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Background and Objectives: We examined associations between sources of social influence (i.e. close friends, other underage people present) within specific settings with the number of drinks underage youth consumed. Methods: Data were collected through a cross-sectional survey with 422 underage youth in California (14 to 19 years old) who reported past-6-month alcohol use. Participants were asked to think about the last time they drank alcohol in the past 6 months at: restaurants, bars/nightclubs, own home, another's home, outdoors, and fraternities/sororities. Outcomes were the number of whole drinks participants drank the last time in each setting. Independent measures were social characteristics of these drinking events including number of people <21 years old present, number of close friends present, number of <21 years old who consumed alcohol, and number of close friends who consumed alcohol. We also assessed socio-demographics and accounted for the overall exposure to each setting in the past 6 months. Results: Using negative binomial regression models, the number of close friends was positively associated with number of drinks consumed at restaurants, another's home, and outdoors. The number of close friends drinking was positively associated with the number of drinks at restaurants, own home, another's home, and outdoors. Number of people <21 years old was positively associated with number of drinks at own home, and number of people <21 years old who consumed alcohol was positivity associated with number of drinks consumed at restaurants, own home, another's home, and outdoors. Conclusions: Results suggest that social influence from close friends and from other underage youth are context-specific. [ABSTRACT FROM AUTHOR]

Background: Predicting substance use in adolescence is a difficult yet important task in developing effective prevention. We aim to extend previous findings on the linear associations between familiarity with (knowledge of) substances in childhood and subsequent substance use in adolescence through a latent class analysis (LCA) to create risk profiles based on substance familiarity. Method: Using the ABCD Study® sample, we conducted an LCA using 18 binary substance familiarity variables (n = 11,694 substance-naïve youth). Complementary analyses investigated the relationship between LCA groups and (1) longitudinal use, (2) use initiation, and (3) early use. Results: The optimal LCA resulted in a four-class solution: Naïve, Common, Uncommon, and Rare, with each group increasing in both the number and rarity of known substances. Analysis 1 revealed an increased risk in use over time among both the Uncommon and Rare groups (ORs = 2.08 and 5.55, respectively, p's < 0.001) compared to the Common group. Analysis 2 observed a decreased risk for initiation between the Naïve and Common groups (OR = 0.61, p = 0.009); however, the Uncommon and Rare groups were at an increased risk compared to the Common group (ORs = 2.08 and 3.42, respectively, p's < 0.001). Analysis 3 found an increased risk of early use between the Common and Uncommon groups (OR = 1.92, p < 0.001) with a similar trend between the Common and Rare groups (OR = 1.90, p = 0.06). Conclusion: These results highlight distinct risk profiles for adolescent substance use based on substance familiarity in middle childhood. Current work could be applied as an early screening tool for clinicians to identify those at risk for adolescent substance use. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, youth e-cigarette use has grown into a national epidemic, with Native Hawaiian and Pacific Islander (NHPI) youths' rates among some of the highest in the nation. Family factors significantly contribute to NHPI youths' decisions to engage in or resist substance use, yet few studies have specifically examined familial influences on NHPI youths' substance use decision-making and behaviors. Objective: The objective of this study is to examine adult familial influences on rural NHPI youths' decisions to engage in e-cigarette use. Method: Seventeen gender-specific focus groups with NHPI youths (N = 69) from eight public schools on Hawai'i Island were conducted. Results: Two family-related themes emerged from the data: 1) parental substance use permissiveness, and 2) family normalization of e-cigarette use. Conclusions: Examining adult familial contributors to NHPI youths' e-cigarette use needs to be part of a comprehensive effort to address NHPI health and substance use disparities. Prevention interventions should be explicit in addressing the family and relational context of NHPI youths' substance use. [ABSTRACT FROM AUTHOR]

Background: College students who identify as a sexual minority (i.e., lesbian, gay, bisexual, or other sexual orientation) are at higher risk for e-cigarette use than their heterosexual or "straight" peers. However, little is known about factors, such as e-cigarette outcome expectancies, that might influence these differences in prevalence rates. Therefore, the current study examined differences between heterosexual and sexual minority college student e-cigarette users in terms of days of past-month e-cigarette use, e-cigarette dependence, and e-cigarette outcome expectancies. A secondary aim of the study was to examine whether outcome expectancies served as an explanatory mechanism in the association between sexual minority status and e-cigarette use frequency and dependence. Methods: Participants were heterosexual (n = 90; Mage = 19.65, SD = 2.70; 76.7% female; 77.8% White) and sexual minority (n = 44; Mage = 20.02, SD = 2.18; 68.2% female; 90.9% White) college student e-cigarette users who completed self-report measures. Results: Students who identified as a sexual minority reported greater e-cigarette dependence, more frequent past 30-day use, and greater negative consequences and positive reinforcement e-cigarette outcome expectancies. Follow-up mediation analyses indicated a significant indirect effect of sexual minority status on both days of past-month e-cigarette use and e-cigarette dependence through expectancies for negative consequences and positive reinforcement. Conclusions: These findings suggest that positive reinforcement and negative consequences outcome expectancies may be contributing to the disparities in e-cigarette use among college students who identify as a sexual minority and could be useful targets for cessation interventions for this population. [ABSTRACT FROM AUTHOR]

Background: E-cigarettes are the most-used tobacco product among US adolescents and are associated with nicotine addiction. This qualitative investigation aimed to understand adolescents' experiences and perceptions with nicotine addiction, and related influences of addiction, to inform product regulation, health communication, and cessation resource development. Methods: Between May 2020 and December 2021, in-depth, semi-structured individual interviews were conducted with 47 California (United States) adolescents ages 13–17 who reported recent tobacco use (primarily e-cigarette use). The topic of addiction both arose organically and followed specific interviewer questions. Researchers used thematic analysis techniques to identify unifying themes related to addiction. Results: Adolescents described e-cigarette addiction in ways that reflected a loss of control over their routines and activities and as physical symptoms, including reward and withdrawal. While some viewed addiction risk as a reason not to vape, others perceived it possible to use e-cigarettes and avoid or manage addiction. Specific characteristics of e-cigarette devices, particularly disposable nicotine-salt products, including flavors, "cool" designs, concealable size and odor, low price, and ease-of-use, were seen as enhancing addiction risk. Quit attempts were difficult and usually unsupported by adults or formal cessation aids. Conclusions: For many adolescents, addiction is a major component of their experience with e-cigarettes, often in ways that disrupt their routines and reduce their quality of life. Tobacco control or regulation could target e-cigarette product characteristics to decrease potential for addiction among adolescents. Needed are youth-targeted public communication about nicotine addiction and adolescent-tailored, evidence-based cessation support. [ABSTRACT FROM AUTHOR]

Background: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (β=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide. [ABSTRACT FROM AUTHOR]

Background: Although substance use rates among adolescents have decreased, drug overdose deaths among adolescents have increased since 2020, driven largely by illegally made fentanyl (IMF). This study explores substance use patterns and characteristics of adolescents who were assessed for substance use disorder (SUD) treatment to inform prevention and response strategies. Methods: A convenience sample of adolescents aged 10–18 years assessed for SUD treatment from September 2017 to December 2021 was analyzed using the Comprehensive Health Assessment for Teens. The percentage of lifetime and past 30-day substance use was examined. Adolescent characteristics (e.g., demographics, history of overdoses or hospital visits due to drug/alcohol use) were analyzed by lifetime substances used. Results: Among 5,377 assessments, most were male (58.7%), aged 16–18 years (50.5%), non-Hispanic White (43.1%), enrolled in school (87.3%), and living with their parent(s) (72.4%). The most commonly reported lifetime substances used were marijuana (68.0%), alcohol (54.2%), and prescription opioid misuse (13.6%). The most common past 30-day substance use combination was alcohol and marijuana (35.6%). The percentage of assessments indicating past-year overdoses or hospital visits due to drug/alcohol use was greatest among those who reported lifetime use of IMF (24.0%), followed by heroin (21.4%) and cocaine (15.3%). Overall, 2.3% reported lifetime IMF use and 0.6% thought IMF was causing them the most problems. Conclusions: Findings inform opportunities to address substance use and increased IMF-involved overdose among adolescents. Continued overdose prevention and response strategies such as evidence-based education campaigns, naloxone distribution and harm reduction efforts, and evidence-based SUD treatment expansion are needed. [ABSTRACT FROM AUTHOR]

