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1.  Stage Movement Following a 5 A’s Intervention in Tobacco Dependent Individuals with Serious Mental Illness (SMI) 
Addictive behaviors  2010;36(3):261-264.
Smoking among the Seriously Mentally Ill (SMI) creates significant health problems. This study explored stage of change transitions over time among smokers with serious mental illness (SMI) and how dose of a brief intervention and other psychosocial variables were related to stage transitions. Participants were a subsample of 110 patients who participated in a larger controlled trial (Dixon, et al., 2009) examining whether psychiatrists in mental health clinics implementing the “5 A’s” (Ask, Advise, Assess, Assist, Arrange) significantly reduced smoking among persons with SMI. Participants were classified into one of the Transtheoretical Model (TTM) stages of change for smoking cessation as well as classified into groups based upon the pattern of stage status transitions over time (i.e., Regressors, Stable, Inconsistent, Progressors with and without a successful quit). Modest quit rates for this brief intervention were found at one-year (6.4%) and the dose of the intervention was meaningfully related to positive stage transitions. Cessation outcomes from the controlled trial (Dixon, et al., 2009) indicated a small effect on smoking cessation, which is confirmed in this stage transition secondary analysis with a subset of these smokers. However, these results suggest that a brief intervention delivered by psychiatrists in a mental health treatment setting does seem to make an impact on these smokers.
PMCID: PMC5694216  PMID: 21146317
smoking cessation; serious mental illness; 5A’s; behavior change process; stages of change
2.  First Tobacco Product Tried: Associations with Smoking Status and Demographics among College Students 
Addictive behaviors  2015;51:152-157.
As the tobacco market expands, so too have the opportunities for youth to be introduced to nicotine. The goal of this study was to identify product choice for initial tobacco trial, correlates associated with product choice, and the relationship between first product and current cigarette smoking among college students.
A cross-sectional web survey of 3,146 first-year students at 11 universities in North Carolina and Virginia was conducted in fall 2010.
Weighted prevalence of ever use of tobacco was 48.6%. Cigarettes were the most common first product (37.9%), followed by cigars (29.3%), hookahs (24.6%), smokeless tobacco (6.1%), and bidis/kreteks (2.2%). Two thirds (65%) of current smokers initiated with cigarettes, but 16.4% started with cigars, 11.1% with hookahs, 5.7% with smokeless, and 1.7% with bidis/kreteks. Females were more likely to report their first product was cigarettes and hookahs, while males were more likely to start with cigars and smokeless tobacco. Compared to those whose first product trial occurred after the age of 18, younger age of initiation (17 years or younger) was associated with cigarettes and smokeless as first products, while older age of initiation (18 or older) was associated with starting with hookahs and cigars. Dual or poly tobacco use was more common among those who initiated with hookahs and smokeless tobacco.
While over a third of students used cigarettes first, two thirds started with a non-cigarette product. Just about a third of current cigarette smokers initiated with a non-cigarette product, suggesting that those non-cigarette products may have facilitated escalation to cigarettes.
PMCID: PMC5669365  PMID: 26265038
Non-cigarette tobacco products; college students; cigarette smoking
3.  A Latent Profile Analysis of Drinking Patterns among Nonstudent Emerging Adults 
Addictive behaviors  2016;62:14-19.
Research indicates that nonstudent emerging adults, as compared to their college-attending peers, are at higher risk for experiencing alcohol-related problems, including alcohol use disorders. The present study sought to extend the limited research on nonstudent drinking by (1) identifying sub-groups of nonstudent drinkers based on their drinking patterns and (2) determining the extent to which social-cognitive between-person factors related to drinking (i.e., social expectancies, perceived drinking norms, social drinking motivations) distinguish these sub-groups. Participants were 195 (65.1% men) nonstudent emerging adult heavy episodic drinkers recruited from the community. Mean age was 21.88 (SD = 2.08) years and 45.4% were unemployed. Latent profile analysis identified two classes based on drinking across 30 days. The “moderate drinkers” group (n = 143; 73.3%) reported consuming 10–11 drinks weekly and drinking two to three times per week, on average. The “heavy drinkers” class (n = 52; 26.7%) reported consuming 42–43 drinks weekly and drinking six to seven days per week. Both groups exhibited a cyclic pattern of drinking whereby weekday drinking was lower, with increases on the weekend; the heavy drinkers class had stronger weekend increases starting earlier. Heavy drinkers reported greater volume, frequency, and problematic drinking behaviors, as compared to the moderate drinkers. The heavy drinkers class also endorsed stronger social motives and perceived their peers to drink more. The present study offered unique insights into nonstudent emerging adult drinking patterns by identifying sub-populations of drinkers based on their past 30-day use. Knowledge gained from this study could aide in tailoring existing alcohol interventions to nonstudents to reduce alcohol-related harms.
