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Characterize college student COVID-19 behaviors and attitudes during the early pandemic. Participants: Students on two university campuses in Wisconsin. Surveys administered in September and November 2020. Few students (3–19%) participated in most in-person activities during the semester, with eating at restaurants as the exception (72–80%) and attending work (35%) and parties (33%) also reported more frequently. The majority wore masks in public (94–99%), but comparatively fewer (42%) did so at parties. Mask-wearing at parties decreased from September to November (p < 0.05). Students attending parties, or consuming more alcohol, were less concerned and more likely to take COVID-19-associated risks. Students were motivated to adhere to COVID-19 prevention measures but gathered socially. Though there was frequent public masking, mask-wearing at parties declined in November and may represent pandemic fatigue. High-yield strategies for decreasing viral spread may include changing masking social norms and engaging with students about creative risk-reduction strategies. [ABSTRACT FROM AUTHOR]

Background: An important life‐course event with respect to alcohol and cannabis use is turning 21 years of age, which may be associated with increases in use of these substances due to celebrations during the month and easier access to them on and following this birthday. We examined the trajectories of alcohol and cannabis use behaviors in the months leading up to, during, and following the 21st birthday month. We also examined whether the use trajectories vary by college status and baseline levels of use. Methods: We used data from 203 young adults recruited from the Greater Seattle region who turned 21 during the course of the study. Surveys were administered each month for 24 consecutive months. Measures included the typical number of drinks per week for the past month, the frequency of heavy episodic drinking, the number of cannabis use days, and any simultaneous alcohol and cannabis use. Multilevel spline models were run that estimated linear slopes over time at four intervals: (1) up to 1 month before the 21st birthday month; (2) from 1 month before to the month of the 21st birthday; (3) from the 21st birthday month to 1 month following; and (4) from 1 month following the 21st birthday month through all following months. Results: Alcohol use, generally, and simultaneous alcohol and cannabis use showed sharp increases from the month before the 21st birthday month to the 21st birthday month and decreases following the 21st birthday month. For cannabis use, there were significant increases in the months leading up to the 21st birthday and no other significant changes during other time intervals. Patterns differed by baseline substance use and college status. Conclusions: Findings from the current study have implications for the timing and personalization of prevention and intervention efforts. Event‐specific 21st birthday interventions may benefit from incorporating content targeting specific hazardous drinking behaviors in the month prior to the 21st birthday. [ABSTRACT FROM AUTHOR]

Objective: Among two-year college students, alcohol and marijuana use, related consequences, and risk factors for use are not well understood. We examined differences between two- and four-year students in alcohol and marijuana use, consequences, and perceived descriptive norms, and explored whether two-year status moderated associations between norms and use. Participants: Data were drawn from a cross-sectional subsample of two- and four-year students aged 18–23 (n = 517) participating in a longitudinal study on alcohol use. Results: Four-year students reported greater alcohol use and consequences than two-year students; two-year students reported greater marijuana use than four-year students. Perceived alcohol and marijuana norms were positively related with use; two-year status did not moderate these associations. Conclusions: Perceived alcohol and marijuana norms function similarly for two- and four-year students in terms of associations to actual use. Adapting normative interventions for two-year students may be an effective strategy for reducing high-risk use among this underserved population. [ABSTRACT FROM AUTHOR]

Background: Simultaneous alcohol and marijuana (SAM) use has been associated with greater alcohol use and consequences at the daily level, but limited research has examined SAM use in relation to marijuana use and its consequences. This study tested daily associations between SAM use and four outcomes: alcohol use (number of drinks), marijuana use (hours high), negative alcohol consequences, and negative marijuana consequences. Methods: A community sample of young adults [ages 18–25, mean (SD) = 21.61 (2.17) years] with recent alcohol and SAM use was recruited (N = 409; 50.9% female; 48.2% non‐Hispanic/Latinx White). Participants completed a baseline survey and six 2‐week bursts of daily surveys (81.1% of morning surveys completed) and reported on substance use and negative substance‐related consequences. Multilevel modeling was used to test the main aims and to explore each specific consequence. Results: Among days with any alcohol use, SAM use days were associated with consuming more drinks and experiencing more total negative alcohol‐related consequences than non‐SAM use days. Among days with any marijuana use, SAM use days were associated with more hours being high than non‐SAM use days. Exploratory models showed that SAM use was related to five specific alcohol‐related consequences and two specific marijuana‐related consequences. Conclusions: These findings build upon prior research by showing that SAM use days are linked to consuming more drinks, reporting more hours being high from marijuana, and experiencing more total alcohol‐related consequences even after controlling for the number of drinks, the number of hours high, any tobacco/nicotine use, and any other substance use. SAM use was also associated with a greater likelihood of experiencing some specific consequences related to alcohol and marijuana. The findings underscore the need for additional research on SAM use and marijuana‐related outcomes. The current study found that, among days with any alcohol use, SAM use days were associated with consuming more drinks and experiencing more total alcohol consequences and also experiencing some specific alcohol consequences. Among days with any marijuana use, SAM use days were associated with more hours high and experiencing some specific marijuana consequences. Findings build on prior research by showing effects of SAM use even after controlling for number of drinks, number of hours high, and other substance use. [ABSTRACT FROM AUTHOR]