Objective: Research has indicated potentially neutral or even positive cognitive effects of e-cigarette usage in adults, but whether these findings extend to adolescents remains uncertain. This study aimed to examine the interplay between e-cigarette use, mind wandering and self-efficacy, and mood. Method: The responses of 432 adolescents aged 11-18 years from an online survey were analyzed. Among them, 88 adolescents had used e-cigarettes. Results: Adolescents who have used e-cigarettes reported poorer academic self-efficacy, t (430) = 3.26, 95% CI [1.12, 4.51], p < 0.001; greater mind-wandering tendencies t(430) = −3.38, 95% CI [-4.14, −1.10], p < 0.001; and greater severity of depression, t(430) = −3.38, p < 0.001, anxiety t(430) = −2.67, p = 0.01, and stress t(430) = −3.32, p <.001. Increased frequency of e-cigarette use was also associated with attitudes toward e-cigarette use, r (86) = 0.31, p = 0.003 and lower academic self-efficacy, r (86) = −0.27, p =.010. However, there was no significant correlation between frequency of use and mind-wandering. Further network analysis suggested negative relationships between frequency of e-cigarette use, academic self-efficacy and mind-wandering. Conclusion: Our findings suggest a potential adverse impact of e-cigarette use on mind-wandering and academic confidence among adolescents. However, the direct or indirect relationship between e-cigarette use and these effects could not be definitively determined due to the cross-sectional survey design employed in our study. Nonetheless, our findings underscore the importance of considering developmental differences and the unique vulnerabilities of adolescents when assessing the impact of e-cigarette use. [ABSTRACT FROM AUTHOR]

Background: Vaping is popular among adolescents and emerging adults; however, little is known about regular vaping patterns in older adolescents and emerging adults. Objective: The current study explored whether gender and age are associated with nicotine-based vaping frequency to ascertain ascertaining which subgroups of youth are most at-risk for frequent use. Methods: In a cross-sectional survey, participants using nicotine-based vaping devices (N=535, age range 16-24) reported frequency measured as vaping days in a week, number of episodes during which participants vaped, and puff numbers for each episode. A two-way multivariate analysis of variance was used to test the effects and interactions of gender and age groups on the three frequency outcomes. Results: Emerging adults and males vaped more frequently than their older adolescent and female counterparts, respectively. Specifically, emerging adults vaped more days per week in comparison to older adolescents, whereas males vaped more days per week and had more vaping episodes per day relative to females. Further, emerging adult males had more vaping episodes in comparison to other subgroups, and adolescent females as well as emerging adult males took more puffs per episode in comparison to emerging adult females. Conclusion: Vaping differences among subgroups suggests the need for policies to reduce regular nicotine vaping targeted toward specific gender and age groups. [ABSTRACT FROM AUTHOR]

Background: E-cigarette advertising, which often includes various features, may prompt e-cigarette use and product switching. This study examined the associations between noticing e-cigarette ad features and perceived product appeal and interest in completely switching from cigarettes to advertised e-cigarettes among young adult dual users of both products. Methods: We analyzed data from an online heatmap experiment among young adult dual users defined as established cigarette smokers who currently used e-cigarettes (ages 18-34 years; n = 1,821). Participants viewed 12 e-cigarette ads, clicked on ad features (e.g., fruit flavors, nicotine warnings, price promotions, smoker-targeted claims) that attracted their attention (defined as "noticing"), and answered questions about e-cigarette product appeal and interest in completely switching from cigarettes to the e-cigarettes shown. We examined within-person associations between noticing specific ad features and outcomes, controlling for demographic and tobacco use-related characteristics. Results: Noticing fruit flavors (AOR = 1.67 and 1.28) and fruit images (AOR = 1.53 and 1.21) was positively associated with having any e-cigarette product appeal and switching interest. Noticing price promotions (AOR = 1.23) was positively associated with product appeal. In contrast, noticing nicotine warnings (AOR = 0.74 and 0.86), smoker-targeted claims (AOR = 0.78 and 0.89), and tobacco flavors (AOR = 0.92 and 0.90) was negatively associated with product appeal and switching interest. Conclusions: Noticing certain e-cigarette ad features (e.g., fruit flavors and nicotine warnings) may be associated with product appeal and/or switching interest among young adult dual users. More research is needed to assess the influence of e-cigarette ad features that promote product switching interests among cigarette smokers while discourage interests among tobacco-naïve individuals. [ABSTRACT FROM AUTHOR]

Background: Peer influence on risky behavior is particularly potent in adolescence and varies by gender. Smoking prevention programs focused on peer-group leaders have shown great promise, and a social influence model has proven effective in understanding adult smoking networks but has not been applied to adolescent vaping until 2023. This work aims to apply a social influence model to analyze vaping by gender in a high school network. Methods: A high school's student body was emailed an online survey asking for gender, age, grade level, vape status, and the names of three friends. Custom Java and MATLAB scripts were written to create a directed graph, compute centrality measures, and perform Fisher's exact tests to compare centrality measures by demographic variables and vape status. Results: Of 192 students in the school, 102 students responded. Students who vape were in closer-knit friend groups than students who do not vape (p <.05). Compared to males who vape, females who vape had more social ties to other students who vape, exhibiting greater homophily (p <.01). Compared to females who do not vape, females who vape were in closer-knit friend groups (p <.05) and had more ties to other students who vape (p <.01). Conclusion: Differences in vaping by social connectedness and gender necessitate school and state policies incorporating the social aspect of vaping in public health initiatives. Large-scale research should determine if trends can be generalized across student bodies, and more granular studies should investigate differences in motivations and social influence by demographic variables to individualize cessation strategies. [ABSTRACT FROM AUTHOR]

Objective: Underreporting of adolescent substance use is a known issue, with format of assessment (in-person vs. remote) a potentially important factor. We investigate whether being assessed remotely (via phone or videoconference) versus in-person affects youth report of substance use patterns, attitudes, and access, hypothesizing remote visits would garner higher levels of substance use reporting and more positive substance use attitudes. Methods: We used the Adolescent Brain and Cognitive DevelopmentSM [ABCD] Study data between 2021-2022 during the COVID-19 pandemic. Participants chose whether to complete assessments in-person (n=615; 49% female; meanage=13.9; 57% White) or remotely (n=1,467; 49% female, meanage=13.7; 49% White). Regressions predicted substance use patterns, attitudes, and access, by visit format, controlling for relevant sociodemographic factors. Effect sizes and standardized mean differences are presented. Results: 17% of adolescent participants reported any level of substance use. Youth interviewed remotely reported more negative expectancies of alcohol and cannabis. In addition, those queried remotely were less likely to endorse use), sipping alcohol, eating cannabis), and reported less curiosity or intent to try alcohol, though these differences did not survive an adjustment for multiple testing. Effect sizes ranged from small to medium. Conclusions: Preliminary evidence suggests youth completing remote visits were more likely to disclose negative expectancies toward alcohol and cannabis. Effect sizes were modest, though 37 of 39 variables examined trended toward restricted reporting during remote sessions. Thus, format of substance use assessment should be controlled for, but balanced by other study needs (e.g., increasing accessibility of research to all sociodemographic groups). [ABSTRACT FROM AUTHOR]

