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In the USA, Black women aged 25–44 years are disproportionately murdered compared with their White counterparts. Despite ongoing efforts to reduce racial and structural inequities, the result of these efforts remains unclear, particularly in light of the COVID-19 pandemic.

Cannabis use disorder is associated with considerable comorbidity and impairment in functioning, and prevalence is increasing among adults with chronic pain. We aimed to assess the effect of introduction of medical cannabis laws (MCL) and recreational cannabis laws (RCL) on the increase in cannabis use disorder among patients in the US Veterans Health Administration (VHA).

Historically, researchers have proposed higher-order factors to explicate the structure of psychopathology, including Externalizing, Internalizing, Fear, Distress, Thought Disorder, and a general factor. Despite extensive research in this domain, the underlying structure of psychopathology remains unresolved. Here, we examine several issues in adjudicating among structural models of psychopathology. Using simulations and analyses of the extant literature, we contrast the model-based reliability of alternative structural models of psychopathology and highlight shortcomings of conventional model-fit indices for such adjudication. We propose alternative criteria for evaluating and contrasting competing structural models, including various model characteristics (e.g., the magnitude and consistency of factor loadings and their precision), the consistency and sensitivity of factors to their constituent indicators, and the variance explained in and patterns of associations with relevant variables. Using these criteria as adjuncts to conventional fit indices should become standard practice and will greatly facilitate adjudication among alternative structural models of psychopathology.

AbstractBackground:Nightlife attendance is an established risk factor for drug use, but studies have not focused on adolescent general population samples or compared risk according to type(s) of venues attended. We examined whether attendance of various types of venues was associated with drug use. Methods:Data were examined from an annual nationally representative survey of high school seniors in the US (2014–2019, N = 11,565). We determined whether past-year attendance of parties, concerts, bars or nightclubs, and raves or dance music events was associated with past-year drug use using mixed-effects logistic regression. Mall and movie attendance were examined as negative controls. Results: Compared to those who reported not attending specific venues, attending parties was associated with higher odds of using alcohol in particular (aOR = 5.03, 95% CI: 3.92–6.44). Attending concerts was associated with higher odds for use of alcohol, cannabis, ecstasy, and nonmedical use of prescription stimulants and opioids. All drugs examined were concentrated among those who attend bars, nightclubs, raves, and dance parties. Rave or dance party attendance was associated with higher odds for use of ecstasy (aOR = 3.71, 95% CI: 2.50–5.50) and methamphetamine (aOR = 4.92, 95% CI: 2.43–9.96) in particular, and bar or nightclub attendance was associated with higher odds of use of cocaine (aOR = 6.49, 95% CI: 4.37–9.63), ecstasy (aOR = 6.49, 95% CI: 4.54–9.27), and methamphetamine (aOR = 5.49, 95% CI: 2.57–11.72) in particular. Attending movies was associated with lower odds for use of cocaine and nonmedical prescription stimulant use. Conclusion:We determined differential risk of drug use depending on types of venues attended by adolescents.

