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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.

PURPOSE: We provide a US national assessment of youth perceptions of the harm and addictiveness of six separate tobacco products, identifying a continuum of perceived harm associated with a range of products in relation to patterns of current use, former use, and susceptibility to use tobacco products. METHODS: We evaluated youth respondents (N = 13,651) ages 12–17 from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Analyses (2015–2016) focused on refining measures of perceived harm for each product and delineating youth characteristics (demographic, tobacco use status) associated with beliefs about the harmfulness and addictiveness of tobacco products. RESULTS: Cigars, hookah and e-cigarettes were each perceived as having significantly lower harm (p's < 0.05) than smokeless products, with the lowest ratings of harmfulness and addictiveness observed for hookah and e-cigarettes (p's < 0.001). Incrementally lower levels of harm and addictiveness perceptions were observed among youth at increasing risk for tobacco use (p's < 0.05). CONCLUSIONS: Among U.S. youth, lower perceptions of harm and addictiveness of tobacco products were associated with susceptibility to use tobacco and patterns of tobacco product use. Future longitudinal assessments from the PATH Study can provide key information on youth development of perceptions of harm and addictiveness and influences on patterns of tobacco use.

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

Individual differences in the ability to tolerate negative affect due to psychological and/or physical discomfort (e.g., distress tolerance) are emerging as an important predictor of smoking cessation outcomes. The purpose of this study was to build on existing evidence by exploring the relationship between levels of distress tolerance (DT) and negative affect on quit date in relation to risk for early lapse. Eighty-one smokers (48% female; M age = 42.6 years) who completed laboratory-based, behavioral distress tolerance tasks prior to an unaided quit attempt were categorized into low, average, and high persistence on the tasks. Low persistence smokers were significantly more likely to lapse on the assigned quit day. Among smokers able to achieve abstinence on quit day, low persistence smokers demonstrated higher levels of negative affect and urges compared to high persistence smokers. Further, negative affect-related risk for early lapse was strongest among those with low persistence. These findings suggest that smokers low in distress tolerance may be particularly vulnerable to very early lapse to smoking and that increases in negative affect may contribute to the risk for early lapse in this high-risk group of smokers.

Despite efforts to operationalize the nicotine dependence syndrome among adolescents, little is known regarding the relative severity of dependence symptoms assessed by different measures. The current study utilized a nonparametric item response model to assess the unidimensionality of the nicotine dependence construct and relative severity of dependence symptoms characterized by the Hooked on Nicotine Checklist (HONC) and the modified Fagerström Questionnaire (mFTQ) in a sample of 109 adolescent smokers (58% female) participating in a prospective investigation of smoking self-change efforts. It was hypothesized that symptoms assessed by the HONC would be associated with lower levels of nicotine dependence severity than symptoms assessed with the mFTQ. Results indicated that HONC and mFTQ items could be linked to a single latent construct. Most HONC items captured variability at the lower range and mFTQ items made discriminations at the middle and higher end of the dependence severity continuum. Findings suggest the HONC and mFTQ may provide complementary information in assessing nicotine dependence levels in adolescent regular smokers and have implications for symptoms expression in youth.

Heavy drinking and associated consequences are widespread among U.S. college students. Recently, Read et al. (Read, J. P., Kahler, C. W., Strong, D., & Colder, C. R. (2006). Development and preliminary validation of the Young Adult Alcohol Consequences Questionnaire. Journal of Studies on Alcohol, 67, 169-178) developed the Young Adult Alcohol Consequences Questionnaire (YAACQ) to assess the broad range of consequences that may result from heavy drinking in the college milieu. In the present study, we sought to add to the psychometric validation of this measure by employing a prospective design to examine the test-retest reliability, concurrent validity, and predictive validity of the YAACQ. We also sought to examine the utility of the YAACQ administered early in the semester in the prediction of functional outcomes later in the semester, including the persistence of heavy drinking, and academic functioning. Ninety-two college students (48 females) completed a self-report assessment battery during the first weeks of the Fall semester, and approximately one week later. Additionally, 64 subjects (37 females) participated at an optional third time point at the end of the semester. Overall, the YAACQ demonstrated strong internal consistency, test-retest reliability, and concurrent and predictive validity. YAACQ scores also were predictive of both drinking frequency, and "binge" drinking frequency. YAACQ total scores at baseline were an early indicator of academic performance later in the semester, with greater number of total consequences experienced being negatively associated with end-of-semester grade point average. Specific YAACQ subscale scores (Impaired Control, Dependence Symptoms, Blackout Drinking) showed unique prediction of persistent drinking and academic outcomes.

We tested the psychometric properties and predictive validity of a newly developed 8-item measure of commitment to quitting smoking, conceptualized as the state of being personally bound or obligated to persist in quitting smoking despite potential difficulties, craving and discomfort. Participants were 157 heavy drinking smokers enrolled in a clinical trial of smoking cessation treatments. The measure showed strong unidimensionality, good internal consistency, and moderate stability from baseline to quit date. Commitment significantly increased from baseline to quit date. Higher commitment to quitting at baseline predicted greater odds of abstinence at post-treatment and 16 and 26 weeks after quit date. Commitment predicted smoking outcome over and above level of tobacco dependence, self-reported importance of quitting smoking, and self-efficacy for remaining abstinent. Results suggest that commitment is a highly relevant construct for smoking cessation, which can be reliably assessed with the Commitment to Quitting Smoking Scale and which may be an excellent target for smoking cessation treatments.

