well the substance use of 248 young urban adolescents was predicted by perceptions of their 3 closest friends' problematic behaviors: (1) using substances, (2) offering substances, and (3) engaging with friends in risky behavior (substance use, illegal behavior, violent behavior, or high-risk sexual behavior). Longitudinal multivariate repeated measures models were tested to predict tobacco, alcohol, and cannabis use and perceived closeness was tested as a moderator of the effects of perceptions of problematic peer behavior. Perceptions of peer substance use were significantly associated with tobacco use, and closeness moderated the influence of peer substance use and offers to use substances on tobacco use. Perceptions of problematic peer behaviors were not significantly associated with alcohol use and closeness was not significant as a moderator. Perceptions of peer substance use was significantly associated with cannabis use, and closeness moderated the influence of perceptions of peer risk behaviors, peer substance use, and offers to use substances on cannabis use. Results implicate the importance of understanding problematic peer behavior within the context of close, adolescent friendships. Adolescents with close friends who were substance users, who made offers to use substances, and who engaged in risky behaviors were more likely to use tobacco and cannabis. Perceptions of young adolescents' close friends' behaviors influenced their substance use up to 2 years later. (PsycINFO Database Record

Peer Network Counseling as Brief Treatment for Urban Adolescent Heavy Cannabis Users.

OBJECTIVE: A small body of evidence supports targeting adolescents who are heavy users of cannabis with brief interventions, yet more research is needed to confirm the effectiveness of these studies. We conducted a secondary analysis of our Peer Network Counseling (PNC) study (Mason et al., 2015), focusing on 46 adolescents of the sample of 119 who reported heavy cannabis use at baseline. METHOD: Urban adolescents (91% African American) presenting for primary health care were randomized to intervention or control conditions and followed for 6 months. We selected cases (n = 46) to analyze based on heavy cannabis use reported at baseline (≥10 times in past month). The ordinal response data (cannabis use) were modeled using a mixed-effects proportional odds model, including fixed effects for treatment, time, and their interaction, and a subject-level random effect. RESULTS: In the subsample of adolescents with heavy cannabis use, those assigned to PNC had a 35.9% probability of being abstinent at 6 months, compared with a 13.2% probability in the control condition. Adolescents in the PNC condition had a 16.6% probability of using cannabis 10 or more times per month, compared with a 38.1% probability in the control condition. This differs from results of the full sample (N = 119), where no significant effects on cannabis use were found. CONCLUSIONS: PNC increased the probability of abstinence and reduced heavy cannabis use. These results provide initial support for PNC as a model for brief treatment with non-treatment seeking adolescents who are heavy users of cannabis.

Depression Moderates the Relationship Between Pain and the Nonmedical Use of Opioid Medication Among Adult Outpatients.

BACKGROUND: The nonmedical use of prescription medication among US adults is a growing public health problem. Healthcare providers should proactively address this problem in outpatient encounters. OBJECTIVE: We sought to understand the interactive effects among prescription drugs, pain, and psychiatric symptoms among adult outpatients to build an empirical foundation for comprehensive screening. METHODS: We screened 625 adult neurosurgery and orthopedic patients at a suburban satellite clinic of an urban academic medical center. A convenience sample was screened for psychiatric and substance use disorder symptoms using the American Psychiatric Association's recommended screening protocol. We tested whether psychiatric symptoms moderated the relationship between pain level and nonmedical use of prescription medicine. RESULTS: Patients reported average levels of depression, anxiety, and pain symptoms, within 1 standard deviation of the screeners' normative data. However, patients reported highly elevated levels of nonmedical use of opioids and benzodiazapines compared with national data. Controlling for age, sex, and race, pain level predicted nonprescription use of opioid and benzodiazapine medications. Patients with high levels of depression and pain were more likely to engage in the unprescribed use of opioids. Likewise, patients with reduced levels of depression and pain were protected against the unprescribed use of opioids. CONCLUSIONS: These findings highlight the importance of examining unprescribed medication use even with patients at moderate levels of psychiatric symptoms and pain.

