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OBJECTIVE As cannabis products are becoming increasingly available and young adults are increasingly using vaporizers to consume cannabis, there is a need to understand how this population is using different modes of administration and the extent to which specific modes are associated with differential cannabis use outcomes. Toward this end, the current study characterized predictors of cannabis mode of administration and examined how consumption levels and subjective intoxication vary as a function of mode of administration in daily life. METHOD Participants were 106 young adult cannabis and heavy alcohol users (51% female) who completed up to 14 daily diaries (n = 1,405 person days). Each day, participants reported whether they used any cannabis and, if any, which mode(s) were used, number of hits used per mode, overall subjective intoxication, and the socio-environmental context in which they used cannabis. RESULTS Across all cannabis use days, Bong-Only and Vape-Only days were the most common, followed by Multimode, Joint-, Pipe-, and Blunt-Only days. Participants reporting a greater proportion of cannabis use days were more likely to report Bong-Only and Multimode days than Vape-Only days. Compared to Vape-Only days, participants reported fewer hits on Bong-Only days and more hits on Blunt-Only, Pipe-Only, and Multimode days. Participants felt more intoxicated on Bong-Only days than Vape-Only days. CONCLUSIONS Mode-specific associations with cannabis consumption and subjective intoxication levels suggest assessing modes of administration may be a meaningful way to guide individual and public health intervention efforts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Among young adults, subjective feelings of alcohol's effects often guide risky decision making. The majority of studies measuring subjective effects have used singular indices ("How drunk do you feel?") which limits our understanding of young adults' full range of subjective states and their individual differences in subjective effects language. Toward a more in-depth understanding of the heterogeneity among alcohol users based on their subjective experiences of alcohol's effects, we identified latent classes of individuals based on their self-generated language describing feelings after drinking and compared these classes across demographic and drinking characteristics. Participants (N = 323, 54% women, 68% White, Ages 18-25 years) were recruited using Amazon's Mechanical Turk (MTurk). Participants listed words they would use to describe how they feel after drinking low, moderate, and heavy amounts of alcohol. Four latent classes of young adults emerged: "happy drinkers" (31%) primarily reported feeling "happy" when drinking; "relaxed drinkers" (24%) reported feeling happy, relaxed, and buzzed; "buzzed drinkers" (18%) reported feeling buzzed and dizzy; and "multiexperience drinkers" (27%) reported feeling buzzed, tipsy, drunk, and wasted. Relaxed drinkers indicated heavier alcohol use and buzzed drinkers reported lower drinking frequency. Classes did not differ by demographic characteristics. Young adult alcohol users can be distinguished based on the language they use to describe their feelings of intoxication. To continue to advance our understanding of subjective effects, it is necessary to take into account the full range of language used and how this language differs by young adult drinking behavior. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

The present study examined associations between exercise and alcohol use at the between- and within-person levels, including temporal sequencing and the impact of gender. Participants were 221 college students that completed an online survey and 14 daily surveys assessing their daily exercise and alcohol use. Individuals who reported higher exercise scores also consumed more alcohol, on average. On days when individuals reported consuming fewer drinks than usual, they also reported greater exercise scores. Individuals reported lower exercise scores following a day with heavier alcohol use than usual or a day with heavy episodic drinking. Exercise was unassociated with next-day alcohol use. There were mixed findings on the impact of gender. Exercise may have a more proximal influence on drinking. Exercise interventions for alcohol use could target days with higher probabilities of drinking to reduce levels of alcohol use among college students.

Recent reports indicate that simultaneous alcohol and marijuana (SAM) use is a growing health concern among college students. As SAM use consists of both alcohol and marijuana, risk factors associated with either can serve as plausible targets by prevention efforts to reduce SAM use. To explore this, the current study investigated the direct and indirect effects of two established risk factors for drinking on SAM use: perceived parental permissiveness toward drinking and friends’ approval toward drinking (injunctive norms). Incoming first-year students (N=470) reported parental permissiveness, injunctive norms, alcohol use, and SAM use at baseline (T1) and 5 months later (T2). SAM use was assessed again 15 months post-baseline (T3). Path analysis was conducted to examine whether T2 variables mediated relationships between T1 variables and T3 SAM use. Results revealed that T2 student alcohol use mediated the effects of T1 parental permissiveness, injunctive norms, and alcohol use on T3 SAM use. Findings from this study extend research on SAM use by identifying perceived parental permissiveness and injunctive drinking norms as risk factors for SAM use through their effects on alcohol use. Based on these findings, it is plausible that parent-based interventions and interventions targeting peer injunctive norms during the first year of college could be used to effectively prevent or reduce SAM use.

Simultaneous use of alcohol and cannabis or marijuana ("SAM") use is prevalent among young adults and associated with adverse outcomes. Impulsivity is a key construct associated with alcohol and other substance use in this age group, but scant work has considered the role of individual facets of impulsivity on SAM use. The present study compared latent profiles defined by facets of impulsivity (negative urgency, lack of perseverance, lack of premeditation, sensation seeking, and positive urgency) and examined whether profiles were associated with recent SAM use relative to alcohol without cannabis use. Participants were 542 young adults (53% female) recruited through Qualtrics Panels who reported past-year alcohol use and blackout drinking behavior. Participants completed online questionnaires regarding their past-year substance use behavior and typical impulsivity. Regression analysis examining the five impulsivity facets revealed that only sensation seeking predicted the likelihood of recent SAM use relative to alcohol without cannabis use. Using latent profile analysis, four profiles were identified: "low impulsivity," "high sensation seeking/urgency impulsivity," "moderate impulsivity," and "high lack of premeditation/perseverance impulsivity." Individuals in the high sensation seeking/urgency group were more likely to engage in SAM use. Impulsivity may be an important individual difference factor associated with SAM use. Young adults who engage in SAM use may be particularly vulnerable for impulsivity related to sensation seeking and urgency, which may further heighten their risk for hazardous use and related outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BACKGROUND: Individuals who engage in alcohol and cannabis co-occurring use are at heightened risk for negative outcomes than individuals who only use alcohol or only use cannabis, but far less is known about implications of alcohol and cannabis co-occurring use for prescription drug misuse (PDM). OBJECTIVES: This study aimed to (1) identify whether co-occurring use was linked with greater risk for PDM across ages 18-60 and to determine ages at which this association was strongest, (2) determine whether associations remain after controlling for pain severity, and (3) test for gender differences. METHODS: Cross-sectional data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) study. The analytic sample included 20,120 (50.6%(wt) men) individuals aged 18-60 reporting past-year alcohol and/or cannabis use. RESULTS: Time-varying effect models indicated that individuals reporting co-occurring use were at increased risk for PDM than individuals reporting single-substance use across all ages, with odds ratios peaking at >3 at age 34. After controlling for pain severity, associations were only slightly weakened. Associations were slightly stronger for men than women from ages 28 to 35. CONCLUSION: Co-occurring use was linked with heightened risk for PDM compared to individuals who used only one substance; co-occurring use may be important to target for PDM prevention. Identifying factors underlying study associations, beyond pain, and how these factors evolve with age are important avenues for prevention work.