Background: The contexts in which young adults drink alcohol play a salient role in alcohol‐related outcomes and negative consequences at an event‐level, but less is known about longitudinal risks. We collected longitudinal monthly data across 2 years on (a) daytime drinking, (b) pregaming/pre‐partying, and (c) playing drinking games. We then examined associations between drinking in these contexts and within‐person variability in alcohol consumption, consequences, and simultaneous alcohol and marijuana (SAM) use in a given month. We also examined the extent to which drinking in these contexts predicted hazardous drinking (using Alcohol Use Disorders Identification Test (AUDIT) scores) at a distal follow‐up timepoint, controlling for baseline AUDIT scores. Method: A community sample of 759 young adults (Mage = 21.1 years; 56.4% female) completed monthly surveys for 24 consecutive months and a distal 30‐month follow‐up. Multilevel models estimated within‐ and between‐person associations between drinking context frequencies (daytime drinking, pregaming, drinking games) and alcohol‐related outcomes (weekly consumption, consequences, SAM use). A single‐level negative binomial regression tested associations between drinking context frequency averages across a two‐year period and changes in AUDIT scores from baseline to a follow‐up 2.5 years later. Results: Over 75% of the sample of non‐abstaining young adults reported drinking in each of the three contexts at least once during the 24‐month period. Within‐persons, young adults reported greater consumption, more negative consequences, and increased likelihood of SAM use during months that they drank in these contexts more often than usual. Each context was associated with negative consequences, even when controlling for alcohol use frequency. More frequent daytime drinking and pregaming, but not drinking games, were associated with increases in AUDIT scores at the 30‐month follow‐up, suggesting that there are potential long‐term risks of drinking in these contexts. Conclusions: Findings suggest that daytime drinking, pregaming, and playing drinking games are high‐risk contexts in terms of month‐to‐month and long‐term risks. Additional research is needed on the various contexts in which young adults drink alcohol and the extent to which contextual factors interact with one another to amplify/reduce risks and harms. [ABSTRACT FROM AUTHOR]

This study seeks to identify and characterize key barriers associated with PrEP therapy as self-reported by users on social media platforms. We used data mining and unsupervised machine learning approaches to collect and analyze COVID-19 and PrEP-related posts from three social media platforms including Twitter, Reddit, and Instagram. Predominant themes detected by unsupervised machine learning and manual annotation included users expressing uncertainty about PrEP treatment adherence due to COVID-19, challenges related to accessibility of clinics, concerns about PrEP costs and insurance coverage, perceived lower HIV risk leading to lack of adherence, and misinformation about PrEP use for COVID-19 prevention. [ABSTRACT FROM AUTHOR]

Objective: To determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study.Research Design and Methods: From 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively.Results: Over a median of 21 years (interquartile range 20-21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52]), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality.Conclusions: Cancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates. [ABSTRACT FROM AUTHOR]

University settings have demonstrated potential for coronavirus disease (COVID-19) outbreaks; they combine congregate living, substantial social activity, and a young population predisposed to mild illness. Using genomic and epidemiologic data, we describe a COVID-19 outbreak at the University of Wisconsin-Madison, Madison, Wisconsin, USA. During August-October 2020, a total of 3,485 students, including 856/6,162 students living in dormitories, tested positive. Case counts began rising during move-in week, August 25-31, 2020, then rose rapidly during September 1-11, 2020. The university initiated multiple prevention efforts, including quarantining 2 dormitories; a subsequent decline in cases was observed. Genomic surveillance of cases from Dane County, in which the university is located, did not find evidence of transmission from a large cluster of cases in the 2 quarantined dorms during the outbreak. Coordinated implementation of prevention measures can reduce COVID-19 spread in university settings and may limit spillover to the surrounding community. [ABSTRACT FROM AUTHOR]