The Dynamic Role of Urban Neighborhood Effects in a Text-Messaging Adolescent Smoking Intervention.

INTRODUCTION: Neighborhood features such as the density of tobacco outlets relative to one's home and evaluations of safety of one's activity space (routine locations), are known to influence health behaviors. Understanding the time-varying nature of these aspects of the urban ecology provides unique insights into the dynamic interactions of individuals and their environments. METHODS: The present study tested the time-varying effects of tobacco outlets and perceived safety within a randomized controlled trial of an adolescent text-messaging smoking intervention. We used ecological momentary assessment data (EMA) from an automated text-messaging smoking cessation randomized trial with 197 primarily African American urban adolescents. We employed a time-varying effect model to estimate the effects of density of tobacco outlets within one-half mile of participants' home locations (time-invariant covariate) and evaluations of safety of their activity space (time-varying covariate) on momentary smoking over 6 months by treatment condition. The time-varying effect model approach models behavioral change and associations of coefficients expressed dynamically and graphically represented as smooth functions of time. RESULTS: Differences in trajectories of smoking between treatment conditions were apparent over the course of the study. During months 2 and 6, the association between tobacco outlet density and smoking was significantly stronger in the control condition, suggesting treatment dampens this association during these time periods. The intervention also significantly reduced the association of perceived safety and smoking among the treatment condition during months 3 through 6. CONCLUSIONS: Results support testing the time-varying effects of urban ecological features and perceptions of safety among adolescents in text-based smoking cessation interventions. IMPLICATIONS: This study makes a unique contribution towards understanding the time-varying effects of urban neighborhoods on adolescent tobacco use within the context of a text-delivered intervention. Helping to adjust the long-held conceptualization of intervention effects as a static outcome, to that of a dynamic, time-varying process, is an important contribution of this study. The ability to specify when behavioral change occurs within the context of a randomized control trial provides understanding into the time-varying treatment effects of text-based smoking intervention. For example, researchers can modify the intervention to have strategically timed booster sessions that align with when the odds of smoking begin to increase in order to provide more precise treatment. The current study results show that increasing support to participants during months 2 and 4 may help suppress smoking over the course of a 6-month intervention.

Peer Network Counseling with Urban Adolescents: A Randomized Controlled Trial with Moderate Substance Users.

Close peer networks can affect adolescents' health behaviors by altering their social environments, and thus their risk for and protection against substance use involvement. We tested a 20 minute intervention named Peer Network Counseling that integrates motivational interviewing and peer network strategies with 119 urban adolescents who reported occasional or problem substance use. Adolescents presenting at primary care clinic were randomized to intervention or control conditions and followed for 6 months. Mixed-effect latent growth models were used to evaluate intervention effects on trajectories of alcohol and marijuana use, offers to use substances, and moderation models to test for interactions between intervention condition and peer network characteristics. A significant intervention effect was found for boys for offers to use alcohol from friends (p<.05), along with a trend significant effect for alcohol use (p<.08). Intervention was more effective in reducing marijuana use, vs. control, for participants with more peer social support (p<.001) and with more peer encouragement for prosocial behavior (school, clubs, sports, religious activities); however, intervention did not affect these network characteristics. Results provide support to continue this line of research to test brief interventions that activate protective peer network characteristics among at-risk adolescents, while also raising some interesting gender-based intervention questions for future research.

What Do Urban Black Mothers Tell Their Adolescents About Alcohol And Other Drugs?

The current study utilized qualitative content analysis to examine messages conveyed about alcohol and other drugs by urban Black mothers (N=130) with a personal, familial, or personal and familial history of problematic substance use to younger and older adolescents (M = 15.2 years). Data from a two-cohort longitudinal sample revealed considerable similarity in themes across the younger and older cohorts. Results suggest Black mothers offer more messages of information and advice to younger adolescents, while communicating directives related to use to older adolescents.