Time perspective is conceptualized as a multidimensional construct that assesses individuals’ feelings and thoughts about the past, present, and future. The current study examined relationships between feelings (time attitudes) and thoughts (time orientation) about time and substance use behaviors across three adolescent samples. Participants included a high-risk sample of adjudicated youth (N=124; M(age)=15.54, SD=1.69; 51.61% female) and two general population school samples (N=777; M(age)=15.82, SD=1.23; 53.41% female; N=1873; M(age)=15.87, SD=1.28; 52.22% female). Cross-sectional survey data were collected from samples in schools during 2010, 2016, and 2011, respectively. Poisson and negative binomial regression analyses indicated that overall, more positive feelings about time were associated with fewer substances used and, conversely, more negative feelings about time were associated with more substances used. These findings were particularly salient for participants with stronger positive and negative feelings toward the past and present time periods. Further, across the three samples, adolescents with a balanced time orientation (i.e., equal emphasis on all three time periods) generally reported less substance use than individuals who emphasized only one or two time periods. Findings highlight relationships between time perspective dimensions and substance use across diverse samples and illustrate opportunities for adapting time perspective-based substance use interventions for adolescents.

Background: Substance use disorders (SUDs) and mental health disorders may change and co-occur in complex patterns across adult ages, but these processes can be difficult to capture with traditional statistical approaches. Objective: To elucidate disorder prevalence and comorbidities across adult ages by using time-varying effect models (TVEMs), latent class analysis (LCA), and modeling latent class prevalences as complex functions of age. Methods: Data were drawn from participants who are 18–65 years old in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women) and a subsample who reported a past-year post-traumatic stress disorder (PTSD), mood, anxiety, or SUD based on DSM-5 diagnoses (n = 11,279). TVEM and LCA were used to examine age trends and comorbidity patterns across ages. Results: SUD prevalence peaked at age 23 (31%) and decreased thereafter, while mental health disorder prevalence was stable (20%–26% across all ages). The prevalence of five classes of individuals based on specific combinations of mental health and SUDs varied by age: the Alcohol Use Disorder class had the highest prevalence at age 26, whereas the Mood and Anxiety Disorder classes peaked around age 63. Interestingly, the Poly-Disorder class prevalence was greatest at age 18 but decreased sharply across young adulthood; however, the prevalence of the other high comorbidity class, PTSD with Mood or Anxiety Disorder, remained fairly constant across age, peaking at age 44. Conclusions: Multimorbid mental health disorders (excluding SUDs) persist in prevalence across adult ages. LCA, TVEM, and their integration together hold substantial potential to advance addiction research.

BACKGROUND: Simultaneous alcohol and marijuana (SAM) use, or using alcohol and marijuana in such a way that their effects overlap, is associated with negative health and behavioral outcomes. OBJECTIVES: Our study sought to fill gaps in our knowledge on this emerging public health concern by comparing SAM users and alcohol-only users on individual-level factors and substance use outcomes as well as examining associations of SAM use frequency, within users. METHODS: Participants were recruited through online postings. Our analytic sample consisted of 1,017 young adults (18–25 years) who reported past-month alcohol use. Most were male (67.8%), Caucasian (71.5%), and had attended at least some college (74.8%). RESULTS: Past-year SAM users reported higher levels of sensation seeking and greater perceptions of their close friends’ drinking behavior in comparison to alcohol-only users. SAM users reported heavier and more frequent alcohol use than alcohol-only users. Within past-year SAM users, 70% reported SAM use at least weekly. More frequent SAM use was associated with all alcohol use outcomes (e.g., weekly quantity, frequency, alcohol-related problems) and marijuana use outcomes (e.g., quantity, frequency, peak use) and higher drinking norms. CONCLUSIONS/IMPORTANCE: It is clear that SAM users are a vulnerable sub-population of young adult drinkers. SAM users are differentiated from alcohol-only users in terms of their personality characteristics and perceptions of peer groups’ drinking. SAM users and more frequent users are also at heightened risk for substance use outcomes. Prevention and intervention efforts targeting high-risk drinking may benefit from also assessing whether they simultaneously use alcohol and marijuana.