PMCID: PMC4955767  PMID: 27305099
Alcohol; nonstudents; emerging adults; drinking patterns
4.  Correlates of current menthol cigarette and flavored other tobacco product use among U.S. young adults 
Addictive behaviors  2016;62:35-41.
Flavored and menthol tobacco products are particularly appealing to young adults. However, little is known about factors associated with their use in this population.
To examine characteristics associated with using menthol cigarettes, flavored other tobacco products (OTP), and flavored e-cigarettes among young adults.
Using a nationally representative online sample of young adults (n=4,239) from the Truth Initiative Young Adult Cohort Study, mutually exclusive groups were created from the subset of current tobacco users (N=1,037) for users of menthol cigarettes (N=311; 30%), non-menthol cigarettes (N=426; 41%), flavored OTP only users (N=114; 11%), and non-flavored OTP only users (N=186; 18%) to examine factors of being in any one group. Data were collected in July 2012.
In the full multivariable model, significant correlates of current menthol cigarette use were female gender (AOR=2.08), Black race (AOR=5.31), other race (AOR=2.72), Hispanic ethnicity (AOR=2.46) and self-identifying as a smoker, social smoker, or occasional smoker (AOR=10.42). Significant correlates of current flavored OTP use were younger age (18–24; AOR=3.50), self-identifying as a smoker, social smoker, or occasional smoker (AOR=30) and generalized anxiety (AOR=0.30).
This study highlights female gender, Blacks/other race/Hispanics, smokers, social smokers and sexual minorities as correlates of menthol cigarette use and younger age as a predictor of flavored OTP use. Restricting access to flavored tobacco products may be one intervention to help slow the tobacco epidemic, particularly among many of the most vulnerable groups—young women and racial and/or ethnic minorities.
PMCID: PMC4955768  PMID: 27310032
5.  The Dimensionality of DSM5 Alcohol Use Disorder in Puerto Rico 
Addictive behaviors  2016;62:20-24.
The test the dimensionality and measurement properties of lifetime DSM-5 AUD criteria in a sample of adults from the metropolitan area of San Juan, Puerto Rico.
Cross-sectional study with survey data collected in 2013-2014.
General population.
Random household sample of the adult population 18 to 64 years of age in San Juan, Puerto Rico (N=1510; lifetime drinker N=1107).
DSM-5 alcohol use disorder (2 or more criteria present in 12 months).
Lifetime reports of AUD criteria were consistent with a one-dimensional model. Scalar measurement invariance was observed across gender, but measurement parameters for tolerance varied across age, with younger ages showing a lower threshold and steeper loading.
Results provide support for a unidimensional DSM-5 AUD construct in a sample from a Latin American country.
PMCID: PMC4955770  PMID: 27305100
DSM-5; dimensionality; Puerto Rico
6.  The Effects of Eliciting Implicit versus Explicit Social Support among Youths Susceptible for Late-Onset Smoking 
Addictive behaviors  2016;62:60-64.
Adolescents susceptible to late-onset smoking (becoming regular smokers at age 18 or later) are an understudied population. Social support is a promising target for intervention, but it is important to distinguish between implicit social support (reminders that one belongs to a network of valued others) and explicit social support (seeking and receiving advice and emotional solace). This study aimed to test the potential protective influence of implicit and explicit social support on reducing the risk of late-onset smoking.