The convergence of advances in medical science, human biology, data science, and technology has enabled the generation of new insights into the phenotype known as "diabetes." Increased knowledge of this condition has emerged from populations around the world, illuminating the differences in how diabetes presents, its variable prevalence, and how best practice in treatment varies between populations. In parallel, focus has been placed on the development of tools for the application of precision medicine to numerous conditions. This Consensus Report presents the American Diabetes Association (ADA) Precision Medicine in Diabetes Initiative in partnership with the European Association for the Study of Diabetes (EASD), including its mission, the current state of the field, and prospects for the future. Expert opinions are presented on areas of precision diagnostics and precision therapeutics (including prevention and treatment), and key barriers to and opportunities for implementation of precision diabetes medicine, with better care and outcomes around the globe, are highlighted. Cases where precision diagnosis is already feasible and effective (i.e., monogenic forms of diabetes) are presented, while the major hurdles to the global implementation of precision diagnosis of complex forms of diabetes are discussed. The situation is similar for precision therapeutics, in which the appropriate therapy will often change over time owing to the manner in which diabetes evolves within individual patients. This Consensus Report describes a foundation for precision diabetes medicine, while highlighting what remains to be done to realize its potential. This, combined with a subsequent, detailed evidence-based review (due 2022), will provide a roadmap for precision medicine in diabetes that helps improve the quality of life for all those with diabetes. [ABSTRACT FROM AUTHOR]

Objective: Substantial research has demonstrated the importance of implicit cognitive processes underlying substance use. However, there is a scarcity of research on implicit processes related to marijuana use. We adapted and tested the predictive validity (concurrent and prospective) of an implicit measure evaluating the strength of associations between marijuana and harm based on research demonstrating less marijuana use among individuals who report stronger explicit attitudes of marijuana's harms.Method: A community sample of 187 U.S. young adults living in a state with legal recreational marijuana use completed an Implicit Association Test (IAT) evaluating marijuana-harm associations and measures of marijuana use and risk of cannabis use disorder (CUD) over time.Results: The marijuana-harm IAT had good internal consistency, and scores did not vary as a function of biological sex, legal age status for recreational marijuana use, or college student status. Scores did vary as a function of lifetime and recent use such that lifetime and current abstainers had stronger marijuana-harm associations. Zero-inflated negative binomial regression models demonstrated that marijuana-harm IAT scores significantly predicted concurrent risk of CUD and use such that stronger marijuana-harm associations were associated with less use and risk of CUD. Results evaluating outcomes longitudinally found limited support for IAT scores predicting increases in use over time and no support for predicting changes in risk of CUD over time.Conclusions: Findings provide preliminary evidence that stronger marijuana-harm associations may act as a protective factor against marijuana use and risk of CUD. [ABSTRACT FROM AUTHOR]

Several different conceptualizations of Oppositional Defiant Disorder (ODD) symptoms have been proposed, including one undivided set of symptoms (DSM-IV-TR; APA 2000); two domains of symptoms subdivided into affective and behavioral; and three domains of symptoms subdivided as angry/irritable, argumentative/defiant, and spiteful. The current study utilizes a novel approach to examining the division of ODD symptoms through use of network analysis. Participants were 109 preschoolers (64 male) between the ages of three and six (M = 4.34 years, SD = 1.08) and their parents and teachers/caregivers, who provided ratings of ODD symptoms. Results are consistent with one-, two-, and three- cluster solutions of ODD, but perhaps provide most support for the three-cluster solution. In addition, results support the idea that negative affect, particularly anger, forms the core of the ODD symptom network during preschool. These results suggest the importance of targeting anger in preschool interventions for ODD. [ABSTRACT FROM AUTHOR]

Most young adults with mental health symptoms do not receive treatment or access services. It remains important to identify barriers to service utilization to improve access to care. The current study was a prospective analysis examining predictors of (a) mental health service utilization and (b) perceived unmet need for mental health services. Barriers to service utilization were examined by prior depression severity status and college student status. Participants included a subsample of young adults ages 18-23 at time of recruitment who were participating in a longitudinal monthly study who completed both baseline and a 15-month follow-up assessment (N = 622, 80% of larger study). At month 15, 23% of young adults reported receiving mental health services in the past 12 months; 26% of young adults reported a perceived unmet need for mental health services at some point in the past 12 months. There were differences in demographic and mental health predictors of service utilization and perceived unmet need for services. Women, sexual minorities, those with moderate depression, those with more impairment from depression, and perceived past year poor mental health were associated with greater likelihood of receiving services. Similar demographic characteristics were associated with greater likelihood of perceiving unmet need for services. Barriers to service utilization differed by severity of depression symptoms and student status. Young adults have distinct reasons for not accessing mental health services; addressing these to improve accessibility to care remains critical. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate how community college students with hazardous drinking perceived the usefulness of alcohol protective behavioral strategy text messages (TM-PBS). Methods: Community college students with past hazardous single occasion or weekly drinking (N = 48; 60% female) were randomized to receive 2 TM-PBS on 3 typical drinking days per week for 2 weeks selected by: (1) research investigators (ie, based on clinical and theoretical application); (2) participants (ie, messages highly rated at baseline by the participants); or (3) a random process. Prior to 2 typical drinking days per week, immediately after receiving TMs, we asked: "How useful do you think this strategy will be for you when you drink? Text a number from 1 (not useful) to 5 (very useful)." Results: Response rates for the 12 messages ranged from 72.9% to 87.5%, with no differences in response rates across selection categories (ie, investigator, participant, random). Investigator-selected messages were rated as less useful than messages that were self-selected by participants or messages that were selected at random. Conclusions: TMPBS chosen a priori by students were perceived as more useful than TM-PBS chosen by investigators, supporting this form of tailoring in alcohol interventions to optimize usefulness. [ABSTRACT FROM AUTHOR]