Simultaneous use of alcohol and cannabis to enhance each other's effect can cause potential harm. Time trends are diverging in adolescent use of alcohol, which is declining, and cannabis, which is increasing among certain subgroups. However, little is known about trends in their simultaneous and non‐simultaneous use. Racial and socioeconomic disparities are emerging in cannabis use, which may portend consequences to public health. The 2000 to 2020 Monitoring the Future surveys included approximately 38,000 U.S. 12th‐grade students with information on simultaneous use and pertinent demographic factors. A 5‐level alcohol/cannabis measure included past‐year simultaneous use (i.e., alcohol and cannabis use at the same time), non‐simultaneous alcohol and cannabis use, alcohol‐use‐only, cannabis‐use‐only, and no use. Multinomial logistic regressions estimated associations (adjusted relative risk ratios; aRRR) with time period (2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2020). Models were adjusted and included interactions with sex, race/ethnicity, and parental education. Between 2000 and 2020, simultaneous alcohol/cannabis use among 12th graders decreased from 24.4% to 18.7%. From 2015 to 2020 compared to 2000 to 2004, the odds of simultaneous use (adjusted relative risk ratio (aRRR) vs. no use = 0.57, 95% CI [0.50, 0.66]) and alcohol‐use‐only (aRRR = 0.55, 95% CI [0.49, 0.61]) decreased, while cannabis‐use‐only odds increased (aRRR = 2.59, 95% CI [1.87, 3.59]). Notably, the prevalence of cannabis‐use‐only more than doubled from 2011 to 2019. The odds of simultaneous use, alcohol‐use‐only, and non‐simultaneous use of alcohol and cannabis declined more rapidly among males than females, whereas the odds for cannabis‐use‐only increased faster for females than males. Increases in cannabis‐use‐only were faster for non‐white adolescents. Simultaneous use of alcohol and cannabis is declining among U.S. adolescents, but the decline is slower among females than males. Declines in simultaneous use are largely concomitant with historical declines in alcohol use, indicating that a continued focus on reducing alcohol use among adolescents and young adults has extended benefits to other adolescent substance use. However, cannabis use without any reported past‐year alcohol use more than doubled in the last decade, a concerning trend. Simultaneous use of alcohol and cannabis is declining among US adolescents, but this decline is slower among females than males. Declines in simultaneous use are largely concomitant with historical declines in alcohol use, indicating that continued focus on reducing alcohol among adolescents and young adults has extended benefits to other adolescent substance use. However, cannabis use without any reported past‐year alcohol use more than doubled in the last decade, a concerning trend.

Objective: Prescriptions for anxiety medications have increased substantially in recent years. Individuals with anxiety disorders are at risk of nonmedical use of these medications, but information about whether this risk is elevated among patients with a prescription for such medications is lacking. The authors compared risk of nonmedical use in individuals in a national sample with and without a prescription for anxiety medication and identified characteristics associated with nonmedical use. Method: Data were drawn from face-to-face surveys of 34,653 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions. The risk of nonmedical use of prescription anxiety medication and associated drug use disorders was computed for individuals who had or had not ever received a prescription for anxiety medication; among those who had received a prescription, characteristics associated with nonmedical use were analyzed. Results: Prescription of anxiety medication was associated with lifetime and past-year nonmedical use (odds ratios, 1.6 and 1.9, respectively) and lifetime DSM-IV abuse or dependence (odds ratio, 2.6). Among respondents who received a prescription (N=4,294), nonmedical use was associated with male sex, younger age, white race, history of use of illicit drugs, history of other drug use disorders, and history of illegal behaviors. Conclusions: These results indicate that prescription for anxiety medications is associated with nonmedical use of these medications, although the direction of causality cannot be determined in this study. Although anxiety medications have clinical utility, greater clinical attention should be given to the potential for their abuse among patients at particular risk.

Objective: The course of alcohol disorders in women is often described as 'telescoped' compared to that in men, with a later age at initiation of alcohol use but shorter times from use to dependence and treatment. This study examined evidence for such a telescoping effect in the general population and tested birth cohort effects for gender differences. Method: Data from two U.S. national surveys conducted 10 years apart (1991-1992 and 2001-2002) using the same diagnostic instrument (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV) were used to analyze five birth cohorts. Age at initiation of alcohol use, time from first use to dependence, and time from dependence to first treatment were analyzed. Interaction terms (cohort by gender; cohort by gender by time) were tested in Cox proportional hazards models. Results: Little evidence was found for a telescoping effect in women. For alcohol use and dependence, cohort and gender interacted, which suggests that gender differences are diminished in more recent cohorts. A three-way interaction of cohort, gender, and time was significant for time from first use to dependence, suggesting that men have a shorter time to dependence, especially in younger cohorts. Conclusions: A telescoping effect is not evident in the general population. Gender differences in the overall hazard of alcohol use and dependence are decreasing in more recent cohorts, while gender differences in time from first use to dependence are increasing. These findings challenge the commonly held notion of a gender-specific course of alcohol disorders and suggest the need for a greater clinical focus on problem drinking in women and further research on accelerated time to dependence in men. doi: 10.1176/appi.ajp.2009.09081161

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co‐occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma‐related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