Background: The prevalence of recreational cannabis use among adolescents is a growing public health concern due to its link to short- and long-term adverse effects on adolescents' wellbeing, physical health, mental health, and interpersonal behaviors. Method: Five databases were searched from inception to March 17, 2023, for exposure (nicotine product, alcohol) and outcome (recreational cannabis) in adolescents (persons aged 10–19 years). The studies were screened independently by two reviewers, and the quality of the studies was assessed with Newcastle Ottawa and AXIS tool. PRISMA guidelines were employed in this review. Result: Twenty-one (21) studies involving 2,778,406 adolescents were included in the appraisal and heterogeneity was found among these studies. Ascertainment bias was commonly detected in thirteen (13) of the included studies. Among the substances examined as potential exposures, nicotine-product use emerged as a significant factor associated with future cannabis use among adolescents, particularly in mid-adolescence and in places where recreational cannabis use has been legalized. Conclusion: Current evidence suggests an association between nicotine-product use and subsequent recreational cannabis use among adolescents. However, further research is needed to establish causality between exposure to nicotine substances and the use of recreational cannabis within this age demographic. Additionally, there is a need for the development of prevention programs and targeted policies that continuously inform and update this vulnerable sub-population about the risks associated with cannabis use for leisure. [ABSTRACT FROM AUTHOR]

Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12–17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use. [ABSTRACT FROM AUTHOR]

Purpose: State-level prevalence data are used to investigate whether recreational cannabis legalization moderates the mediated pathway from the perception of low risk of harm, to cannabis use, to cannabis use disorder (CUD) treatment admissions, among adolescents (age 12–17) in the US. Methods: Annual state prevalence measures of perception of low risk, cannabis use, and CUD treatment admissions between 2008 and 2019 (N = 542 state-year observations) were collected from the National Survey on Drug Use and Health (NSDUH) and the Treatment Episode Dataset – Admissions (TEDS-A). A two-way fixed effects (state and year) moderated mediation model was used to test whether recreational legalization moderated the indirect effect of perception of low risk on treatment admissions via cannabis use. Results: A positive indirect effect of perceiving cannabis as low risk on CUD treatment admissions via cannabis use was observed prior to legalization but not afterwards. After legalization, the positive association of perceiving cannabis as low risk with cannabis use was strengthened, and the positive association of cannabis use with treatment admissions was suppressed, as compared to before legalization. Discussion: Recreational legalization may alter the social acceptability and medical self-administration of cannabis, potentially leading to CUD treatment utilization decline among adolescents even as risk factors for CUD increase. Linking recreational cannabis legalization to advancing awareness of the health risks associated with adolescent cannabis use and promoting adolescent CUD treatment engagement through mHealth approaches and primary care providers are key to addressing potential adolescent health challenges brought about by expanding cannabis legalization. [ABSTRACT FROM AUTHOR]

Background: Existing evidence showed that social anxiety represents a significant factor in eating disorders. However, to our knowledge, no prior study has examined the association between social anxiety and drunkorexia behaviors. Objectives: The present study aimed at exploring the relationship between social anxiety and drunkorexia behaviors, and investigating resilience as a moderator of this relationship. Participants were 333 adolescents and young adults aged 15–24 years (Mage=18.26, SDage= 1.55; 66% females) who completed an online survey. Results: The results indicated that drunkorexia behaviors were positively correlated to three dimensions of social anxiety; however, only fear of negative evaluation had a significant predictive effect. In addition, resilience only moderated the relationship between fear of negative evaluation and drunkorexia behaviors, such that youths reporting high fear of negative evaluation and low resilience showed greater drunkorexia behaviors, whereas youths reporting high resilience showed no correlation between fear of negative evaluation and drunkorexia behaviors. Conclusions: The findings highlight the importance of drunkorexia interventions and preventive measures aimed at strengthening youths' resilience and ability to effectively manage stress and social anxiety (i.e., fear of negative evaluation). [ABSTRACT FROM AUTHOR]

Few studies of recreational cannabis legalization (RCL) have assessed adolescents both before and after RCL or considered moderators of RCL effects. The present study tested whether RCL was more strongly associated with cannabis use for girls and among youth whose parents had a history of cannabis use during adolescence. Data were pooled from 940 adolescents from three intergenerational studies that began in Washington (where RCL was enacted in 2012), Oregon (RCL year = 2015), and New York (RCL year = 2021). Youth were assessed repeatedly from ages 13 to 18 years (k = 3,650 person–years) from 1999 to 2020 (prior to RCL in New York). Parent cannabis use at or before age 18 years (yes/no) was assessed prospectively during the parent's adolescence. Multilevel models focused on the between-subjects effects of years of youth exposure to RCL on adolescents' mean cannabis use likelihood, and interactions with child sex and parent use history. Child exposure to RCL was associated with a higher likelihood of cannabis use if their parents had a history of adolescent use, (Estimate [SE] = 0.67 [0.25], p = 0.008), versus no such history (Estimate [SE] = −0.05 [0.28], p = 0.855). RCL effects were not moderated by child sex. The effects of RCL on adolescents' cannabis use may depend on their parents' history of using the drug. Identifying other moderators of RCL effects, and understanding the mechanisms of these risks and the ways that parents and communities can offset them, are prevention priorities. (1) Adolescents' use of cannabis may have intergenerational consequences, making it more likely their future offspring will use cannabis. (2) Whether or not recreational cannabis legalization influences adolescents' cannabis use may depend on their parents' cannabis use history. (3) Parenting in a state with liberalized cannabis policies may present new challenges and require that novel prevention resources be developed. [ABSTRACT FROM AUTHOR]

Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors (N = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018–2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935–0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926–0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820–0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers. [ABSTRACT FROM AUTHOR]

Background: Alcohol cognitions can emerge early in life and have lasting associations with alcohol use behavior. Observational learning theories suggest that witnessing alcohol use and its consequences may be an important mechanism underlying early development of alcohol cognitions. Parents are among the earliest contributors to children's alcohol-related learning, although findings regarding the association of parental alcohol use and problems with children's alcohol-related beliefs and attitudes are considerably mixed. This study tested associations of parent alcohol use and problems with adolescent alcohol expectancies, motives, and subsequent alcohol use to help clarify this literature. Methods: Families (N = 227) comprising family alcohol use disorder cases and demographically matched controls were recruited as part of a longitudinal investigation on child development. Parents reported on their alcohol use and problems at seven assessments throughout the index adolescents' childhood, and adolescents reported on their own alcohol expectancies in 6th grade, alcohol motives in 8th grade, and alcohol use in 12th grade. Results: Father alcohol problems and mother alcohol use were linked to more positive and less negative child alcohol expectancies, respectively. However, these cognitions did not contribute unique variance in adolescent alcohol use after accounting for additional risks included in the model. Conclusions: Findings highlight the need for future research aimed at modeling broader and potentially indirect sources of parent influences on adolescent alcohol-related learning and subsequent drinking behavior. [ABSTRACT FROM AUTHOR]

Background: This study examined resistance strategies used by predominantly Pacific Islander young adolescents in response to offers of tobacco, e-cigarettes, and betel [areca] nuts. This study was intended to inform the development of a prevention curriculum focused on training young adolescents from the U.S.-Affiliated Pacific Islands (USAPI) on culturally appropriate strategies to resist substance use offers. Currently, very little is understood in terms of how Pacific Islander youths deal with tobacco and other substance use offers, although the use of tobacco products among Pacific Islander youths is high. Specifically, given the collectivist sociocultural orientation of the Pacific Islander communities, it is unclear whether the direct (overt) confrontational style of resistance is a viable mode of resistance for youths to practice when faced with a substance use offer. Methods: We conducted 10 focus groups with public middle school students (N = 34) from Guam, which is part of the USAPI. Results: Results suggested that, as with other communities in the U.S., the resistance strategies fall into two categories—overt/confrontational and non-confrontational resistance strategies. Overt/confrontational strategies included (a) saying "no" and (b) verbally confronting the offeror. Non-confrontational strategies included (a) avoiding or leaving the situation and (b) telling an adult. Conclusions: Our findings have implications for the development of culturally grounded interventions aimed at preventing youth tobacco and other substance use in Guam, the USAPI, and the Pacific region. [ABSTRACT FROM AUTHOR]