Background: Cannabis is purported to alleviate symptoms related to cancer treatment, although the patterns of use among cancer patients are not well known. This study was designed to determine the prevalence and methods of use among cancer patients, the perceived benefits, and the sources of information in a state with legalized cannabis.Methods: A cross-sectional, anonymous survey of adult cancer patients was performed at a National Cancer Institute-designated cancer center in Washington State. Random urine samples for tetrahydrocannabinol provided survey validation.Results: Nine hundred twenty-six of 2737 eligible patients (34%) completed the survey, and the median age was 58 years (interquartile range [IQR], 46-66 years). Most had a strong interest in learning about cannabis during treatment (6 on a 1-10 scale; IQR, 3-10) and wanted information from cancer providers (677 of 911 [74%]). Previous use was common (607 of 926 [66%]); 24% (222 of 926) used cannabis in the last year, and 21% (192 of 926) used cannabis in the last month. Random urine samples found similar percentages of users who reported weekly use (27 of 193 [14%] vs 164 of 926 [18%]). Active users inhaled (153 of 220 [70%]) or consumed edibles (154 of 220 [70%]); 89 (40%) used both modalities. Cannabis was used primarily for physical (165 of 219 [75%]) and neuropsychiatric symptoms (139 of 219 [63%]). Legalization significantly increased the likelihood of use in more than half of the respondents.Conclusions: This study of cancer patients in a state with legalized cannabis found high rates of active use across broad subgroups, and legalization was reported to be important in patients' decision to use. Cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers. Cancer 2017;123:4488-97. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. [ABSTRACT FROM AUTHOR]

Motives for substance use have garnered considerable attention due to the strong predictive utility of this construct, both in terms of use and problems associated with use. The current study examined the cross-lagged relations between alcohol use and motives, and marijuana use and motives over three yearly assessment periods in a large sample (N=526, 48% male) of college students. The relations between substance use and motives were assessed at each time point, allowing for the examination of these inter-relations over time. Results indicated different trends based on the type of substance. For alcohol use, cross-lagged trends were found between freshman and sophomore year for coping, social, and conformity motives with cross-lagged relations between enhancement motives and alcohol use across all years. However, outside of enhancement motives, cross-lagged relations were not found between sophomore and junior year. In contrast, cross-lagged effects were found for marijuana use and coping, enhancement, and expansion motives between sophomore and junior year, but not freshman year. These results suggest that people's expectations that drinking or smoking marijuana makes activities more reinforcing and helps them cope with distress may perpetuate use. In turn, use itself may enhance these expectations over time. Results have direct implications for treatment, with recommended focus on motives, behavior activation, and healthy coping skills in order to interrupt the cycle of substance use. [ABSTRACT FROM AUTHOR]

The purpose of the present paper was to examine the extent to which college students underestimate the quantity of alcohol they will consume during Spring Break (SB), and whether individual, interpersonal, and contextual factors may be related to underestimation of SB drinking and drinking consequences. College students participated in web-based surveys prior to and after SB (N=603; 57% women). Overall, results indicated that individual factors (being male, being a member of a fraternity or sorority, previously experiencing more alcohol-related consequences, and intending to drink less during SB), interpersonal factors (reporting friends encourage getting drunk), and contextual factors (going on a SB trip with friends and receiving drinks from others) predicted underestimating peak drinks consumed during SB. Underestimating the peak number of drinks to be consumed on SB was associated with experiencing a greater number of alcohol-related consequences. Targeted interventions designed specifically to focus on underestimation of college student drinking and the impact of SB contextual and interpersonal factors may be an important area of study to reduce negative consequences of alcohol use during SB. [ABSTRACT FROM AUTHOR]