Background Alcohol and marijuana co-users are at heightened vulnerability for experiencing a variety of negative alcohol use outcomes including heavier alcohol use and driving under the influence. The current study explored willingness to experience negative consequences as a potential factor underlying the association between co-user status and negative consequences in an effort to guide future intervention work. From a longitudinal study of first-year college students, we examined willingness to experience consequences at Time 2 as a mediator of co-user status at Time 1 and experience of negative consequences at Time 3. Methods First-year college student drinkers (n = 1,914) at a large university completed surveys in the fall and spring of their freshman year and the fall of their sophomore year. Results Alcohol and marijuana co-users reported higher willingness to experience consequences than alcohol-only users. Willingness to experience consequences partially explained the association between alcohol and marijuana couse and consequences. Conclusions The current study was the first to compare co-users of alcohol and marijuana to alcohol-only users on willingness to experience consequences, and examine the role of willingness as a mediator between co-user status and consequences experienced. Co-users were more willing to experience adverse effects from drinking, in turn predicting more consequences. Intervention work targeting consequences may be less effective for co-users; thus, additional work is needed to identify other potential mechanisms for change for this at-risk group.

This event-level study examined within-person differences in consequences for college students who engaged in alcohol-only, marijuana-only, or simultaneous alcohol and marijuana (SAM) use across 18 weekend days. Participants (n = 451) were asked to report consequences they experienced on each occasion across five different types of events: (a) heavier alcohol combined with marijuana; (b) lighter alcohol combined with marijuana; (c) heavier alcohol only; (d) lighter alcohol only; and (e) marijuana only. Occasions involving heavy drinking, alone and in combination with marijuana, were associated with higher rates of consequences relative to lighter alcohol-only occasions, lighter alcohol combined with marijuana occasions, and marijuana-only occasions. Light alcohol-only occasions did not significantly differ on consequences from lighter alcohol combined with marijuana occasions or marijuana-only occasions. Past research has shown SAM use is associated with more consequences compared with alcohol-only use. The current findings suggest that SAM use is not necessarily riskier than drinking or using marijuana alone. Results suggested that on heavy drinking occasions, the number of consequences did not significantly change by also using marijuana. Findings suggest the benefit of targeted intervention strategies to reduce harms associated with heavy drinking occasions with and without SAM use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Pre-gaming, or drinking before going out, is common among young adults and associated with heavier drinking and negative consequences. However, findings have been mixed as to whether a unique, day-level association between pre-gaming and negative consequences exists independent of alcohol intake. It is also unknown whether young adults experience more positive consequences of alcohol use on days they engage in pre-gaming. This study tested day-level associations between pre-gaming and positive and negative consequences, controlling for same-day alcohol intake, as well as whether these associations were moderated by person- and day-level variables. Methods Participants were 148 young adult heavy drinkers (Mage = 20.30, SDage = 1.45, 57.4% female) who reported past-month simultaneous alcohol and marijuana use. For up to 14 consecutive days, participants completed electronic surveys asking about their drinking behaviors and consequences the previous day. Results Prior to adjusting for alcohol intake, Poisson multilevel models showed that participants reported more negative and positive consequences on days they pre-gamed and those who reported pre-gaming more often throughout the study also experienced more negative and positive consequences overall. After controlling for alcohol intake, a positive, day-level association between pre-gaming and positive consequences remained. There was no evidence of moderation of study associations by person- or day-level variables. Conclusion The unique association between pre-gaming and positive consequences may help explain why pre-gaming is linked with heavy drinking and other risky behaviors as positive consequences have been shown to reinforce such behaviors. Findings suggest pre-gaming may be a useful intervention point for alcohol reduction programs.

Objective Combined use of alcohol and cannabis has increased in recent years among certain age groups, and it is well established that individuals who use both alcohol and cannabis (especially if they use both at the same time) are at increased risk for substance-related harms relative to individuals who use only one substance. Far less attention has been placed on the patterns, predictors, and psychological processes associated with alcohol and cannabis co-use, which may inform prevention and intervention programming. Accordingly, this special issue was assembled to advance our understanding of the characteristics and consequences of combined use of alcohol and cannabis. Method In this introductory article, the Guest Editors present the background for this work and provide an overview of the 14 articles that comprise this special issue. Results Studies contained in this special issue capitalize on a variety of methodologies, with a particular focus on investigating typologies of alcohol and cannabis co-use, clarifying motivational and social contexts of co-use, and tracking co-use in daily life via daily diary and ecological momentary assessment designs. Experimental and neuroimaging examinations of co-use are also included. Collectively, the studies generally provide evidence that combined use of alcohol and cannabis is associated with unique characteristics, predictors, consequences, and psychological processes relative to single-substance use. Conclusions The studies in this special issue provide new insight into combined use of alcohol and cannabis. They also highlight a number of promising avenues for future inquiry as the literature on alcohol and cannabis co-use continues to grow. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background and aims The simultaneous use of alcohol and cannabis (“simultaneous alcohol and marijuana [SAM] use”) is common among young adults and associated with negative substance-related consequences. SAM use may be tied to fluctuating mood states such as negative affect and individual characteristics including trait level of anxiety and sex. However, little is understood about their collective role. In this study, we sought to understand the daily link between SAM use and negative affect and whether this link might differ by both trait anxiety and sex. Method Participants were 154 young adults (57.8% female, 72.7% White, M age = 20.2) who completed baseline surveys on trait anxiety symptoms and up to 14 consecutive daily surveys on their substance use and affective states. Results Multilevel models tested for associations of type of substance use day (i.e., alcohol-only days, cannabis-only days, and no use days relative to SAM use days) with next-day negative affect. Three-way and lower order interactions were tested for substance use day type, anxiety, and sex. Two three-way interactions between cannabis-only days, anxiety, and sex and between alcohol-only days, anxiety, and sex emerged such that SAM use was associated with greater next-day negative affect relative to single substance use days particularly among female participants with elevated anxiety. Conclusions Anxiety and sex are salient factors in the link between SAM use relative to single-substance use and daily negative affect. Study findings reinforce the need to account for all of these factors in order to develop maximally efficacious substance use interventions.