Background: Investigating tobacco use and associated factors is essential to set priorities and health promotion strategies among adolescents. Several studies examined the relationship between this behavior and the psychosocial salutogenic construct Sense of Coherence (SOC), but the evidence is limited to adolescents in high-income countries. This study aimed to analyze the association between tobacco use and SOC among Brazilian adolescent students. Methods: A cross-sectional school-based survey was conducted in 2018. Dependent variables were categorical binary (Yes/No): (1) Smoking experimentation (at least one puff in a lifetime); (2) Current smoking (at least one cigarette smoked in the last 30 days); (3) Daily cigarette smoking; and (4) Experimentation with hookah and/or other tobacco products (at least once in a lifetime). Independent variable SOC was assessed with the SOC-13 item scale. Independent-samples t-Test and Logistic regression were used in the statistical analyses. Potential confounders were identified using a Directed Acyclic Graph. Results: Participants were 3034 adolescents aged 13–19. The mean SOC scores were higher among adolescents who answered no to each of the dependent variables than among those who answered yes (p <.05). In the regression analysis, those with higher SOC scores were less likely to report smoking experimentation, current use, daily use, and experimentation with hookah and/or other tobacco products, than those with lower SOC scores. The associations remained after controlling for sociodemographic and/or social-environmental factors. Conclusion: An inverse relationship between SOC and tobacco use was observed among Brazilian adolescent students. [ABSTRACT FROM AUTHOR]

Background: Adolescence is a common time for experimentation with substance use and the emergence of sex differences in substance use patterns. Although similar in early adolescence, male and female substance use patterns historically diverge by young adulthood, with males using more substances than females. We aim to add to current literature by utilizing a nationally representative sample, assessing a broad range of substances used, and focusing on a sentinel period during which sex differences emerge. We hypothesized that certain sex-specific substance use patterns emerge in adolescence. Methods: Data are from the 2019 Youth Risk Behavior Survey (n = 13,677), a nationally representative sample of high school students. Weighted logistic analyses of covariance adjusting for race/ethnicity evaluated males' and females' substance use (14 outcomes) by age category. Results: Among all adolescents, more males reported illicit substance use and cigarette smoking than females, whereas more females reported prescription opioid misuse, synthetic cannabis use, recent alcohol use, and binge drinking. Divergence between male and female use usually occurred at 18+ years. Odds of using most illicit substances were significantly greater among males than females at age 18+ years (aORs 1.7–4.47). Among 18+ year-olds, males and females did not differ in electronic vapor product use, alcohol use, binge drinking, cannabis use, synthetic cannabis use, cigarette smoking, or prescription opioid misuse. Conclusions: Sex differences in adolescent use of most but not all substances emerge by age 18+ years. Sex-specific patterns of adolescent substance use may inform specific prevention efforts and identify peak ages for intervention. [ABSTRACT FROM AUTHOR]

Background: Puff Bar has rapidly captured a large proportion of the disposable e-cigarette market. To stay abreast of the rapidly changing e-cigarette-product landscape, researchers have turned to social media platforms to monitor e-cigarette-related discussions and marketing trends. TikTok is the latest social media platform to capture the attention of adolescents and young adults; however, e-cigarette-related research using TikTok is limited. Objectives: This study examined Puff Bar-related posts on TikTok to identify themes and user engagement. Methods: Data were collected by scraping publicly available TikTok posts that contained the hashtag #puffplus, between January 31, 2020 and May 4, 2021 (n = 581). The research team used an inductive approach to identify 19 themes from the data. User engagement with posts including the number of likes, shares, plays, and comments was also collected. Results: The most prevalent themes included Music at 75.39% (438/581), followed by Flavors at 51.64% (300/581), Youth/Young Adults at 42.86% (249/581), Tobacco Use at 41.14% (239/581), Nicotine Concentration at 35.11% (204/581), Humor at 19.45% (113/581) and Product Review at 19.1% (111/581). Cessation 1.38% (8/581) and Health Warnings 2.58% (15/581) were two themes rarely observed but commonly engaged with by TikTok users. Conclusions: Health communication strategists should prepare to address TikTok's popularity to combat its contribution to the online e-cigarette environment. Future research should determine the impact of exposure to Puff Bar-related content on TikTok on adolescents' and young adults' attitudes and behaviors. [ABSTRACT FROM AUTHOR]

Background: This study examines the moderating effects of cigarette and e-cigarette co-use on the relationship between adolescent intention to use and marijuana use using the Theory of Planned Behavior (TPB). Method: A total of 217,276 adolescents in grades 6, 8, 10, and 12 were assessed using data from a large statewide surveillance dataset of youth self-report of substance use and related risk and protective factors. Structural Equation Models consisting of latent variables representing behavioral, normative, and control beliefs were regressed on intention to use and past 30-day marijuana use. Tests of moderation of the pathways between intention and marijuana use were used to test hypotheses, and grade level, gender, and race were included as covariates. Results: The overall model fit of the TPB predicting adolescent marijuana use provided good fit to the data (χ2(127) = 58042, p < 0.01, CFI = 0.95, TLI = 0.94, RMSEA = 0.04, SRMR = 0.03). After controlling for features of the model that may serve as common liability to substance use, past 30-day cigarette use moderated the relationship between intention and marijuana use (β = 0.46, p <.001). A stronger moderating effect was observed with past 30-day e-cigarette use (β = 0.63, p <.001). Past 12-month nicotine vaping (β = 0.44, p <.001) and flavor-only vaping (β = 0.30, p <.001) strengthened the relationship between intention and marijuana use. Conclusion: Adolescent marijuana use prevention may be enhanced by targeting general inhalation behaviors and restricting access to cigarettes, e-cigarettes, and flavor-only vaping products. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarettes (e-cigarettes) were introduced to the United States marketplace in 2007 and had dominated all other tobacco products used by youth by 2014. In May 2016, the Food and Drug Administration extended the final rule to include e-cigarettes in implementing text-based health warnings on cigarette packs and advertising, as required by the 2009 Tobacco Control Act. This study tested the hypothesis that youth's perceived harm of using e-cigarettes mediates the impact of seeing warning labels on their use intentions. Methods: We used a cross-sectional quantitative research design to analyze the 2019 National Youth Tobacco Survey data from 12,563 students in middle schools (grades 6 – 8) and high schools (grades 9 – 12) in the U.S. We conducted the 4-step Baron and Kenny Mediation Analysis using IBM SPSS® Hayes' PROCESS macro analysis. Results: Our study revealed a mediational process's presence, confirming the mediational role of youth's perceived harm of e-cigarettes on the relationship between seeing a warning label and their use intentions. Conclusion: This study provided insights into the relationship between seeing warning labels and the intention to use e-cigarettes among youth. Through the Tobacco Control Act, influential warning labels potentially increase youth's perception of harm in e-cigarettes, lowering their intention to use. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to make a new contribution to the literature by developing a scale to detect the substance initiation tendencies of young people and adolescents and to create a leading tool for preventive policies to be implemented against substance use. Method: An 8-item and 2-factor measurement tool called the "Substance Initiation Tendency Scale" was created. The data obtained from 470 students studying in 5 high schools in the Genç County of Bingöl, Turkey, were subjected to reliability and validity tests. In this context, Explanatory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), item analysis, and halving methods were used along with the SPSS 24 and AMOS 24 data analysis programs. Results: It was found that the Kaiser-Meyer Olkin (KMO) value was "excellent" with.909 and the Bartlett Sphericity Test was significant, and the scale, which could explain 57.332% of the total variance, had the feature of distinguishing what was intended to be measured. The values obtained from the Confirmatory Factor Analysis showed a "good fit". Conclusion: It was understood that the obtained data were sufficient to confirm the construct's validity. [ABSTRACT FROM AUTHOR]