Background Marijuana policies are rapidly evolving. In the United States, recreational use of marijuana is now legal in 4 states and medical marijuana is legal in 23 states. Research evaluating such policies has focused primarily on how policies affect issues of price, access to, use, and consequences of marijuana. Due to potential spillover effects, researchers also need to examine how marijuana policies may impact use and consequences of alcohol. Methods The current paper is a critical review of articles evaluating alcohol outcomes associated with marijuana decriminalization, medical marijuana legalization, and nonmedical or recreational marijuana legalization. We identified articles and reports through (1) online searches of EBSCO host database including Academic Search Premier, Econlit, Legal Collection, Medline, PsycARTICLES, and Psyc INFO, as well as PubMed and Google Scholar databases; (2) review of additional articles cited in papers identified through electronic searches; and (3) targeted searches of state and local government records regarding marijuana law implementation. We reviewed studies with respect to their data sources and sample characteristics, methodology, and the margin of alcohol and marijuana use, timing of policy change, and the aspects of laws examined. Results The extant literature provides some evidence for both substitution (i.e., more liberal marijuana policies related to less alcohol use as marijuana becomes a substitute) and complementary (i.e., more liberal marijuana policies related to increases in both marijuana and alcohol use) relationships in the context of liberalization of marijuana policies in the United States. Conclusions Impact of more liberal marijuana policies on alcohol use is complex, and likely depends on specific aspects of policy implementation, including how long the policy has been in place. Furthermore, evaluation of marijuana policy effects on alcohol use may be sensitive to the age group studied and the margin of alcohol use examined. Design of policy evaluation research requires careful consideration of these issues. [ABSTRACT FROM AUTHOR]

Background: Functional independence with aging is an important goal for individuals and society. Simple prognostic indicators can inform health promotion and care planning, but evidence is limited by heterogeneity in measures of function.Methods: We performed a pooled analysis of data from seven studies of 27,220 community-dwelling older adults aged 65 or older with baseline gait speed, followed for disability and mortality. Outcomes were incident inability or dependence on another person in bathing or dressing; and difficulty walking ¼ - ½ mile or climbing 10 steps within 3 years.Results: Participants with faster baseline gait had lower rates of incident disability. In subgroups (defined by 0.2 m/s-wide intervals from <0.4 to ≥ 1.4 m/s) with increasingly greater gait speed, 3-year rates of bathing or dressing dependence trended from 10% to 1% in men, and from 15% to 1% in women, while mobility difficulty trended from 47% to 4% in men and 40% to 6% in women. The age-adjusted relative risk ratio per 0.1 m/s greater speed for bathing or dressing dependence in men was 0.68 (0.57-0.81) and in women: 0.74 (0.66-0.82); for mobility difficulty, men: 0.75 (0.68-0.82), women: 0.73 (0.67-0.80). Results were similar for combined disability and mortality. Effects were largely consistent across subgroups based on age, gender, race, body mass index, prior hospitalization, and selected chronic conditions. In the presence of multiple other risk factors for disability, gait speed significantly increased the area under the receiver operator characteristic curve.Conclusion: In older adults, gait speed predicts 3 year incidence of bathing or dressing dependence, mobility difficulty, and a composite outcome of disability and mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the associations between definitions of sarcopenia and clinical outcomes and the ability of the definitions to discriminate those with a high likelihood of having these outcomes from those with a low likelihood. DESIGN: Osteoporotic Fractures in Men Study. SETTING: Six clinical centers. PARTICIPANTS: Community-dwelling men aged 65 and older (N = 5,934). MEASUREMENTS: Sarcopenia definitions from the International Working Group, European Working Group on Sarcopenia in Older Persons, Foundation for the National Institutes of Health Sarcopenia Project, Baumgartner, and Newman were evaluated. Recurrent falls were defined as two or more self-reported falls in the year after baseline (n = 694, 11.9%). Incident hip fractures (n = 207, 3.5%) and deaths (n = 2,003, 34.1%) were confirmed according to central review of medical records over 9.8 years. Self-reported functional limitations were assessed at baseline and 4.6 years later. Logistic regression or proportional hazards models were used to estimate associations between sarcopenia and falls, hip fractures, and death. The discriminative ability of the sarcopenia definitions (vs reference models) for these outcomes was evaluated using area under the receiver operating characteristic curve or C-statistics. Referent models included age alone for falls, functional limitations and mortality, and age and bone mineral density for hip fractures. RESULTS: The association between sarcopenia according to the various definitions and risk of falls, functional limitations, and hip fractures was variable; all definitions were associated with greater risk of death, but none of the definitions materially changed discrimination based on the AUC and C-statistic when compared with reference models (change <1% in all models). CONCLUSION: Sarcopenia definitions as currently constructed did not consistently improve prediction of clinical outcomes in relatively healthy older men. [ABSTRACT FROM AUTHOR]