Young adults' subjective feelings of alcohol's effects are a key predictor of engagement in risky behavior such as deciding whether to drive after drinking. To best inform prevention messaging and tailor intervention techniques that target high-risk drinking, it is critical that our measurement best captures subjective feelings. Standard sliding scales (0-100 rating of, "how drunk do you feel?") may have some challenges with distinguishing between levels of subjective responses to alcohol. The current daily diary study compared the utility of the standard sliding scale to a newly developed sliding scale that uses contemporary, crowd-sourced language from young adults as evenly spaced anchors (slightly buzzed, tipsy/"happy," drunk, and wasted) along a continuum of subjective effects of alcohol. Participants were 154 young adult substance users (58% women) who completed up to 14 consecutive daily reports of their substance use behavior. The four-anchored sliding scale performed similarly well as the standard scale in predicting alcohol use outcomes while showing the advantages of recording higher mean values/standard deviations and demonstrating that participants used the anchors to denote varying degrees of subjective effects. Findings suggest that the four-anchored subjective alcohol effects sliding scale is a viable alternative to the standard scale. By providing evenly spaced anchors that reflect incremental differences in language young adults use to describe their subjective states, the proposed scale may provide a guide for participants to indicate how they feel after drinking and may better capture variability in alcohol's effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In this chapter, we introduce the use of time-varying effect modeling (TVEM) to examine historical change in the prevalence of health behaviors, investigate how these historical trends vary across population subgroups, and estimate the time-varying associations between risk factors and health behaviors. The empirical example focuses on the historical trends in the prevalence of cigarette smoking and the perceived risk of smoking among high school seniors from 1990 to 2017, the time-varying association between cigarette use and the perceived risk of smoking, and the time-varying moderation effect of sex. We use the publicly available repeated (annual) cross-sectional data from the Monitoring the Future study. The national sample analyzed here consists of n = 68,422 high school seniors who were assessed during this 28-year period. This chapter presents a roadmap for using TVEM to address research questions about historical shifts in (1) prevalence of outcomes and of corresponding risk factors, (2) associations between risk factors and outcomes, and (3) moderation effects that unfold over historical time.

We begin with a conceptual overview of time-varying effect modeling (TVEM), focusing on definitions of “time” and how this modeling framework extends the commonly used linear regression framework. In this first chapter, we describe the concept and promise of TVEM and convey the utility of TVEM findings for researchers (e.g., epidemiologists, prevention scientists), administrators (e.g., policy-makers, public school administrators), and practitioners (e.g., clinicians). This discussion presents a wide range of research questions TVEM could be used to address. To help more concretely illustrate the conceptual approach of TVEM, we walk the reader through a recently published empirical example assessing the risk for suicidal behavior across ages 18–60 for sexual minority versus heterosexual adults. We conclude with a brief roadmap of the subsequent chapters of the book.

In this chapter, we guide the reader through model specification and interpretation in time-varying effect modeling (TVEM) with a continuous dependent variable. We begin by discussing selecting data that meet the requirements for TVEM and structuring the dataset. Next, we discuss technical details, including two variants of spline regression to estimate the coefficient functions, weighted estimation, nested structures in repeated-measures data, model selection, and significance testing. We then walk readers through a progression of four hypothetical models: an intercept-only TVEM, a model with a single independent variable (i.e., main effect model with a single covariate), an extended model that incorporates a statistical control variable, and a model to examine time-varying moderation. For each, we describe the mathematical model, the variables included in the analysis, specification of the model in SAS, and interpretation of the resultant coefficient functions. Finally, we present an empirical example examining depressive symptoms across age using data from a longitudinal panel study to facilitate a concrete understanding of the concepts presented earlier in this chapter. In this section, we walk the reader through the various decisions an analyst must make when using TVEM. A sample results section based on this empirical example, similar to what one might include in an applied paper, is included.

In this chapter, we discuss the use of time-varying effect modeling (TVEM) for examining time-varying associations in intensive longitudinal data (ILD). We will demonstrate the application of TVEM to examine associations across real-time using data from a 21-day daily diary study assessing interparental and parent-child conflict. Particular focus will be given to the meaning of the variable used to indicate time and types of research questions that TVEM is poised to address when applied to ILD. Additionally, we compare and contrast TVEM with multilevel modeling.

In this chapter, we introduce readers to the use of time-varying effect modeling (TVEM) to estimate prevalences and associations that vary as a function of continuous age. Tests of age-varying associations can include either (a) tests of how associations change throughout development as people age in longitudinal studies or (b) tests of how associations differ between people of different ages in a cross-sectional study. We present an empirical example of the latter, estimating age-varying associations in a large, nationally representative cross-sectional sample of adults aged 18–65. The overall goal of this study is to examine generalized anxiety disorder (GAD) across adults aged 18–65, its links to major depressive disorder (MDD), and the moderating role of sex across this age range. Specifically, analyzing data from a subset of 30,999 adults from the National Epidemiologic Survey of Alcohol and Related Conditions-III (NESARC-III), we examine (a) prevalence of past-year GAD and past-year MDD across ages 18–65, (b) associations between MDD and GAD across age, (c) associations between sex and GAD across age, and (d) sex as a moderator of the relationship between MDD and GAD across age.

In this chapter, we discuss extensions of time-varying effect modeling (TVEM) for binary and count outcomes. Specifically, this chapter will present model specification and interpretation of (a) logistic TVEM for binary dependent variables and (b) Poisson TVEM for count dependent variables. Interpretation of logistic models will cover time-varying logistic regression coefficients, odds ratios, and predicted probabilities. We will guide the reader through an empirical example that estimates the age-varying prevalence of past-year hypertension and estimates the age-varying effects of sex, racial/ethnic group, and their interaction on past-year hypertension. Interpretation of Poisson models will cover time-varying regression coefficients, incidence rate ratios, and predicted counts. An empirical example is included that estimates the age-varying mean number of drinks during one’s typical drinking occasion during the past year. The age-varying effects of sex, racial/ethnic group, and their interaction are similarly examined.