Use of appearance- and performance-enhancing drugs and substances (APEDS) is common among adolescent and young adults. Many APEDS are legally sold "over-the-counter," however research has documented contamination of legal APEDS and many adverse effects of use. Despite this, little research has been conducted on legal APEDS use in Canada, particularly regarding the prevalence and sociodemographic predictors of use, which was the aim of this study. Data from the Canadian Study of Adolescent Health Behaviors (N = 2,731) were analyzed. Prevalence and frequency of use of 10 common APEDS in the past 12 months were estimated overall and across genders. Multiple modified Poisson regression analyses were conducted to determine the sociodemographic predictors of APEDS use. Overall, use of caffeine was most common among the sample (71.3%), along with protein bars (63.4%), and whey protein powders or protein shakes (63.1%). Boys and men reported greater prevalence of use of eight of the 10 APEDS, with the exception of diuretics or water pills and probiotics, compared to girls and women and transgender/gender non-confirming participants. Over three quarters (82.5%) of boys and men reported use of whey protein powders or protein shakes and 50.3% reported use of creatine monohydrate. Use of APEDS varied based on several key sociodemographic identifiers. This study is the first to document legal APEDS use among a sample of Canadian adolescents and young adults, providing important implications for health care and policymaking professionals. Further research is needed to gain greater insight into APEDS use among Canadian young people. [ABSTRACT FROM AUTHOR]

Background: Given increasing use of e-cigarettes among adolescents in the United States and its potential for nicotine addiction, encouraging adolescents to quit using these products has become a public health priority. This study examined factors at various socio-ecological levels associated with e-cigarette quit intention (pre-contemplation, contemplation, or preparation) using the Stages of Change of the Trans-theoretical Model among the U.S. adolescents. Methods: We used cross-sectional data from the past 30-day adolescent exclusive e-cigarette users participating in Wave 4 of the Population Assessment of Tobacco and Health study (n = 349). Weighted adjusted multinomial logistic regression models were used to analyze the data. Results: Compared to pre-contemplators and contemplators, preparators were more likely to believe that nicotine in e-cigarettes was "very/extremely harmful" (vs. "not at all harmful") to health (p < 0.001) and people cause a "lot of harm" (vs. "no harm") to themselves when they use e-cigarettes (p < 0.001). In comparison to pre-contemplators, contemplators and preparators were more likely to report that their parents/guardians talked with them about not using e-cigarettes than those whose parents/guardians did not talk with them (p < 0.001). Additionally, contemplators and preparators were also more likely to report that they "often/very often" (vs. never) noticed health warnings on e-cigarette packages (p < 0.001). Conclusion: Our findings suggest that harm perception, influence of family, and e-cigarette health warnings are some of the important factors associated with the stages of change for intention to quit among adolescent e-cigarette users. This study will help public health practitioners and researchers design multi-level e-cigarette cessation interventions for adolescents. [ABSTRACT FROM AUTHOR]

Background: Understanding time trends in risk factors for substance use may contextualize and explain differing time trends in substance use. Methods: We examined data (N = 536,291; grades 8/10/12) from Monitoring the Future, years 1991-2019. Using Latent Profile Analyses, we identified six time use patterns: one for those working at a paid job and the other five defined by levels of socialization (low/high) and engagement in structured activities like sports (engaged/disengaged), with the high social/engaged group split further by levels of unsupervised social activities. We tested associations between time use profiles and past two-week binge drinking as well as past-month alcohol use, cigarette use, cannabis use, other substance use, and vaping. We examined trends and group differences overall and by decade (or for vaping outcomes, year). Results: Prevalence of most substance use outcomes decreased over time among all groups. Cannabis use increased, with the largest increase in the group engaged in paid employment. Vaping substantially increased, with the highest nicotine vaping increase in the high social/engaged group with less supervision and the highest cannabis vaping increase in the highly social but otherwise disengaged group. Substance use was lowest in the low social groups, highest in the high social and employed groups. Conclusions: While alcohol, cigarette, and other substance use have declined for all groups, use remained elevated given high levels of social time, especially with low engagement in structured activities or low supervision, or paid employment. Cannabis use and vaping are increasing across groups, suggesting the need for enhanced public health measures. [ABSTRACT FROM AUTHOR]

Background: Adolescent electronic (e-)cigarette use intentions are related to initiation. Low self-control is also a risk factor for early stages of substance use. Yet, the impact of low self-control on use through intentions may vary across individuals; depression and anxiety may affect this association. Methods: A sample of 200 adolescents who completed waves 1 and 2 of an ongoing longitudinal study were assessed. We hypothesized that high internalizing symptoms would moderate the indirect effect of low self-control on actual e-cigarette use through e-cigarette use intentions. Results: The mediation pathway was significant at high levels of internalizing symptoms, but not at low or moderate levels. Conclusion: Specifically, those with low self-control and high internalizing symptomatology endorsed the highest e-cigarette use intentions and were more likely to subsequently use e-cigarettes. Youth low in self-control and high in depression and anxiety might be at increased risk to initiate e-cigarette use compared to youth high in self-control and high in internalizing symptomatology. [ABSTRACT FROM AUTHOR]

Objective: According to the reward- stress dysregulation model of addiction and parenting, parenting stress may play a critical role in the etiology and maintenance of substance misuse. To date, limited work has examined how parenting stress may relate to hazardous alcohol use among mothers of adolescents. The present study examined if parenting stress interacted with maternal stress responses (i.e., disengagement coping, involuntary disengagement stress responses) in relation to maternal hazardous alcohol use. Method: Two hundred and fifty-three mothers (n = 147 hazardous alcohol users; 58% of the sample) of adolescents between the ages of 12 and 16 years participated in the current study. Mothers were recruited using Qualtrics panel services. Mothers reported on their parenting stress, strategies for managing parenting stress, and use of alcohol. Mothers also reported basic demographic information (Mage = 41.10 years, 86.6% identified as white, 81.1% of mothers were married). Interaction analyses were used to test hypotheses. Results: Maternal parenting stress interacted with maternal involuntary disengagement stress responses in relation to maternal hazardous alcohol use, such that at average and high levels of disengagement stress responses, parenting stress was associated with hazardous alcohol use. These results were robust to covariates (i.e., family income, maternal anxiety symptoms, maternal depressive symptoms, general levels of maternal stress, maternal cigarette use). Maternal disengagement coping strategies were not related to maternal hazardous alcohol use. Conclusion: Results suggest that parenting stress and involuntary disengagement stress responses may be associated with hazardous alcohol use among mothers of adolescents. [ABSTRACT FROM AUTHOR]

Although siblings are conceptualized as a salient social influence during adolescence, few studies have examined how adolescent siblings influence each other's substance use and risky sexual behavior. Objectives: In this study, we investigated the influence of alcohol use days, cannabis use days, and cannabis and alcohol co-use days on the sexual risk behavior of siblings while accounting for dyadic influence. At the baseline visit for a randomized controlled trial for adolescents referred due to parents' concerns about their substance use ("referred adolescents"; n = 99; Mage=15.95; 38.38% female), we assessed alcohol and cannabis use days as well as sexual risk behavior of the referred adolescents and their sibling (Mage=15.03; 51.52% female). We computed the number of days in the 30 days prior to the baseline that alcohol and cannabis use occurred on the same day. Using a cross-sectional actor partner interdependence model, we tested two models of how adolescents' substance use is associated with their own ("actor effect") and their siblings' ("partner effect") sexual risk behavior—one model for alcohol and cannabis use, and one model for daily co-use. For referred adolescents and their siblings, within an individual, greater alcohol, cannabis, and daily co-use was significantly associated with sexual risk behavior (actor effects). Furthermore, more sibling co-use days was positively associated with referred adolescent sexual risk behavior (partner effect), representing interdependence. These findings confirm the influence siblings have on one another's risky behavior in adolescence and have implications for prevention and intervention efforts for adolescent substance use. [ABSTRACT FROM AUTHOR]