Objective: Underestimating how much one will drink has been associated with greater alcohol-related consequences. Elevated mood or drinking context may relate to drinking more than planned (or intended) among college students. The aims of the current study were to test (a) whether positive and negative mood and contextual factors on a given day were associated with the likelihood of unplanned heavy drinking (defined as unplanned heavy episodic or high-intensity drinking), and (b) whether days with unplanned heavy drinking were associated with more negative consequences.Method: The analytic sample included 352 college students (53.4% female; 71.3% non-Hispanic White) who completed daily assessments via automated telephone interviews. Multilevel models were used to test predictors of unplanned heavy drinking (Aim 1) and predictors of consequences (Aim 2).Results: Almost a third (29.60%) of drinking days were unplanned heavy drinking days. Individuals with higher average positive mood across the sampled days had lower odds of unplanned heavy drinking. No significant associations were observed between negative mood and unplanned heavy drinking. Weekend days and days with special occasions were associated with lower odds of unplanned heavy drinking. Unplanned heavy drinking was associated with more negative consequences on that day.Conclusions: Students were frequently not able to accurately predict the amount of alcohol they would consume on that day, which conferred an increased risk of negative consequences. Interventions could incorporate strategies that help students anticipate their alcohol consumption in order to employ protective behavioral strategies in high-risk contexts. [ABSTRACT FROM AUTHOR]

Alcohol expectancies are a central construct in understanding college student typical alcohol use. However, to our knowledge, there is no research addressing how alcohol expectancies for specific events (i.e. 21st birthday) are different from expectancies regarding typical drinking. We examine the extent to which 21st birthday alcohol expectancies differ from general alcohol expectancies and how 21st birthday expectancies are associated with actual alcohol use and consequences experienced on 21st birthdays, above and beyond expectancies for typical drinking. Participants were college students (N=585; 54% women) who were turning 21 within a week, and intended to drink 4/5 (female/male) drinks on their birthday. All negative expectancies (impairment, risk and aggression, negative self-perception) and positive expectancies (social, liquid courage, sex) except tension reduction were significantly greater for 21st birthday drinking than for typical drinking. While 21st birthday expectancies were not uniquely related to actual birthday drinking, several positive and negative 21st birthday expectancy subscales were associated with 21st birthday drinking-related consequences, even when controlling for typical drinking expectancies. Expectancy challenge interventions aimed specifically at these subscales may be effective at attenuating alcohol-related consequences that result from 21st birthday drinking. [ABSTRACT FROM AUTHOR]

Objective: There has been ample research on college student risks and consequences related to 21st Birthday Drinking. To date, no studies we are aware of have examined how 21st birthday drinking impacts subsequent drinking and related consequences. This study evaluates the effect of a single night of drinking on peak drinking, heavy drinking, and negative consequences over 12months following the event. Furthermore, we examine if typical drinking behavior prior to 21st birthday moderates the relationship between the event drinking and subsequent use.Method: Participants included 599 college students (46% male) who intended to consume at least five/four drinks (men/women respectively) on their 21st birthday. Screening and baseline assessments were completed approximately four weeks before turning 21. A follow-up assessment was completed approximately one week after students' birthdays and every 3months for one year thereafter.Results: Those who drank more on their 21st birthday, also reported higher peak consumption, increased likelihood of consequences, and increased number of consequences throughout the year. Additionally, baseline peak drinking moderated the relationship such that those who drank less at peak occasion prior to turning 21 showed the strongest effects of 21st BD drinking on subsequent consumption.Conclusions: 21st BD drinking could impact subsequent choices and problems related to alcohol. Interventions are warranted and implications discussed. [ABSTRACT FROM AUTHOR]

Background: Measuring marijuana use quantity in survey research is complicated due to wide variation in the types (e.g., flower, edibles) and potency of marijuana products and in the modes (e.g., smoking, dabbing) used to consume products. There is currently no gold standard marijuana use quantity measure for survey research. This study examined whether number of hours high can be used as a proxy for marijuana use quantity in survey research, particularly in intensive longitudinal designs.Methods: Participants came from a community sample of young adults participating in a longitudinal study on simultaneous alcohol and marijuana use that used a longitudinal measurement-burst design in which participants completed surveys on up to 14 consecutive days in up to five bursts across nearly two calendar years. Those who reported using marijuana on at least one sampled day were included in present analyses (N = 379; Mage = 21.6; 50.7 % female). Hypotheses were tested using Poisson multilevel models and a logistic regression.Results: Within persons, mode-specific marijuana use quantity variables predicted same-day number of hours high indicating evidence of initial criterion validity. In turn, hours high predicted same-day negative marijuana-related consequences indicating evidence of proximal predictive validity. Between persons, participants' average number of hours high was positively associated with their odds of possible cannabis use disorder following the last burst demonstrating distal predictive validity.Conclusions: Number of hours high may be a parsimonious proxy for measuring marijuana use quantity (regardless of mode of use) in survey research, particularly in intensive longitudinal designs. [ABSTRACT FROM AUTHOR]