In this final chapter, we begin with a discussion of several considerations related to the interpretation of results from time-varying effect modeling (TVEM), including time lags and conceptual differences between TVEM and multilevel modeling for analyzing longitudinal data. We then present several ways that TVEM holds potential to advance the social, behavioral, and health sciences. We first consider alternative conceptualizations of “time” beyond developmental time, historical time, and real-time. For example, time could reflect the age of onset for a particular behavior, such as the age at which one first used cannabis. Further still, time could reflect a continuous dimension that is not time at all, for example, to estimate associations as a nonparametric function of a characteristic such as severity of disease. We conclude with a brief summary of future methodological work to expand the capabilities of TVEM, including software extensions, the accommodation of ordinal or zero-inflated Poisson outcomes, and the integration of TVEM and mixture modeling.

Simultaneous alcohol and marijuana (SAM) use—or use of both substances with overlapping effects—is common among emerging adults and is linked to increased risk for problematic substance use outcomes. The current study identified subgroups of emerging adult SAM users based on their typical alcohol and marijuana use patterns and compared groups on key individual characteristics. Latent profile analysis uncovered four profiles of SAM users ( n = 522): Light Users (LU; 49.0%), Moderate Drinkers With Frequent Marijuana Use (MDFM; 37.9%), Moderate Drinkers With High Peak Levels (MDHP; 5.4%), and Heavy/Frequent Users (HFU; 7.7%). Group differences by demographic characteristics were found, with LU more likely to be college attendees/graduates than MDFM. In addition, HFU were more likely to be Greek-affiliated than both LU and MDFM. Groups also differed based on other drug use behavior and preferred route of marijuana administration. Findings demonstrate diversity among SAM users based on typical substance use patterns.

INTRODUCTION AND AIMS: Simultaneous alcohol and marijuana (SAM) use is reported by roughly 30% of young adult drinkers. Among SAM users, SAM use days have more negative substance-related consequences than single-substance days. Little information is available about contextual factors contributing to the likelihood of SAM use on a particular day. This study compared days on which individuals reported SAM use relative to days on which they reported alcohol but not marijuana use in terms of physical location, engagement in risky activities, and social context of use. DESIGN AND METHOD: Participants were 148 young adults (57% female) reporting past-month SAM use and past two-week binge drinking. Participants completed up to 14 daily surveys assessing substance use behaviour and socio-environmental characteristics of use. RESULTS: For those

AIMS: We tested the age-varying associations of cannabis use (CU) frequency and disorder (CUD) with psychotic, depressive and anxiety symptoms in adolescent and adult samples. Moderating effects of early onset (≤ 15 years) and sex were tested. DESIGN: Time-varying effect models were used to assess the significance of concurrent associations between CU and CUD and symptoms of psychosis, depression and anxiety at each age. SETTING AND PARTICIPANTS: Adolescent data (V-HYS; n = 662) were collected from a randomly recruited sample of adolescents in Victoria, British Columbia, Canada during a 10-year period (2003-13). Adult cross-sectional data (NESARC-III; n = 36 309) were collected from a representative sample from the United States (2012-13). MEASUREMENTS: Mental health symptoms were assessed using self-report measures of diagnostic symptoms. CU was based on frequency of past-year use. Past-year CUD was based on DSM-5 criteria. FINDINGS: For youth in the V-HYS, CU was associated with psychotic symptoms following age 22 [b = 0.13, 95% confidence interval (CI) = 0.002, 0.25], with depressive symptoms from ages 16-19 and following age 25 (b = 0.17, 95% CI = 0.003, 0.34), but not with anxiety symptoms. CUD was associated with psychotic symptoms following age 23 (b = 0.51, 95% CI = 0.01, 1.01), depressive symptoms at ages 19-20 and following age 25 (b = 0.71, 95% CI = 0.001, 1.42) and anxiety symptoms ages 26-27 only. For adults in the NESARC-III, CU was associated with mental health symptoms at most ages [e.g. psychotic symptoms; age 18 (b = 0.22, 95% CI = 0.10, 0.33) to age 65 (b = 0.36, 95% CI = 0.16, 0.56)]. CUD was associated with all mental health symptoms across most ages [e.g. depressive symptoms; age 18 (b = 0.96, 95% CI = 0.19, 1.73) to age 61 (b = 1.11, 95% CI = 0.01, 2.21)]. Interactions with sex show stronger associations for females than males in young adulthood [e.g. V-HYS: CUD × sex interaction on psychotic symptoms significant after age 26 (b = 1.12, 95% CI = 0.02, 2.21)]. Findings were not moderated by early-onset CU. CONCLUSIONS: Significant associations between cannabis use (CU) frequency and disorder (CUD) and psychotic and depressive symptoms in late adolescence and young adulthood extend across adulthood, and include anxiety.

AIMS: Alcohol use disorders (AUDs) are linked with numerous severe detrimental outcomes. Evidence suggests that there is a typology of individuals with an AUD based on the symptoms they report. Scant research has identified how these groups may vary in prevalence by age, which could highlight aspects of problematic drinking behavior that are particularly salient at different ages. Our study aimed to (a) identify latent classes of drinkers with AUD that differ based on symptoms of AUD and (b) examine prevalences of latent classes by age. SHORT SUMMARY: Our findings advocate for personalized treatment approaches for AUD and highlight the need for carefully considering the role of age in prevention and intervention efforts. METHODS: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Current drinkers aged 18–64 who met criteria for a past-year AUD were included (n = 5402). RESULTS: Latent class analysis (LCA) based on 11 AUD criteria revealed 5 classes: ‘Alcohol-Induced Injury’ (25%), ‘Highly Problematic, Low Perceived Life Interference’ (21%), ‘Adverse Effects Only’ (34%), ‘Difficulty Cutting Back’ (13%) and ‘Highly Problematic’ (7%). Using time-varying effect modeling (TVEM), each class was found to vary in prevalence across age. The Adverse Effects Only and Highly Problematic, Low Perceived Life Interference classes were particularly prevalent among younger adults, and the Difficulty Cutting Back and Alcohol-Induced Injury classes were more prevalent as age increased. CONCLUSIONS: Findings suggest that experience of AUD is not only heterogeneous in nature but also that the prevalence of these subgroups vary across age.