IMPORTANCE: Childhood adversity (CA) is a powerful determinant of long-term physical and mental health that is associated with elevated risk for chronic disease and psychopathology. However, the degree to which CA contributes to mortality as a preventable driver of ill-health and death is unknown. OBJECTIVE: To estimate the contribution of CA to health behaviors, including smoking and sedentary behavior, as well as the annual mortality attributable to CA in the US through influences on leading causes of death (eg, cardiovascular disease). EVIDENCE REVIEW: For this systematic review, the PsycINFO and MEDLINE databases were searched on November 15, 2019. The databases were searched for publications from inception (1806 for PsycINFO, 1946 for MEDLINE) to November 15, 2019. Meta-analyses of the associations between CA and morbidity outcomes were included. The population attributable fraction (PAF) was calculated from these associations along with the estimated US prevalence of CA. The PAF was then applied to the number of annual deaths associated with each cause of death to estimate the number of deaths that are attributable to CA. Additionally, the PAF was applied to the incidence of health behaviors to derive the number of cases attributable to CA. Exposure to 1 or more experiences of adversity before the age of 18 years was analyzed, including abuse, neglect, family violence, and economic adversity. FINDINGS: A total of 19 meta-analyses with 20 654 832 participants were reviewed. Childhood adversity accounted for approximately 439 072 deaths annually in the US, or 15% of the total US mortality in 2019 (2 854 838 deaths), through associations with leading causes of death (including heart disease, cancer, and suicide). In addition, CA was associated with millions of cases of unhealthy behaviors and disease markers, including more than 22 million cases of sexually transmitted infections, 21 million cases of illicit drug use, 19 million cases of elevated inflammation, and more than 10 million cases each of smoking and physical inactivity. The greatest proportion of outcomes attributable to CA were for suicide attempts and sexually transmitted infections, for which adversity accounted for up to 38% and 33%, respectively. CONCLUSIONS AND RELEVANCE: The results of this systematic review suggest that CA is a leading contributor to morbidity and mortality in the US and may be considered a preventable determinant of mortality. The prevention of CA and the intervention on pathways that link these experiences to elevated disease risk should be considered a critical public health priority.

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Binge drinking among adolescents and young adults has changed over time, but patterns differ by age and gender. Identifying high‐risk groups to target future efforts at reducing drinking in this population remains a public health priority. Forecasting methods can provide a better understanding of variation and determinants of future binge drinking prevalence. We implemented regression‐based forecasting models to estimate the prevalence and gender differences in binge drinking among cohort groups of U.S. young adults, ages 18, 23–24, and 29–30 through 2040. Forecasting models were adjusted for covariates accounting for changes in demographic, Big‐5 social roles (e.g., residential independence), and drinking norms and related substance use, to understand the drivers of forecasted binge drinking estimates. From the last observed cohort group (years varied by age) through 2040, unadjusted binge drinking prevalence was forecasted to decrease from 26% (95% CI: 20, 33%) (2011–15) to 11% (95% CI: 4, 27%) at age 18, decrease from 38% (95% CI: 30, 45%) (2006–2010) to 34% (95% CI: 18, 55%) at ages 23/24, and increase from 32% (95% CI: 25, 40%) (2001–2005) to 35% (95% CI: 16, 59%) at ages 29/30. Gender‐stratified forecasts show a continuation in the narrowing of binge drinking prevalence between young men and women, though the magnitude of narrowing differs by age. Estimated trends were partially explained by changing norms regarding drinking and other substance use, though these indirect effects explained less of the total trend as age increased. Understanding how covariates influence binge drinking trends can guide public health policies to leverage the most important determinants of future binge drinking to reduce the harm caused by binge drinking from adolescence to adulthood. Adolescence is a critical developmental window during which the brain is highly sensitive to insult while increased risk‐taking behavior such as high dose alcohol consumption frequently occurs. Activation of microglia, the macrophages of the brain, has been suggested to contribute to alcohol‐induced brain changes. We critically review evidence of microglial activation following alcohol exposure in adolescence through a lens that encompasses recent research highlighting the complexity of microglial functions in neurodevelopment, homeostasis and response to perturbation.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co‐occurrence in the modal case, heterogeneity of presentation within dis­orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and “Cluster B” personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self‐assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