Study Objectives: To examine the effects of sleep duration on next-day alcohol and cannabis craving and use among young adults.Method: A community sample of young adults who reported recent simultaneous alcohol and cannabis use at screening (N = 409; Mage = 21.61; 50.9% female) completed twice daily surveys (morning and afternoon) for five 14-day sampling bursts (i.e., 70 days total). Daily measurements included sleep duration, alcohol and cannabis craving, and alcohol and cannabis use (i.e., number of drinks, hours high). Multilevel models enabled examining associations between sleep duration and substance use/craving at three distinct levels: daily-level, burst-level, and person-level.Results: At the day-level, sleep duration was inversely associated with craving for both alcohol and cannabis: Stronger craving was reported on mornings and afternoons after relatively shorter sleep duration. At the burst-level, sleep duration was inversely associated with morning and afternoon alcohol craving indicating stronger alcohol craving, but not cannabis craving, during two-week periods when young adults have accumulated shorter sleep duration. Pertaining to alcohol and cannabis use, no daily-level effects were found, but the burst-level effect showed that participants engaged in greater alcohol use during two-week bursts with shorter sleep duration.Conclusions: Based on a non-clinical sample of young adults reporting substance use, results suggest shorter sleep duration may be a modifiable risk factor as it pertains to substance use and cravings. Results highlight day-level effects of shorter sleep duration on substance use cravings and adverse effects of cumulative sleep deficit on alcohol use. [ABSTRACT FROM AUTHOR]

Objective: Although the concepts of harmonious and obsessive passion have been productive in explaining why people eagerly engage in such activities as sports, Internet use, and gambling, previous research has not yet extended these models to explain alcohol and marijuana use among college students. The current research was conducted to clarify the relationships among harmonious and obsessive passion, alcohol and marijuana use, and negative consequences.Method: Two studies were conducted using online assessments. In Study 1, 748 heavy drinking college students (58% female) were recruited and completed measures of passion for drinking alcohol, alcohol use, and alcohol-related negative consequences. In Study 2, 352 regular marijuana-using students (54% female) were recruited and completed assessments of marijuana passion, marijuana use, and marijuana-related consequences.Results: Study 1 found that among heavy drinking college students, harmonious passion was a stronger predictor of increased consumption than was obsessive passion, whereas obsessive passion was a stronger predictor of alcohol-related problems than was harmonious passion. Study 2 revealed similar findings with regard to harmonious passion predicting marijuana consumption; however, unlike Study 1, no significant difference between the passions was found in predicting marijuana-related problems.Conclusions: This research provides a novel perspective on motivation for alcohol and marijuana use. Findings suggest that understanding the locus of young adults' passion for substance use may be helpful in identifying those who are likely to develop a substance use disorder and therefore may be the most in need of assistance and intervention. [ABSTRACT FROM AUTHOR]

Background: Simultaneous alcohol and marijuana use (SAM) may be linked to both short- and longer-term problems for young adults. Across two years of longitudinal data, we examined between- and monthly within-person associations of alcohol and marijuana use patterns, including SAM, with negative alcohol-related consequences, depressive symptoms, and general health.Methods: 773 young adults (aged 18-23 at screening; 56% women) who used alcohol in the year prior to study enrollment were surveyed monthly for 24 months. Multilevel models assessed associations of alcohol and marijuana use patterns with outcomes.Results: Individuals who reported a higher proportion of SAM months had more negative alcohol-related consequences (Rate Ratio [RR] = 1.49, 95% CI: 1.17,1.89). At the within-person level, participants experienced more alcohol-related consequences on months when SAM was reported compared to months of alcohol-only (RR = 1.17, 95% CI: 1.10,1.25) and months of concurrent alcohol and marijuana use without simultaneous use (CAM; RR = 1.20, 95% CI: 1.11,1.29). Compared to alcohol-only, SAM was associated with more depressive symptoms and poorer general health at the between-person level and with more depressive symptoms at the monthly within-person level; however, SAM did not differ substantially from using neither alcohol nor marijuana or CAM for these outcomes at either the between- or within-person level.Conclusions: SAM use may indicate risk for negative alcohol-related consequences, both within months of SAM use and across more extended time periods. Individuals who engage in SAM may experience worse mental and physical health than individuals who use alcohol exclusively. [ABSTRACT FROM AUTHOR]

Background: Young adults who engage in simultaneous alcohol and marijuana (SAM) use may be more likely to engage in unsafe behaviors including riding with impaired drivers and driving after alcohol and/or marijuana use.Methods: Young adult SAM users (N = 408) self-reported their behavior for five 14-day bursts, yielding daily-level responses on a total of 14,675 substance use days. Adjusted odds ratios (AOR) estimated the likelihood of riding with an impaired driver and of driving after use on SAM use days compared to alcohol- or marijuana-only use days.Results: More frequent SAM users were more likely to ride with an impaired driver and to drive after use than less frequent SAM users (between-persons). On SAM use days, there were greater odds of riding with an impaired driver, compared to alcohol-only days (AOR = 1.28) and marijuana-only days (AOR = 2.22), and of driving after use, compared to marijuana-only days (AOR = 1.25). Driving after use was more likely on days with non-simultaneous alcohol and marijuana use compared to SAM use (AOR = 1.59).Conclusions: Riding with an impaired driver is common among young adult substance users, and more likely following simultaneous use of alcohol and marijuana compared to other types of alcohol and marijuana use. Driving after use is more likely after SAM use than marijuana-only use days, but most likely on days when both alcohol and marijuana were used but not simultaneously. Future research on situation-level predictors of riding and driving-related risks among young adults is warranted. [ABSTRACT FROM AUTHOR]