Purpose The goal of this study was to examine changes in contemporary patterns of marijuana use and attitudes over time. Given shifts in state-by-state marijuana legislation, there is a reason to believe that the patterns of high school seniors’ marijuana use behavior and attitudes about use have changed from 2010 to 2016. Methods Data are from high school seniors in the 2010–2016 waves of Monitoring the Future, a nationally representative, cross-sectional survey in the United States. Latent class analysis was used to determine underlying patterns of marijuana use and related attitudes. Differences in latent class membership were examined across years, and gender and race/ethnicity were also examined. Results Five latent classes were identified: Intolerant Nonusers (49% of the sample), Tolerant Nonusers (12%), Disapproving Users (7%), Experimenters (6%), and Marijuana Enthusiasts (26%). Class prevalences remained relatively stable from 2010 to 2013; beginning in 2014 a significant decrease in prevalence was observed for Intolerant Nonusers and significant increases in prevalence were observed for Tolerant Nonusers and Marijuana Enthusiasts. Membership in the Marijuana Enthusiasts class was consistently more likely for males; Hispanic and black adolescents were more likely to be Disapproving Users. Conclusions Contemporary patterns of marijuana use and attitudes have remained consistent over time, however, significant shifts in class prevalence emerged in 2014. Findings also suggest that a substantial subgroup of adolescents would benefit from prevention and intervention efforts targeting marijuana use and attitudes.

Aims Alcohol mixed with energy drink (AmED) use is associated with negative consequences including hazardous alcohol use and driving under the influence. While many studies have focused on correlates of AmED use among college samples, very few have examined patterns of AmED use during adolescence and young adulthood within the general population. Accordingly, the purpose of this study is to assess age differences in AmED use among a national sample of respondents aged 18 to 30. Methods The data for this study come from the Monitoring the Future panel study from 2012 to 2015. The sample consists of 2222 respondents between the ages of 18 and 30. Multiple logistic regression using generalized estimating equations (GEE) was used to model past-year AmED prevalence across age and other covariates. Results Nearly half (45.0%) of respondents indicated past-year AmED use at some point during the study period. The lowest prevalence rates were found at age 18 (25.9%) and the highest prevalence rates at age 21/22 (43.5%). GEE analyses indicated a statistically significant positive linear and negative quadratic trend with respect to the association between age of respondent and past-year AmED use. Namely, peak use occurred in early young adulthood (age 21/22 and 23/24) and then declined, reaching 32.0% by age 29/30. College attendance and several substance use behaviors at age 18 moderated these linear and quadratic age trends. Conclusions AmED use peaked rapidly in early young adulthood and declined into later young adulthood. Substance use during adolescence was associated with a higher incidence of AmED use across all young adult ages and a slower decline of AmED use after age 21/22. Several sociodemographic factors were associated with AmED use, particularly college attendance at the age of 21/22.

BACKGROUND: Emerging adults with lower educational attainment are at higher long-term risk for problematic drinking and alcohol use disorders. Efforts to gain a more in-depth understanding of the drinking habits of nonstudent emerging adults are critical to reduce disparities and to shed light on targets of intervention for this vulnerable group. OBJECTIVES: The current investigation aimed to: (1) provide a description of the daily drinking habits of nonstudent emerging adult drinkers using a 14-day diary method, and (2) examine non-drinking days by assessing their reasons for not drinking as well as strategies used to avoid drinking. METHODS: Participants were 27 (55.5% women) emerging adult drinkers recruited from the community. Results: On drinking days, multilevel results indicated that heavier alcohol use was positively associated with level of subjective intoxication and alcohol-related problems. Men reported higher alcohol use outcomes than women across all alcohol use indicators. Regarding non-consumptive days, the most frequently endorsed reasons for not drinking largely reflected an internal motivation, while the least endorsed reasons were related to external constraints. Pertaining to strategies used to avoid drinking, the most frequently endorsed response related to choosing alternative enjoyable activities. Diary compliance with the 14-day protocol was 90.9% for at least one daily survey. CONCLUSION/IMPORTANCE: The present investigation represents one of the first to examine drinking behaviors using a daily diary approach with nonstudent emerging adult drinkers. Study findings filled an important gap regarding our understanding of the context of drinking of an at-risk and understudied group of drinkers.

BACKGROUND: Young adults report the heaviest drinking of any age group, and many are at risk for experiencing an alcohol use disorder. Most research investigating young adult drinking has focused on single indicators of use. Using multiple dimensions of consumption, such as federal guidelines for daily/weekly drinking and engagement in drinking at twice the binge threshold (“high-intensity drinking”) to characterize drinking behavior could illuminate drinking patterns linked with harms. OBJECTIVES: We used a person-centered approach to examine latent classes of drinkers from a national sample of young adults. Further, we compared classes on college status. METHODS: We used 2012–2013 data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-III. We included past-year drinkers aged 18–22 years (n = 2213). Latent classes were estimated based on drinking frequency, daily/weekly drinking, frequency of heavy episodic drinking (4+/5+ drinks for women/men), frequency of high-intensity drinking (8+/10+ drinks), and intoxication frequency. RESULTS: Five latent classes were identified: Occasional, Light Drinkers (30%), Regular Drinkers (6%), Infrequent Drinkers with Occasional Binging (10%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (32%). Although membership in the two riskiest classes were more common among college-attenders, odds of being a High-Intensity Drinker relative to the second riskiest class was not significantly different for college- and non-college-attending young adults. CONCLUSIONS/IMPORTANCE: As high-intensity drinking does not appear to be a drinking pattern unique to college-attenders and non-college-attenders are less likely to mature out of heavy drinking patterns, intervention efforts are needed for this at-risk age group.