The SARS‐CoV‐2 pandemic created disruptions and stressors which may have influenced alcohol consumption frequency trends. Varying COVID‐19 health burden and alcohol policies may have contributed to different consumption trends between states. The aim of this study is to assess trends in alcohol consumption and moderation by state of residence. We examined trends in adult drinking days, during the first wave of the pandemic (March 10 to June 8) using longitudinal data from the Understanding America Study (N= 6,172 unique participants; N= 28,059 observations). Because state mandates were responsive to disease burden, we modeled the interaction of time by COVID‐19 burden, defined as whether the state had the median (or higher) daily incidence of COVID‐19 cases on the survey date, and state random effects. We controlled for individual sociodemographics, perceived personal/familial COVID‐19 burden, mental health symptomology, and risk avoidance. Drinking days increased throughout the duration (incidence risk ratio [IRR] for drinking per increase in one calendar day = 1.003, 95% CI 1.001, 1.004); trends were heterogeneous by disease burden, with individuals living in states with lower COVID‐19 burden increasing (IRR = 1.005, 95% CI 1.003, 1.007) faster than those living in states with higher COVID‐19 burden (IRR = 1.000, 95% CI 0.998, 1.002). Trends were heterogeneous between states, but there was no evidence of systematic geographic clustering of state trends. Drinking days increased during the first months of the COVID‐19 pandemic, particularly among residents of states with lower disease burden. During the first wave of the pandemic, Americans consumed alcohol at higher frequencies. However, we found heterogeneity in consumption by US state, specifically state‐level COVID‐19 burden. People living in states with higher COVID‐19 burdens did not increase alcohol consumption; the national increases were concentrated only among people living in states with lower COVID‐19 burdens.

BackgroundRidesharing services (eg, Uber, Lyft) have facilitated over 11 billion trips worldwide since operations began in 2010, but the impacts of ridesharing on motor vehicle injury crashes are largely unknown.—MethodsThis spatial ecological case-cross over used highly spatially and temporally resolved trip-level rideshare data and incident-level injury crash data for New York City (NYC) for 2017 and 2018. The space-time units of analysis were NYC taxi zone polygons partitioned into hours. For each taxi zone-hour we calculated counts of rideshare trip origins and rideshare trip destinations. Case units were taxi zone-hours in which any motor vehicle injury crash occurred, and matched control units were the same taxi zone from 1 week before (−168 hours) and 1 week after (+168 hours) the case unit. Conditional logistic regression models estimated the odds of observing a crash (separated into all injury crashes, motorist injury crashes, pedestrian injury crashes, cyclist injury crashes) relative to rideshare trip counts. Models controlled for taxi trips and other theoretically relevant covariates (eg, precipitation, holidays).ResultsEach additional 100 rideshare trips originating within a taxi zone-hour was associated with 4.6% increased odds of observing any injury crash compared with the control taxi zone-hours (OR=1.046; 95% CI 1.032 to 1.060). Associations were detected for motorist injury and pedestrian injury crashes, but not cyclist injury crashes. Findings were substantively similar for analyses conducted using trip destinations as the exposure of interest.ConclusionsRidesharing contributes to increased injury burden due to motor vehicle crashes, particularly for motorist and pedestrian injury crashes at trip nodes.

The role of sex, race, and suicide method on recent increases in suicide mortality in the United States remains unclear. Estimating the age, period, and cohort effects underlying suicide mortality trends can provide important insights for the causal hypothesis generating process. We generated updated age-period-cohort effect estimates of recent suicide mortality rates in the US, examining the putative roles of sex, race, and method for suicide, using data from all death certificates in the US between 1999 and 2018. After designating deaths as attributable to suicide according to ICD-10 underlying cause of death codes X60-X84, Y87.0, and U03, we (i) used hexagonal grids to describe rates of suicide by age, period, and cohort visually and (ii) modeled sex-, race-, and suicide method-specific age, period, and cohort effects. We found that, while suicide mortality increased in the US between 1999 and 2018 across age, sex, race, and suicide method, there was substantial heterogeneity in age and cohort effects by method, sex, and race, with a first peak of suicide risk in youth, a second peak in older ages—specific to male firearm suicide, and increased rates among younger cohorts of non-White individuals. Our findings should prompt discussion regarding age-specific clinical firearm safety interventions, drivers of minoritized populations’ adverse early-life experiences, and racial differences in access to and quality of mental healthcare.