Young adult frequent cannabis use has increased in prevalence and some frequent users have problems reducing their use. A strong link between momentary craving and subsequent use behaviors among individuals with problematic cannabis use has been reported in the literature, including young adults. In treatment contexts, interventions based on associative learning and reinforcement aim to reduce the prevalence of problematic substance use by altering the association between craving and use by increasing craving management skills such as mindfulness and reducing unhelpful responding such as avoidance or suppression. However, this model has not been tested among young adult cannabis users. The current study examined the influence of trait and state craving management strategies (mindfulness, coping style, experiential avoidance, and craving beliefs) on the link between momentary craving and use, using ecological momentary assessment in a sample of young adults with problematic use interested in reducing their use. Results demonstrated that two craving management constructs were associated with use: non-reactivity (p = 0.02) and non-judgment (p < 0.01). Interactions with momentary craving were observed for two constructs: non-judgmentalness (p = 0.02) and craving beliefs (p < 0.01). Findings suggest that treatments that increase non-reactivity and non-judgmentalness may reduce the occurrence of cannabis use for young adults contemplating reduction during an important period of biopsychosocial development by mitigating the impact of craving or directly reducing use. Additionally, negative beliefs about craving may serve a protective function during acute periods of elevation in momentary craving, an unexpected finding deserving further investigation. [ABSTRACT FROM AUTHOR]

Introduction: The current study examines the norms-behavior link by investigating a novel cognition for protective behavioral strategies (PBS)-descriptive and injunctive norms for close friends' reasons to use PBS (e.g., limit drinking, reduce consequences)-in relation to one's own perception of usefulness and personal use of PBS. Further, we tested whether the association between perceived norms for reasons to use PBS and personal PBS use was mediated by perceived usefulness of PBS.Methods: College student drinkers ages 18-24 [N = 301; 53% female, 69% White, mean age = 20.16 years (SD = 1.54)] were recruited for a larger study. Eligible students reported alcohol use 2+ days a week and 1+ occasions of heavy episodic drinking in the last two weeks. Linear regression tested whether descriptive and injunctive norms for reasons to use PBS were associated with perceived usefulness and personal use of PBS; path analysis was used to test mediation. All analyses were conducted by PBS subscale (limiting/stopping, serious harm reduction, manner of drinking).Results: Descriptive norms for reasons to use PBS (i.e., perceptions that close friends use PBS to reduce drinking/consequences) were positively associated with perceived usefulness and personal PBS use for limiting/stopping and to some extent manner of drinking. For each subscale, the association between descriptive norms for reasons to use PBS and personal PBS use was mediated by perceived usefulness of PBS. Results were not significant for injunctive norms.Conclusions: Findings suggest descriptive norms, rather than injunctive norms, for close friends' reasons to use PBS, may be relevant for inclusion in brief interventions. [ABSTRACT FROM AUTHOR]

In the United States, turning 21 often involves heavy drinking and high rates of alcohol-related consequences. Friends are an important source of social influence on young adult drinking, including during 21st birthdays. However, research is needed to investigate the specific pathways through which this interpersonal influence occurs. Data were drawn from a larger intervention study focused on reducing 21st birthday drinking. Using data from 166 celebrant and friend dyads (N = 332 individuals), we prospectively examined relations among each person's beliefs about 21st birthday celebrations, drinking intentions for the celebrant, and celebrants' estimated blood alcohol concentration (eBAC) on their 21st birthdays. Path analyses evaluated the impact of celebrant and friend beliefs on their own report of celebrant intentions, each other's report of celebrant intentions, and celebrant eBAC, as well as the mediating role of each individual's report of celebrant intentions. Results revealed significant indirect effects of each individual's beliefs on celebrant eBAC via their own report of celebrant 21st birthday drinking intentions. Friend beliefs also predicted celebrant eBAC via celebrant drinking intentions, beyond the effect of celebrant beliefs. Importantly, celebrant eBAC was as strongly predicted by friend 21st birthday celebration beliefs as they were by their own beliefs. Results highlight multiple pathways through which friends influence 21st birthday drinking and reveal that friend influence is not constrained to the celebration, but begins in advance of the event by shaping celebrants' drinking intentions. Findings highlight key directions for future work leveraging friends as intervention agents to reduce drinking related to this high-risk event. [ABSTRACT FROM AUTHOR]