Introduction Subjective ratings of cannabis effects are important predictors of use-related consequences. However, psychometric research is fairly limited, particularly for measures to capture variability in daily life when diverse modes of cannabis administration and co-substance use are common. Methods This study evaluated the predictive utility of a revised item to assess perceived cannabis effects and examined modes of cannabis administration and alcohol and nicotine co-use as moderators. Participants were 106 young adults (18-25 years; 51% female) who completed up to 14 consecutive daily reports of substance use (n = 1,405 person-days). Two measures of subjective effects were examined: a standard item (0-100 rating of “how high do you feel?”) and a revised item that uses four crowd-sourced anchor points ranging from relaxed (0), calm/chill (33), high (67), and stoned/baked (100). The items shared substantial variance (Pseudo-R2 = 59.5%), however, the revised item showed greater within-person variability (77.0% vs. 68.8%) and stronger day-level associations with consumption levels (Pseudo-R2 = 25.0% vs. 16.7%). Results The cannabis consumption-subjective effects link was weaker on blunt-only days compared to vape-only days. Subjective cannabis effects were higher on nicotine co-use days after controlling for cannabis consumption; neither alcohol nor nicotine co-use moderated the cannabis consumption-subjective effects link. Discussion The revised subjective cannabis effects item is a viable alternative to the standard item among young adults who engage in simultaneous alcohol and cannabis use. Conclusions Future research focused on characterizing the variability in cannabis effects is needed.

Despite a growing literature on college students' sexual behaviors, little is known about how sexual behaviors, and their associations with alcohol, differ for college and noncollege attenders, and whether these patterns represent changes during college or an extension of pre-college behaviors. This paper applied time-varying effect models to data from the National Longitudinal Study of Adolescent to Adult Health to examine (1) prevalence of four sexual behaviors from ages 14 to 24 and (2) how their association with frequent heavy episodic drinking varied across these ages for college and noncollege attenders. Nonattenders have higher prevalence of all sexual behaviors than college attenders across most ages; however, the association between heavy episodic drinking and sexual behaviors is stronger for college attenders during ages 18-20.

Research indicates that a drinker's environmental and social context can be differentially associated with drinking outcomes. Further, although many researchers have identified that more frequent use of protective behavioral strategies (PBS) is associated with lower alcohol consumption and negative consequences, scant research has examined how one's drinking context may promote or hinder PBS use. The present study examined how the context of drinking each day (i.e., where and with whom) is associated with level of consumption and reported alcohol-related problems among n = 284 college drinkers (69.0% female) directly, as well as indirectly through the use of PBS. Two different dimensions of PBS are examined (i.e., "Limits" or limiting consumption, and "Avoidance" or avoiding alcohol in general or specific alcohol situations), as well as their relationship with daily drinking. Moreover, we explored these relationships intraindividually (within-person across time), as well as interindividually (between people). Daily drinking was assessed using a weekly diary design. Using multilevel structural equation modeling, we found that environmental context (i.e., drinking at a bar or party) is associated with heavier alcohol use directly and indirectly through PBS that involve limiting one's drinking; these effects occurred only at the daily (within-person) level. Additionally, social context (i.e., drinking with friends) predicts elevated drinking but is unrelated to PBS use. Similar findings were present for alcohol-related problems, controlling for consumption level. College student drinking interventions may benefit from a focus on increasing the use of PBS within potentially risky drinking environments to help reduce problematic alcohol use. (PsycINFO Database Record

We examined the prevalence of psychological outcomes (i.e., symptoms of depression and anxiety) by age and age-varying associations between physical activity and psychological outcomes among rural cancer survivors. Participants (N=219; ages 22–93) completed sociodemographic, psychological, and physical activity questionnaires. Time-varying effect models (TVEM) estimated the prevalence of psychological outcomes and assessed associations between physical activity and psychological outcomes as a flexible function of age. Depression and anxiety symptoms decreased with age among cancer survivors aged 22–40 years and were relatively stable across age among those >40 years. Positive associations between vigorous physical activity and psychological outcomes in those aged 22–40 years were identified. In those >70–80 years, there were negative associations between vigorous physical activity and psychological outcomes. Results suggest there is variation across age in the associations between physical activity and psychological outcomes among rural survivors. Future research should further explore these age-varying relationships to identify important intervention targets.