IMPORTANCE: An important consequence of cannabis legalization is the potential increase in the number of cannabis-impaired drivers on roads, which may result in higher rates of traffic-related injuries and fatalities. To date, limited information about the effects of recreational cannabis laws (RCLs) on traffic fatalities is available. OBJECTIVE: To estimate the extent to which the implementation of RCLs is associated with traffic fatalities in Colorado and Washington State. DESIGN, SETTING, AND PARTICIPANTS: This ecological study used a synthetic control approach to examine the association between RCLs and changes in traffic fatalities in Colorado and Washington State in the post-RCL period (2014-2017). Traffic fatalities data were obtained from the Fatality Analysis Reporting System from January 1, 2005, to December 31, 2017. Data from Colorado and Washington State were compared with synthetic controls. Data were analyzed from January 1, 2005, to December 31, 2017. MAIN OUTCOME(S) AND MEASURES: The primary outcome was the rate of traffic fatalities. Sensitivity analyses were performed (1) excluding neighboring states, (2) excluding states without medical cannabis laws (MCLs), and (3) using the enactment date of RCLs to define pre-RCL and post-RCL periods instead of the effective date. RESULTS: Implementation of RCLs was associated with increases in traffic fatalities in Colorado but not in Washington State. The difference between Colorado and its synthetic control in the post-RCL period was 1.46 deaths per 1 billion vehicle miles traveled (VMT) per year (an estimated equivalent of 75 excess fatalities per year; probability = 0.047). The difference between Washington State and its synthetic control was 0.08 deaths per 1 billion VMT per year (probability = 0.674). Results were robust in most sensitivity analyses. The difference between Colorado and synthetic Colorado was 1.84 fatalities per 1 billion VMT per year (94 excess deaths per year; probability = 0.055) after excluding neighboring states and 2.16 fatalities per 1 billion VMT per year (111 excess deaths per year; probability = 0.063) after excluding states without MCLs. The effect was smaller when using the enactment date (24 excess deaths per year; probability = 0.116). CONCLUSIONS AND RELEVANCE: This study found evidence of an increase in traffic fatalities after the implementation of RCLs in Colorado but not in Washington State. Differences in how RCLs were implemented (eg, density of recreational cannabis stores), out-of-state cannabis tourism, and local factors may explain the different results. These findings highlight the importance of RCLs as a factor that may increase traffic fatalities and call for the identification of policies and enforcement strategies that can help prevent unintended consequences of cannabis legalization.

Sociodemographic inequalities in depression are well established. However, less is known about variation in inequalities across countries. In this study, we describe cross-national variation in sociodemographic inequalities in depression among older adults. Comparing inequalities across countries is an important step towards understanding how the social environment shapes depression risk.

ObjectiveAdolescent cigarette smoking declined steadily and substantially from 2000 to 2018. This paper considers the potential consequences of this ‘great decline’ for the prevalence of other drug use among adolescents.MethodsData are annual, cross-sectional, nationally representative Monitoring the Future surveys of more than 1.2 million US students in 12th, 10th and 8th grades from 2000 to 2018. Analyses include trends in the past 12 months’ non-medical amphetamine, tranquillisers and opioid use overall, among ever and never cigarette smokers, and projected if adolescent cigarette smoking levels had remained at 2000 levels.ResultsWithin groups of ever and never cigarette smokers, the prevalence for each of the three substances has either changed little or overall increased in 2018 as compared with 2000. When the two groups were combined into one pool, the overall prevalence for each of the drugs declined by about half. The decline resulted from the growing group of never smokers, whose levels of non-medical drug use over the study period were at least four times lower than the levels of ever smokers.ConclusionsThe results support the ‘gateway’ prediction that declines in cigarette smoking among adolescents pull downward their non-medical use of amphetamines, tranquillisers and opioids. Continuing to reduce adolescent smoking through policy and programmatic prevention efforts should have further positive spillover effects on adolescent drug use.

Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.