Despite its utility for the dichotomous differentiation of pathological and nonpathological gamblers, some have questioned the use of the South Oaks Gambling Screen (SOGS) [Am. J. Psychiatry 144 (1987) 1184.] for discriminating individuals across the entire range of gambling problems. Using methods from item response theory, we derived a six-item version of the SOGS. This shortened version of the SOGS performed uniformly across a sample of pathological gamblers and a sample of students and resulted in five levels of discrimination and the following interpretation: a score of 1 reveals potential for problems; 2 reveals likely problem gambling; 3 or 4 items endorsed represent significant levels of problems noticeable by others; while 5 or 6 represents severe problems with significant financial involvement. We discuss the implications and remaining limitations of using this shortened measure for the continuum-based assessment of gambling problems.

We examined baseline differences in dysfunctional attitudes and coping associated with a history of major depressive disorder (MDD) among 435 smokers participating in a smoking cessation trial. Consistent with expectations, MDD history was associated with greater dysfunctional attitudes, greater use of maladaptive coping, less use of adaptive coping, and greater dysphoria and negative mood. The effects of MDD history on cognition and coping were independent from the effects of a history of alcohol dependence (AD), indicating that MDD history is a unique risk factor for variables associated with vulnerability to depression. Finally, regression analyses showed that the effects of MDD history on depressive symptoms and negative mood were mediated by dysfunctional attitudes and by both adaptive and maladaptive coping. Results indicate that smokers with an MDD history seeking cessation treatment possess characteristics that may be targets for cognitive-behavioral treatments (CBT) aimed at addressing vulnerability to depression and negative moods during smoking cessation.

Introduction Overweight and obese tobacco users possess increased risk of cancer, diabetes, heart disease and chronic tobacco-related disease. Efforts to prevent tobacco-related health risk in this comorbid population would be informed by better understanding and monitoring of trends in the concurrent use of electronic nicotine delivery systems (ENDS) among smokers in the US marketplace. Method The California Longitudinal Smokers Study (CLSS) established a cohort of current cigarette smokers in 2011 who were surveyed for tobacco use and health behavior at baseline and again in 2012 at follow-up. Results We observed a large increase in reported experimentation with ENDS. As hypothesized, overweight or obese smokers were more likely to report experimentation with ENDS, an increase that was also observed among women. Experimentation with ENDS was not associated with a reduction in use of cigarettes or a decrease in cigarette dependence in this high risk population of smokers. Conclusions Continued surveillance of this vulnerable population is needed to better understand how experimentation with new ENDS products may impact health, facilitate switching to non-combustible tobacco or facilitate persistent cigarette dependence.

Despite increased attention to adolescent smoking cessation, little is known about adolescent relapse following a quit attempt. To address this issue, the present study was designed to provide initial information regarding the characteristics of adolescent lapses to smoking following abstinence. Included in the present study were 204 adolescent participants in four independent smoking cessation trials. For the full sample, participants averaged 15.99 (1.27) years of age; 56% were female and 78% were white. Lapse characteristics and precipitants were assessed using the Adolescent Smoking Relapse Review. Three domains of the lapse experience were assessed: lapse situation characteristics, precipitants of use in the situation, and proximal influences (i.e., potential precipitants occurring on the same day, prior to the lapse situation). Participant reports indicated that the modal lapse situation occurred in the evening while socializing with friends at home. Urges or cravings and social pressure were commonly endorsed as occurring in lapse situations. The most frequently reported proximal influence was desire for a cigarette, followed by abstinence-violation cognitions (okay to smoke occasionally, wanted to see what it would be like) and negative emotions. The findings indicate that a broad range of factors appear to influence adolescent smoking lapse and commend the value of incorporating content relevant to managing social and affective cues, strategies for inhibiting the prepotent response to ask for a cigarette, addressing cognitions regarding the difficulty of not smoking (i.e., cessation expectancies) and combating perceptions of the ability to smoke occasionally.

There has been recent increased interest in utilizing motivational interviewing (MI) to increase adolescents readiness to quit smoking, but attempts to impact quit rates have thus far been discouraging. A better understanding of factors associated with adolescent readiness to quit smoking prior to receiving any intervention may provide guidance when tailoring future MI interventions in order to increase their effectiveness with this population. Adolescent smokers (N = 191) who had been admitted to a psychiatric hospital and enrolled in a clinical trial evaluating MI completed questionnaires that assessed smoking behavior and variables thought to be related to smoking. Confidence to quit smoking and negative beliefs about smoking were significant predictors of adolescents' baseline readiness to quit smoking. The failure to demonstrate relationships between health consequences and readiness suggest that caution may be warranted in the use of feedback, a common component of MI-based interventions. Such feedback tends to focus on health consequences, which was unrelated to adolescent baseline readiness to change smoking behavior in the current study. Parallels between current results and the Theory of Planned Behavior are discussed in consideration of developing more effective MI-based interventions for adolescent smokers.

We examined baseline differences in dysfunctional attitudes and coping associated with a history of major depressive disorder (MDD) among 435 smokers participating in a smoking cessation trial. Consistent with expectations, MDD history was associated with greater dysfunctional attitudes, greater use of maladaptive coping, less use of adaptive coping, and greater dysphoria and negative mood. The effects of MDD history on cognition and coping were independent from the effects of a history of alcohol dependence (AD), indicating that MDD history is a unique risk factor for variables associated with vulnerability to depression. Finally, regression analyses showed that the effects of MDD history on depressive symptoms and negative mood were mediated by dysfunctional attitudes and by both adaptive and maladaptive coping. Results indicate that smokers with an MDD history seeking cessation treatment possess characteristics that may be targets for cognitive-behavioral treatments (CBT) aimed at addressing vulnerability to depression and negative moods during smoking cessation.