Prevalence of heavy alcohol use remain high, and daily marijuana use is at an all-time high in young adults. As perceptions of drug effects may guide risky decision making, understanding subjective feelings for alcohol and marijuana use is critical. Existing laboratory-based and diary metrics (0-100 rating of "how drunk/high do you feel?") may be problematic in differentiating levels of subjective effects. Measures incorporating contemporary language may better capture subjective feelings in experimental and ambulatory assessment designs. We developed 2 sliding scales based on crowd-sourced and rank-ordered feelings of subjective alcohol and marijuana effects. Two U.S. young adult (18-25 years) samples were drawn from Amazon's Mechanical Turk (MTurk). In the first study, 323 (53.6% women, 68.4% White, M age = 23.0 years) alcohol and marijuana users provided words to describe subjective effects from alcohol use and from marijuana use. In a second study, 289 (46.4% female, 66.4% White, M age = 23.0 years) users rank-ordered the most common terms to correspond with subjective levels. The sliding scale for alcohol effects resulted in 4 anchors ranging from 0 to 100: slightly buzzed, tipsy/"happy," drunk, and wasted. The sliding scale for marijuana effects also had 4 anchors: relaxed, calm/chill, high, and stoned/baked. By incorporating broader and more contemporary subjective effects language, our metrics may better capture variability in young adults' perceived subjective effects from alcohol and marijuana use. Future work could build upon these findings by pairing sliding scales with measures of actual intoxication to understand within- and between-person covariation in subjective effects, actual impairment, and consequences. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Simultaneous alcohol and marijuana (SAM) use is prevalent among young adult drinkers and associated with increased risk for harms. Less understood about SAM use is whether increased risk is incurred on SAM use occasions relative to occasions in which individuals used only 1 substance. From a sample of young adult SAM users, we compared occasions in which individuals simultaneously used alcohol and marijuana so that the effects overlapped ("SAM days"), occasions involving only alcohol ("alcohol days"), and occasions involving only marijuana ("marijuana days") on level of use, level of subjective intoxication, and negative and positive consequences. Eligible participants (N = 154; 57.8% female, 72.7% non-Hispanic/Latinx White) were 18-25 years old, reported past-month SAM use, and reported past 2-week binge drinking. Participants completed up to 14 daily assessments on their substance use behavior. Multilevel models indicated that, relative to alcohol days, SAM days had more negative consequences. SAM and alcohol days were not statistically different on level of use, level of subjective alcohol intoxication, or positive consequences. Relative to marijuana days, SAM days had more negative consequences and more positive consequences. Level of use (number of hits) and level of marijuana intoxication were not statistically different. In addition to SAM users being a more at-risk group, SAM occasions are associated with greater risk within this vulnerable population. Fine-grained ecological momentary assessments are needed to better understand perceptions and behavior throughout a SAM use episode. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Affect regulation models state that affect both motivates and reinforces alcohol use. We aimed to examine whether affect levels and rates of change differed across drinking versus nondrinking days in a manner consistent with affect regulation models. Four hundred four regularly drinking adults, aged 18-70 years, completed ecological momentary assessments over 3 weeks. Participants provided positive affect (PA; enthusiastic, excited, happy) and negative affect (NA; distressed, sad) reports during all prompts; alcohol consumption reports were also provided. Multilevel spline models revealed that on drinking days, PA was higher and NA was lower both before and after drinking compared to matched times on nondrinking days. PA and NA were also higher and lower, respectively, both before and after drinking, when heavy drinking days were compared to moderate drinking days. Examination of affect rates of change revealed that (a) accelerating increases in PA and accelerating decreases in NA preceded drinking initiation, (b) PA increases and NA decreases were seen up to 2 hr after drinking initiation, and (c) pre- and postdrinking PA increases were larger on heavy versus moderate drinking days, whereas only postdrinking NA decreases were larger on heavy drinking days. Results supported affect regulation models while adding nuance, showing accelerating changes in predrinking affect on drinking days and pre- and postdrinking differences in affect levels and rates of change across days of varying drinking intensity. Beyond theory, our results suggest that accelerating changes in affect may provide a clue to future commencement of heavy drinking, which may aid momentary intervention development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BACKGROUND: This study sought to inform research with noncollege-attending emerging adults, an at-risk and understudied population, by identifying patterns of response following a brief alcohol intervention. The present study was a reanalysis of data from a randomized controlled intervention trial testing a brief, personalized feedback alcohol intervention targeting nonstudent emerging adult drinkers. OBJECTIVES: Study aims were to (1) model intervention response by identifying subgroups characterized by changes in heavy drinking (i.e., peak use, number of binges during a typical week, proportion of binge days, peak estimated blood alcohol concentration [eBAC]) following the alcohol intervention, and (2) distinguish subgroups on factors related to intervention response (i.e., perceived norms regarding how much peers drink, alcohol use severity, mental health symptoms, and readiness to change). METHODS: Participants were 81 (64.2% men) nonstudent heavy drinkers between ages 18 to 25 years (average age = 22.04) recruited from the community. RESULTS: Findings revealed two latent subgroups that exhibited differential response to the intervention (i.e., intervention “responders” and “nonresponders”). Further, responders reported higher pre-intervention descriptive normative perceptions and alcohol use severity. CONCLUSIONS/IMPORTANCE: The current investigation contributed to knowledge regarding for whom brief alcohol interventions work in the short term within nonstudent emerging adults and could inform future research to facilitate behavior change in those unresponsive to intervention efforts.

Background The link between use of alcohol mixed with energy drinks (AmEDs) and alcohol-related harms is well established, but limited research has examined the context in which AmEDs are consumed. Identifying the social and environmental characteristics of use may illuminate whether AmEDs are used in settings that could increase the likelihood of engaging in risky behaviors or experiencing harms. The present study used a two-week daily diary assessment to compare days in which AmEDs were consumed (“AmED days”) and days where other types of alcohol were used (“non-AmED days”) on where, when, and with whom drinking occurred Methods Participants were 122 (90 women) heavy drinking college students who reported mixing caffeine with alcohol at least once in the past week. Data were collected across 389 drinking days; 40 of these days involved AmED use Results Multilevel modeling findings revealed that odds of drinking AmEDs were higher on days where individuals drank at a bar or club and drank at home relative to other locations. In addition, odds of pre-gaming were higher on AmED days as compared to non-AmED days. AmED use was linked with lower odds of drinking game behavior Conclusions Overall, AmEDs appear to be consumed in potentially risky contexts. In combination with prior findings that AmED days are linked with heavier alcohol use and more harms experienced, these findings support the unique nature of AmED consumption in terms of the factors that may predict or maintain potentially hazardous drinking patterns. This article is protected by copyright. All rights reserved.

The current study examined event-level characteristics (e.g., contextual factors, risk behaviors) during the most recent episode of Molly use among a sample of college students who reported previously using Molly. Participants ( N = 151; 66.7% female) were drinkers aged 18 to 25 years. Data were collected from October to November 2014, February to April 2015, and September to November 2015. Participants completed measures regarding typical Molly use and items related to context and behaviors during their most recent episode of Molly use. Findings revealed that our sample most commonly reported using Molly earlier in the evening while hanging out with friends or at a party. In addition, sexual and other drug use behaviors commonly occurred when using Molly. Findings provide preliminary information in guiding future work exploring Molly use and potential substance-related issues associated with the context of when and how Molly is consumed.