Background: Evidence suggests that suicide mortality increases after high-profile suicide deaths. Indeed, suicide in the United States increased disproportionately after the suicide by suffocation of well-known comedian Robin Williams in August 2014. Such increases are often attributed to irresponsible media coverage of the suicide contributing to “copycat suicides.” However, recent research indicates that the mainstream Canadian media have significantly improved their suicide coverage, with high fidelity to suicide reporting guidelines after Williams’ death. As such, the aim of the present study is to examine suicide mortality in Canada after Robin Williams’ suicide.Methods: We obtained deidentified monthly suicide count data from January 1999 to December 2015 stratified by age, sex, and method of suicide from Statistics Canada. We used time-series analyses to estimate the expected number of suicides in the months following Robin Williams’ death. This was done using a seasonal autoregressive integrated moving averages (SARIMA) method. Expected suicides were then compared with observed suicides.Results: August 2014 was the month with the highest number of suicides from 2010 to 2015. The time-series model indicated a 16% increase in the expected number of suicides during the months from August to December 2014 inclusive. Moreover, males over 30 had the greatest number of excess suicides, and suicides by suffocation (the method used by Robin Williams) were also higher in August and the following months.Interpretation: Suicides increased in Canada after Robin Williams’ death, despite the improved mainstream media coverage witnessed in other studies. Other factors (e.g., social and alternative media) may have contributed to the observed increase in suicide.

Alcohol consumption in later life has increased in the past decade, and the relationship between alcohol consumption and mortality is controversial. Recent studies suggest little, if any, health benefit to alcohol. Yet most rely on single–time point consumption assessments and minimal confounder adjustments. We report on 16 years of follow‐up from the Health and Retirement Study (HRS) cohorts born 1931 to 1941 (N= 7,904, baseline mean age = 61, SD = 3.18). Respondents were queried about drinking frequency/quantity. Mortality was established via exit interviews and confirmed with the national death index. Time‐varying confounders included but were not limited to household assets, smoking, body mass index, health/functioning, depression, chronic disease; time‐invariant confounders included baseline age, education, sex, and race. After adjustment, current abstainers had the highest risk of subsequent mortality, consistent with sick quitters, and moderate (men: HR = 0.74, 95% CI: 0.60 to 0.91; women: HR = 0.82, 95% CI: 0.63 to 1.07) drinking was associated with a lower mortality rate compared with occasional drinking, though smokers and men evidenced less of an inverse association. Quantitative bias analyses indicated that omitted confounders would need to be associated with ~4‐fold increases in mortality rates for men and ~9‐fold increases for women to change the results. There are consistent associations between moderate/occasional drinking and lower mortality, though residual confounding remains a threat to validity. Continued efforts to conduct large‐scale observational studies of alcohol consumption and mortality are needed to characterize the changing patterns of consumption in older age. Low levels of alcohol consumption promote longevity in the golden years. Analyzing data from almost 8,000 older adults followed for almost two decades, Keyes et al. demonstrate that heavy drinking predicts mortality, and while moderate drinking in old age is associated with a longer life, it is those who are healthy enough to moderately drink who have the biggest benefit.

Alcohol consumption is increasing in the United States, as is alcohol‐attributable mortality. Historically, men have had higher rates of alcohol consumption than women, though evidence for birth cohort effects on gender differences in alcohol consumption and alcohol‐related harm suggests that gender differences may be diminishing. We review studies using U.S. national data that examined time trends in alcohol consumption and alcohol‐related harm since 2008. Utilizing a historical–developmental perspective, here we synthesize and integrate the literature on birth cohort effects from varying developmental periods (i.e., adolescence, young adulthood, middle adulthood, and late adulthood), with a focus on gender differences in alcohol consumption. Findings suggest that recent trends in gender differences in alcohol outcomes are heterogeneous by developmental stage. Among adolescents and young adults, both males and females are rapidly decreasing alcohol consumption, binge and high‐intensity drinking, and alcohol‐related outcomes, with gender rates converging because males are decreasing consumption faster than females. This pattern does not hold among adults, however. In middle adulthood, consumption, binge drinking, and alcohol‐related harms are increasing, driven largely by increases among women in their 30s and 40s. The trend of increases in consumption that are faster for women than for men appears to continue into older adult years (60 and older) across several studies. We conclude by addressing remaining gaps in the literature and offering directions for future research. Among adolescents and young adults, both males and females are rapidly decreasing alcohol consumption, binge and high intensity drinking, and alcohol‐related outcomes, with gender rates converging because males are decreasing consumption faster. This pattern does not hold among adults. In middle‐adulthood, consumption, binge drinking, and alcohol‐related harms are increasing, driven largely by women in their 30s and 40s. The trend of increases in consumption that are faster for women than men appears to continue into older adult years.