Background: E-cigarette use is increasing among Canadian youth, with experimentation especially prevalent among never-smoking youth. Among this group, there is concern e-cigarette use contributes to future initiation of smoking through a gateway effect. However, e-cigarette use and smoking share many common risk factors; a postulated mechanism to explain the apparent causal pathway from e-cigarette use to smoking initiation in previously smoking-naïve youth. A better understanding of the relationships between smoking susceptibility and e-cigarette use among never-smoking youth is needed. Purpose/objectives: The primary aim of this study was to gain a deeper understanding of the risk factors associated with smoking susceptibility in youth who have recently used e-cigarettes. Methods: This study used data (n = 40,363) from the 2018/2019 Canadian Student Tobacco Alcohol and Drug Use Survey (CSTADS) to compare the risk factor profiles of susceptible and non-susceptible never-smoking e-cigarette users, as well as susceptible and non-susceptible never-smoking youth who have never used an e-cigarette. Results: E-cigarette use, independent of susceptibility status, was associated with a sociodemographic and behavioral risk factor profile likely to confer a higher risk of initiating smoking. Among e-cigarette users, smoking susceptibility was associated with more smoking risk factors. Conclusions/importance: Study findings support a common risk-factor model, rather than e-cigarette use itself, to explain differences in the likelihood of smoking initiation among e-cigarette users. E-cigarette use and smoking initiation may be interchangeable outcomes amongst those with smoking risk factors. The risks of e-cigarette use, and their regulatory status, need to be balanced with their potential as harm reduction tools. [ABSTRACT FROM AUTHOR]

Ketamine has remained the most commonly used illicit drug among adolescents in Taiwan. A dual process model proposes that addictive behaviors develop in adolescents as a result of an imbalance between an appetitive, approach-oriented system (implicit and explicit attitudes) and a regulatory executive system (cool and hot executive functions). We aimed to examine the appetitive and regulatory processes in adolescent ketamine users in comparison to matched healthy adolescents. Method: The participants were 30 adolescent ketamine users and 32 nondrug controls, matched with gender, age, education years, and education systems. Both groups completed the affective priming task (APT), the stop-signal task (SST), an Iowa Gambling Task (IGT), and finally a Drug Use Disorders Identification Test: Extended (DUDIT-E). Results: The controls had higher positive and negative outcome expectancy with respect to using ketamine compared to the adolescent ketamine users. There was no significant between-group performance difference in APT. The adolescent ketamine users may have shown marginally poorer performance compared to the controls in hot executive functions (IGT), but their cold executive functions (SST) remained intact. Conclusion: The current study reported that the adolescent ketamine users may not have imbalanced dual processes (biased appetitive motivation and impaired regulatory executive process). A different therapeutic focus on adolescent ketamine users may be developed accordingly. More advocacies on ketamine's aversive outcomes are needed, particularly on campus in order to reduce substance misuse. [ABSTRACT FROM AUTHOR]

This study examined differences among current vapers, those susceptible to vaping, and those non-susceptible to vaping among adolescents and young adults (AYAs) in the U.S. We sought to understand vaping-related characteristics, preferences, and beliefs across these populations to inform prevention efforts. Methods: Participants were N=543 adolescents and N=557 young adults recruited in mid-2019 in the U.S. In two separate cross-sectional surveys, we assessed vaping preferences, tobacco product use, and both health harm and addiction risk beliefs about vaping. We ran separate multivariate logistic regressions to assess differences in risk beliefs across the three distinct e-cigarette groups among AYAs. Results: A majority of AYAs were either current vapers (adolescents: 32%, young adults: 36%) or susceptible to vaping (adolescents: 34%, young adults: 24%). In both samples, pod-based devices were the most common device type used, and fruit and mint/menthol were the most commonly used flavors. In multivariate analyses, adolescent (p<.05) and young adult (p<.05) current vapers both had lower risk beliefs about the health harms of vaping compared to those susceptible to vaping. Susceptible adolescents also had lower health harm risk beliefs compared to those who were non-susceptible (p<.05). Addiction risk beliefs seldom predicted use or susceptibility in multivariate analyses, with only susceptible young adults having lower addiction beliefs than those non-susceptible (p<.05). Conclusion: Results from this study highlight the role of health harm risk beliefs among AYA vapers and those susceptible to vaping. Prevention efforts should examine the most potent ways to communicate vaping health harms to discourage AYA vaping. [ABSTRACT FROM AUTHOR]

Alcohol use among Thai adolescents has been increasing over the past few decades, and efforts to control consumption by underaged youth have proven largely ineffective. Objectives: This study tested components of the Theory of Planned Behavior (TPB) and Readiness to Change, based on the Transtheoretical Model (TTM), to identify useful constructs for developing alcohol use interventions for youth. Methods: A sample of 825 Thai student drinkers (65% female), between the ages of 14 and 19, were recruited in Bangkok, Thailand. Hierarchical regression analyses were used to test components of the TPB and Readiness to Change as predictors of intention to reduce/stop alcohol use while controlling for age, gender and alcohol use. Results: The model accounted for 58% of the variance of intentions. The TPB components accounted for a significant increase in variance beyond that explained by age, gender and alcohol use, ΔR2 =.23, p <.001; Perceived Behavioral Control (PBC) was the strongest predictor (β =.41, p <.001), followed by Attitudes (β=.13, p <.001), and Subjective Norms (β =.09, p =.002). Readiness to Change composite scores (β=.54, p <.001) were added last and accounted for a further significant increase, ΔR2 =.24, p <.001. Conclusions: The findings suggest that interventions should assess Readiness to Change and utilize effective processes in facilitating change at each stage. Other suggestions are to improve participants' PBC and to further examine the role of specific social norms and attitudes regarding perceived benefits and disadvantages of alcohol use. [ABSTRACT FROM AUTHOR]

Most research on prescription stimulant misuse has focused on college students, and research on high school-aged adolescents is limited. This study aimed to characterize risk correlates of prescription stimulant misuse among a racially-diverse and socioeconomically-disadvantaged sample of urban adolescents. Cross-sectional data were drawn from an ongoing study of adolescent health behaviors, Project Teen. Participants were 414 9th to 11th graders (Mage=16.00 [SD = 1.08]; 57% female; 41% Black or African American, 22% White, 18% Asian, 17% Multiracial, 2% Pacific Islander, and 1% Native American; 12% Hispanic/Latinx). Participants completed a web-based survey assessing prescription stimulant misuse, demographics, mental health and personality, social environment, and substance use. Eight percent of participants endorsed past-year prescription stimulant misuse. Compared to non-misusing peers, participants endorsing past-year prescription stimulant misuse reported greater depression/anxiety symptoms, sensation seeking, perceived peer risk behavior, and alcohol and cigarette use, as well as a lower level of parental monitoring; null group differences were observed for academic goal orientation, perceived peer approval of risk behavior, and cannabis use. Binary logistic regression demonstrated that binge drinking and cigarette use were significantly associated with prescription stimulant misuse over and above all other identified risk variables. Adolescent prescription stimulant misuse appears to overlap with general adolescent substance use, sharing several known risk correlates. Results highlight potential targets for identification of emerging prescription stimulant misuse risk profiles at earlier stages of development. Longitudinal replication is needed to examine directional associations and risk mechanisms underlying adolescent prescription stimulant misuse. [ABSTRACT FROM AUTHOR]