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Maximizing both efficiency and equity are core considerations for population health. These considerations can result in tension in population health science as we seek to improve overall population health while achieving equitable health distributions within populations. Limited work has explored empirically the consequences of different population health intervention strategies on the burden of disease and on within- and between-group differences in disease. To address this gap, we compared the impact of four simulated interventions using data from the National Health and Nutrition Examination Survey. In particular, we focus on assessing how population and high-risk primary prevention and population and high-risk secondary interventions efforts to reduce smoking behavior influence systolic blood pressure (SBP) and hypertension, and how such strategies influence inequalities in SBP by income. The greatest reductions in SBP mean and standard deviation resulted from the population secondary prevention. High-risk primary and secondary prevention and population secondary prevention programs all yielded substantial reductions in hypertension prevalence. The effect of population primary prevention did little to decrease population SBP mean and standard deviation, as well as hypertension prevalence. Both high-risk strategies had a larger impact in the low-income population, leading to the greatest narrowing the income-related gap in disease. The population prevention strategies had a larger impact in the high-income population. Population health approaches must consider the potential impact on both the whole population and also on those with different levels of risk for disease within a population, including those in under-represented or under-served groups.

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IMPORTANCE: Historical shifts are occurring in marijuana policy. The effect of legalizing marijuana for recreational use on rates of adolescent marijuana use is a topic of considerable debate. OBJECTIVE: To examine the association between the legalization of recreational marijuana use in Washington and Colorado in 2012 and the subsequent perceived harmfulness and use of marijuana by adolescents. DESIGN, SETTING, AND PARTICIPANTS: We used data of 253 902 students in eighth, 10th, and 12th grades from 2010 to 2015 from Monitoring the Future, a national, annual, cross-sectional survey of students in secondary schools in the contiguous United States. Difference-in-difference estimates compared changes in perceived harmfulness of marijuana use and in past-month marijuana use in Washington and Colorado prior to recreational marijuana legalization (2010-2012) with postlegalization (2013-2015) vs the contemporaneous trends in other states that did not legalize recreational marijuana use in this period. MAIN OUTCOMES AND MEASURES: Perceived harmfulness of marijuana use (great or moderate risk to health from smoking marijuana occasionally) and marijuana use (past 30 days). RESULTS: Of the 253 902 participants, 120 590 of 245 065(49.2%) were male, and the mean (SD) age was 15.6 (1.7) years. In Washington, perceived harmfulness declined 14.2% and 16.1% among eighth and 10th graders, respectively, while marijuana use increased 2.0% and 4.1% from 2010-2012 to 2013-2015. In contrast, among states that did not legalize recreational marijuana use, perceived harmfulness decreased by 4.9% and 7.2% among eighth and 10th graders, respectively, and marijuana use decreased by 1.3% and 0.9% over the same period. Difference-in-difference estimates comparing Washington vs states that did not legalize recreational drug use indicated that these differences were significant for perceived harmfulness (eighth graders: % [SD], −9.3 [3.5]; P = .01; 10th graders: % [SD], −9.0 [3.8]; P = .02) and marijuana use (eighth graders: % [SD], 5.0 [1.9]; P = .03; 10th graders: % [SD], 3.2 [1.5]; P = .007). No significant differences were found in perceived harmfulness or marijuana use among 12th graders in Washington or for any of the 3 grades in Colorado. CONCLUSIONS AND RELEVANCE: Among eighth and 10th graders in Washington, perceived harmfulness of marijuana use decreased and marijuana use increased following legalization of recreational marijuana use. In contrast, Colorado did not exhibit any differential change in perceived harmfulness or past-month adolescent marijuana use following legalization. A cautious interpretation of the findings suggests investment in evidence-based adolescent substance use prevention programs in any additional states that may legalize recreational marijuana use.

After remaining stable for many years, the prevalence of depression among adolescents increased over the past decade, particularly among girls. In this study, we used longitudinal data from a cohort of high school students to characterize sex-specific trajectories of depressive symptoms during this period of increasing prevalence and widening gender gap in adolescent depression.

Given slowing secular declines and persistent racial disparities, stillbirth remains a major health burden in the US. We investigate changes in stillbirth rates overall and for Black and White women, and determine how maternal age, delivery year (period), and birth year (cohort) have shaped trends.

•Nicotine vaping is linked to non-cigarette tobacco product use among adolescents.•These links were stronger among non-smokers, putting non-smoking vapers at risk.•As nicotine vaping rises, non-cigarette tobacco product use may be a major issue.

Neighborhood context is associated with binge drinking and has significant health, societal, and economic costs. Both binge drinking and neighborhood context vary by race and ethnicity. We examined the relations between neighborhood characteristics—neighborhood norms that are accepting of drunkenness, collective efficacy, and physical disorder—and binge drinking, with a focus on examining race and ethnic‐specific relationships. Respondent data were collected through 2005 random digit‐dial‐telephone survey for a representative sample of New York City residents; neighborhood data were based on the 2005 New York City Housing and Vacancy Survey. Participants were 1,415 past‐year drinkers; Whites (n =877), Blacks (n =292), and Hispanics (n =246). Generalized estimating equations were used to estimate population average models. For the overall sample, neighborhood norms that were more accepting of drunkenness were associated with greater binge drinking (odds ratio [OR]=1.22; 95% confidence interval [CI]=1.09, 1.37); collective efficacy and physical disorder were not significant. However, when examining this by race/ethnicity, greater collective efficacy (OR=0.75; 95% CI=0.62, 0.91) and greater physical disorder (OR=0.76; 95% CI=0.62, 0.93) were associated with less binge drinking for Whites only. Neighborhood norms that were more accepting of drunkenness were associated with binge drinking among Whites (OR=1.20; 95% CI=1.05, 1.38) and, while not significant (perhaps due to power), the associations were similar for Hispanics (OR=1.18; 95% CI=0.83, 1.68) and slightly lower for Blacks (OR=1.11; 95% CI=0.67, 1.84). Overall, results suggest that neighborhood characteristics and binge drinking are shaped, in part, by factors that vary across race/ethnicity. Thus, disaggregating data by race/ethnicity is important in understanding binge drinking behaviors. We examined the relations between neighborhood norms that are accepting of getting drunk, collective efficacy, and physical disorder and binge drinking, with a focus on race and ethnicity. Greater collective efficacy and greater physical disorder were associated with less binge drinking for Whites only. Neighborhood norms that are more accepting of getting drunk were associated with binge drinking among Whites and, while not significant (perhaps due to power), the associations were similar for Hispanics and slightly lower for Blacks.

Adolescent time use in recent cohorts is distinguished by large-scale changes, including shifts in parental monitoring, supervision, and adolescent activity patterns, that together may provide a more complete perspective on changing patterns of mental health than can be captured by single risk factors.

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Adolescent use of marijuana is associated with adverse later effects, so the identification of factors underlying adolescent use is of substantial public health importance. The relationship between US state laws that permit marijuana for medical purposes and adolescent marijuana use has been controversial. Such laws could convey a message about marijuana acceptability that increases its use soon after passage, even if implementation is delayed or the law narrowly restricts its use. We used 24 years of national data from the USA to examine the relationship between state medical marijuana laws and adolescent use of marijuana.

Depression and anxiety have been inconsistently associated with diabetes. Sex differences in the biological and behavioral correlates of these forms of distress could partially explain these inconsistencies. We investigated sex-specific associations between depressionanxiety symptoms and diabetes in two separate samples.

•Approximately 6.7 to 7.6 million adults in the US are currently living with OUD.•Methods to estimate the prevalence of OUD require extrapolation and estimation.•Existing estimates of OUD prevalence estimates are biased and undercount the number of people with OUD at least 3–5 times.