Deaths related to opioid overdose have increased substantially in the past few years, raising concerns about how to combat this public health emergency. Objectives: We investigated the association of family, school, and community social capital with opioid misuse in the adolescent population. In addition, we examined if adolescents' depressive symptoms have any mediating effects on opioid misuse. Methods: We used the 2018 National Survey on Drug Use and Health (NSDUH) data, and two substantive models with binary logistic regressions. Three social capital variables were added to the full model with control for sociodemographic and health status variables. A mediation analysis was estimated for family and school social capital, major depressive episodes in the past year, and opioid misuse. Results: We found statistically significant relationships between adolescent opioid misuse and family and school social capital. Adolescents' odds of opioid misuse decreased 10% with each additional family situation where they felt supported. Not knowing students in their grade who drank alcohol or used marijuana/hashish decreased the odds of misusing opioids 42% (p <.01). Experience of depressive episodes acted as a mediator for the social capital effects on adolescents' opioid misuse. Conclusions: Our findings lend support that opioid misuse is associated with despair, and therefore, opioid prevention programs need to incorporate strategies to address mental health issues as well. Our findings also underscore the need for focusing on increasing parental awareness and involvement as well as scaling up prevention efforts in high schools where substance abuse is relatively higher. [ABSTRACT FROM AUTHOR]

Background: Adolescent substance use is highly prevalent and problematic; it has been reported as one of the most pertinent leading health concerns in the United States. The current longitudinal study examined the presence of peer and parental interpersonal relationship consequences (IP) as a motivating factor in activating coping skills to decrease the frequency of adolescent substance use, while further evaluating the role of impulsivity within that process. Objectives: Two main hypotheses were proposed: (1) IP will decrease substance use frequency mediated by increases in motivation and temptation coping; and (2) impulsivity will moderate the link between coping and substance use frequency. Participants included 343 adolescents between the ages of 13-19 (M = 16.23) referred to Project READY, a school-based substance use intervention. Assessments were completed during Sessions 1 and 4 of the intervention. Results: Serial mediation analyses indicated temptation coping, baseline alcohol use, and Time 2 marijuana use were the only statistically significant predictors of Time 2 alcohol use. Temptation coping and baseline marijuana use were the only statistically significant predictors of Time 2 marijuana use. Conclusions: Once adolescents' baseline and concurrent substance use were incorporated into the model, there was no statistical significance of the indirect effects. Results provided a stronger examination of the factors related to long-term substance use among adolescents. Knowing that temptation coping and baseline substance use levels were significant predictors of time 2 substance use independent of interpersonal consequences and motivation to change provides a structural frame and highlights need for early intervention. [ABSTRACT FROM AUTHOR]

Background: Justice-involved youth are at risk to become cigarette smokers as they age, leading to a variety of poor health outcomes. However, little is known about cigarette use among justice-involved youth, especially youth supervised in the community where there is ample opportunity to smoke. Objective: This study investigates the prevalence of cigarette smoking and the associations between cigarette smoking, emotional and behavioral functioning, and other substance use among a sample of first-time offending court-involved, non-incarcerated (FTO-CINI) youth. Methods: Youth were recruited from a family court in the Northeast (N = 423). Substance use was self-reported using the Adolescent Risk Behavior Assessment (ARBA). Emotional and behavioral functioning was measured using the Behavior Assessment Schedule for Children-Second Edition (BASC-2), the Affect Dysregulation Scale (ADS), National Stressful Events Survey PTSD Short Scale (NSESSS), and the National Survey of Self-Reported Delinquency (NYS-SRD). Results: About 9.9% of FTO-CINI youth had smoked cigarettes in the past 30 days. Compared with FTO-CINI youth who had not smoked recently, recent smokers endorsed more emotional and behavioral symptoms, such as school problems (p <.001), internalizing problems (p =.012), inattention/hyperactivity (p =.020), affect dysregulation (p =.044), PTSD symptoms (p =.006), and delinquent behavior (p <.001). Recent smokers were also more likely to use alcohol (OR = 5.61, p <.001), marijuana (OR = 11.27, p <.001), and other drugs (OR = 5.00, p <.001). Conclusions: Recent smoking was higher among FTO-CINI youth than youth in the general population. Findings underscore the need to incorporate nicotine into existing substance use prevention interventions for this population, who are at high risk to initiate cigarette use as they age. [ABSTRACT FROM AUTHOR]

Background: Alcohol craving is common among adolescents, stronger among those with more alcohol-related problems, and predicts drinking levels in their daily lives. Yet, the conditions that predict momentary changes in craving in real time among adolescents remain unclear. Objectives: This study examined the interactive effects of momentary risk-taking propensity and affect on adolescents' alcohol craving by leveraging ecological momentary assessment (EMA) methods. Methods: Participants were 29 adolescents ages 15–19 years (55% female; 69% White; 10% Black; 17% Hispanic); 45% met criteria for alcohol dependence. Following a laboratory session that captured self-report and behavioral assessments, including the well-established Balloon Analog Risk Task (BART), participants completed multiple daily assessments of alcohol craving, positive and negative affect, and risk propensity for approximately one week. Momentary risk propensity was captured in real-world settings via an EMA behavioral task ("Balloon Game"). Results: Mixed-effects models with EMA reports (Level 1) nested within participants (Level 2) revealed the majority (74%) of variability in "Balloon Game" performance was due to within-person, momentary, fluctuations. Greater momentary positive affect predicted increased alcohol craving, but only when participants exhibited heightened risk-taking propensity. Negative affect did not influence the relation between momentary risk-taking and craving. Conclusions/Importance: Momentary fluctuations in positive affect predicted acute increases in craving but only in moments when adolescents demonstrated higher levels of risk-taking propensity, as captured with an EMA-delivered behavioral task. Momentary risk-taking assessments offer new avenues to substantiate dominant theories on the driving mechanisms of craving and alcohol use among adolescents. [ABSTRACT FROM AUTHOR]

Background: A relatively large body of evidence indicates that coping motives for cigarette smoking are associated with a number of problematic outcomes (e.g., greater smoking frequency) among adolescents. Evidence also indicates that lower distress tolerance (or higher distress intolerance) is related to higher levels of coping motives for cigarette smoking among adults and adolescents. Therefore, it is critical to improve our understanding of factors that may increase the likelihood of smoking to cope among adolescents. In addition, evidence suggests that a number of parenting behaviors may affect adolescent smoking behavior. No work to date, however, has examined the relation between parental distress intolerance and adolescent smoking motives, or adolescent smoking behavior. Objective/methods: The current study involving adolescents (n = 46) and one of their parents aimed to address this gap in the literature by examining the association between parent-reported parental distress intolerance, self-reported adolescent motives for cigarette use, and self-reported adolescent cigarette smoking levels. Results: Results indicated that parental distress intolerance was related to greater adolescent coping motives for cigarette smoking, but not to other motives for adolescent cigarette use. Furthermore, results indicated that parental distress intolerance was indirectly associated with higher adolescent cigarette smoking levels through adolescent coping motives for cigarette smoking. Conclusions: Parental distress intolerance is associated with coping motives for adolescent cigarette smoking. This suggests parental emotional factors may be associated with adolescent cigarette use. [ABSTRACT FROM AUTHOR]

Background: Doping is a prevalent issue, not only among Olympians and professional athletes; young athletes and those at the sub-elite level have reported doping as well. Doping programs have been developed to target adolescent athletes and prevent doping initiation. The efficacy of primary doping prevention initiatives may be enhanced with health communication strategies, such as message framing. To date, there have been very few studies examining message framing among adolescents and none in the context of doping prevention. Objectives: The purpose of this study was to compare the efficacy of gain-framed and loss-framed messages on key psychological antecedents of doping among adolescent athletes. Methods: In a randomized controlled trial, 133 athletes aged 12 to 16 years old (Mage=13.73; 53% boys) from a variety of sports viewed either a gain- or loss-framed video. Intentions, attitudes, self-efficacy, and perceived norms were all assessed immediately before and after the videos. Results: Mixed between-within subjects ANOVAs revealed no differential influence for either message frame on changes in any of the outcomes. Attitudes, self-efficacy, and perceived norms all increased significantly over time for participants in both conditions. Conclusions/Importance: Overall, the findings suggest that a brief messaging intervention may have a beneficial influence on psychosocial constructs related to doping. There is no strong evidence to support definitive recommendations regarding optimal message framing for doping prevention among adolescent athletes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5–5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as "I don't know" were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study's finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems. [ABSTRACT FROM AUTHOR]

Background: Maternal depression has been linked to substance use in adolescents, but the mechanisms of the relationship between maternal depression and adolescent substance use are less clear. Specifically, previous literature has overlooked the role of fathers as a potential protective or exacerbating factor in buffering this relationship. Objectives: The goal of this study was to investigate the association between maternal depressive symptoms and adolescent substance use, exploring father's residential status as a moderator for adolescents living with a mother with depressive symptoms. Method: Paper-and-pencil surveys were administered to a sample of 176 mothers and their adolescent daughters aged 14-18, predominantly identifying as African American/Black. Participants included a subset of mothers with HIV. Results: The results revealed that maternal depressive symptoms were not directly associated with adolescent substance use. However, father's residential status was found to be a significant moderator in the relationship between maternal depressive symptoms and adolescent substance use. Specifically, when fathers were involved in the daughter's life (residential or non-resident), substance use was higher in adolescents of mothers with high depressive symptoms than in those of mothers with low depressive symptoms. Conclusion: The results suggest that varied family dynamics are critical to understanding engagement in substance use among adolescent girls, including the influence of both mothers and fathers. [ABSTRACT FROM AUTHOR]

Background: Neighborhood disadvantage (ND) and population density (PD) are two community characteristics contextualizing friends' influence on adolescent alcohol use. However, these community characteristics are rarely examined for potential joint contributions, although it is possible that the way friends are selected or influence alcohol use are shaped by both ND and PD. In addition, prior studies examining ND or PD contexts on friend influence rarely discern between socialization and selection. Objectives: The current study examined how selection and socialization influences on adolescent alcohol use are shaped by unique and joint contexts of ND and PD. Methods: Adolescents from Waves I and II of the National Longitudinal Study of Adolescent and Adult Health (Add Health) were included in three models assessing friends' socialization of alcohol us initiation and binge drinking, and selection of drinking friends. ND and PD were tested for mediation and moderation individually and jointly. Results: Results indicated that socialization of drinking initiation was stronger in high ND contexts, and that continued binge drinking was stronger in low ND contexts. PD indirectly influenced socialization of initiation and binge drinking maintenance via a negative association with number of drinking friends. PD and ND jointly influenced the association between initial binge drinking and next-year selection of drinking friends, such that selection was stronger within areas related to lower levels of drinking friends. Conclusions/Importance: Current results indicate that PD and ND shape friends' influence on alcohol use in unique ways. These must be accounted for to better understand bidirectional effects of friend influence. [ABSTRACT FROM AUTHOR]

Background: Use of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball. Objectives: This study aimed to assess factors associated with adolescent male athletes' ST-related behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort. Methods: Baseline and one-year follow-up questionnaires assessed sociodemographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9- to12th-grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use). Results: Of 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this high-risk adolescent population. [ABSTRACT FROM AUTHOR]

Background: The prevalence of Korean adolescents with depression was 25.1% in 2017, and the suicide rate among Korean teens increased from 4.2 deaths per 100,000 in 2015 to 4.9 deaths per 100,000 in 2016, suggesting that a high prevalence of depression and suicide among adolescents is a serious social problem in South Korea. Owing to the rapid growth of e-cigarettes in the last several years, it is important for research on smoking and mental health to distinguish different uses of tobacco products. Objectives: To examine the relationship between depression and suicidality among Korean adolescents, classified into nonusers, conventional-cigarette-only users, e-cigarette-only users, and dual users. Methods: Data were examined from the 2017 Korean Youth Risk Behavior Web-based Survey. The study included 62,276 students. A multivariate logistic regression was performed to assess the association of depression and suicidality with electronic and conventional cigarette use. Results: There were significant differences among the users: dual users had a higher prevalence of depression and suicidality for both lifetime and current use; e-cigarette-only users had higher levels of depression and suicidality than nonusers; and among female adolescents, conventional-cigarette-only users, e-cigarette-only users, and dual users had a higher prevalence of depression and suicidality than male adolescents. Conclusions: This is the first study to assess the association of depression and suicidality with conventional and e-cigarette use using a nationally representative Korean adolescent sample. These findings suggest an urgent need for evaluation of and intervention for e-cigarette use by health professionals providing smoking cessation programs for adolescents. [ABSTRACT FROM AUTHOR]

Background: While there is evidence for socioeconomic inequalities in some adolescent substance use behaviors, there is limited information on how socioeconomic inequalities compare across European countries and over time. Objectives: To compare socioeconomic inequalities in problematic adolescent substance use (regular smoking, heavy episodic drinking, and cannabis use) across 24 European countries at two time points. Methods: We use the European School Survey Project on Alcohol and Other Drugs (ESPAD) to examine socioeconomic inequalities in problematic adolescent substance use across 24 European countries in 2007 (n = 73,877) and 2011 (n = 71,060) using within country logistic regressions. Socioeconomic inequalities are measured using a relative index of inequality based on highest level of parental education relative to country of residence within survey year. Countries are ranked according to socioeconomic differentials. Results: In 2007, lower socioeconomic status (SES) adolescents had significantly higher odds of heavy episodic drinking in 10 countries, regular smoking in 12 countries, and recent cannabis use in 1 country. In 2011, the number of countries were 11, 15, and 0, respectively. In 2007, lower SES adolescents had a significantly lower odds of heavy episodic drinking in one country, regular smoking in one country, and cannabis use in four countries. In 2011, the number of countries were two, one, and six, respectively. There was little evidence for changes in socioeconomic inequalities over time. Conclusions: There are large country level differences in socioeconomic inequalities in adolescent substance use. [ABSTRACT FROM AUTHOR]

Background: Several studies have uncovered a relationship between parenting styles and the likelihood that adolescents use tobacco, alcohol or illegal drugs. Objectives: This paper extends existing research in two ways. First, we consider a longer time-frame, investigating the relationship between parenting in adolescence and substance use in adulthood. Second, we explore the pathways by which this relationship is expressed, in particular the extent to which the relationships in question are mediated by age at first use and depression. Methods: Our analysis is based on data from the National Longitudinal Study of Adolescent Health (Add Health), N = 2954, and is conducted using structural equation modeling (SEM). We consider warmth and control as distinct dimensions of parenting, as well as a typology of parenting which combines the two dimensions. Results: Warmth is associated with reduced risks of problem substance use in adulthood, via reduced risks of early initiation and a lower risk of depression. Parental control also has a protective effect via reduced risks of early initiation, but this is offset by a detrimental effect on depression, particularly in the case of older adolescents. We also find that indulgent parenting is not associated with extra risk of any kind compared with the authoritative style, whereas authoritarian and neglectful styles are. Conclusions/Importance: The nexus of relationships which we uncover has implications for policy aimed at reducing substance use in the longer term, suggesting that initiatives to promote warm and responsive parenting may be most effective in reducing the risks of later substance use problems. [ABSTRACT FROM AUTHOR]