Fifty-eight smoking-susceptible youths (aged 16–18, 45% African American, 55% non-Hispanic White) completed an experimental session that included a video-recording task designed to elicit thoughts about implicit, explicit, or no social support. Youths reported their behavioral willingness and intentions (BW and BI) to smoke immediately following the social support manipulation; a random sample of 39 youths reported again at a 3-week follow-up.
Following the manipulation, BW and BI for cigarette smoking were significantly higher among youths assigned to the explicit-support condition, compared to those in the implicit-support or control conditions. At follow-up, BW and BI were highest in the explicit-support condition and lowest in the implicit-support condition, but the differences were not significant.
Overall, findings indicated that for teens susceptible for late-onset smoking, eliciting thoughts about implicit social support produces lower risk for cigarette initiation than does eliciting thoughts about explicit social support. The present results and the video task that yielded them are important to researchers and practitioners interested in reducing the likelihood of late-onset smoking.
PMCID: PMC4955778  PMID: 27322670
smoking; social support; stress; youth tobacco use
7.  Longitudinal Psychosocial Factors Related to Symptoms of Internet Addiction among Adults in Early Midlife 
Addictive behaviors  2016;62:65-72.
In this longitudinal study, we applied structural equation modeling (SEM) to examine the psychosocial factors from adolescence to adulthood as related to symptoms of Internet addiction (IA) during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N=548) followed from adolescence to early midlife (mean age=43; SD=2.8). The findings supported a meditational model: adolescent (mean age = 16) conflictual parent-child relationship was associated with internalizing problem behaviors at mean age 21 in emerging adulthood (b=.13, p<.01), which, in turn, were associated with both alcohol/drug use problems at mean age 27-32 (b=.24, p<.001) and affective disorders at mean age 37 (b=.29, p<.001), which, ultimately, were associated with symptoms of IA in early midlife (b=.23, p<.01; b=.21, p<.05, respectively). In addition, alcohol/drug use problems were associated with affective disorders (b=.22, p<0.05). Among the constructs, alcohol/drug use problems had the greatest total effects on symptoms of IA in early midlife (b=.28, p<.001). Findings suggest that family therapy focused on an increase in the affectionate relationship between the adolescent and his/her parents, cognitive-behavioral treatment of internalizing problem behaviors, and effective treatment of individuals who have alcohol/drug use problems may reduce the likelihood of having symptoms of IA in early midlife.
PMCID: PMC4955795  PMID: 27341513
symptoms of Internet addiction; midlife; affective disorders; alcohol and substance use problems; internalizing behaviors; conflictual parent-child relationship
8.  Childhood Cigarette and Alcohol Use: Negative Links with Adjustment 
Addictive behaviors  2016;62:122-128.
Children who initiate cigarette or alcohol use early—during childhood or early adolescence—experience a heightened risk of nicotine and alcohol dependence in later life as well as school failure, crime, injury, and mortality. Using prospective intergenerational data from the Millennium Cohort Study (MCS), we investigate the association between early substance use initiation (cigarettes or alcohol) and age 11 school engagement, academic achievement, and wellbeing. The ongoing MCS tracks the development of a nationally representative sample of children in the United Kingdom (born 2000–2002) from infancy through adolescence. At age 11, MCS children (n=13,221) indicated whether they had ever used cigarettes or alcohol; at age 7 and 11 they reported on school engagement and wellbeing and completed investigator-assessed tests of academic achievement. Using propensity score methods, children who had initiated cigarette or alcohol use by age 11 were matched to abstaining children with similar risks (or propensities) of early substance use, based on numerous early life risk and protective factors assessed from infancy to age 7. We then examined whether early initiators differed from non-initiators in age 11 adjustment and achievement. Results show that substance use by age 11 was uncommon (3% cigarettes; 13% alcohol). After matching for propensity for early initiation, school engagement and wellbeing were significantly lower among initiators compared to non-initiators. Academic achievement was not consistently related to early initiation. We conclude that initiation of smoking and drinking in childhood is associated with poorer adjustment.
PMCID: PMC4955834  PMID: 27347653
9.  Comorbid Trajectories of Substance Use as Predictors of Antisocial Personality Disorder, Major Depressive Episode, and Generalized Anxiety Disorder 
Addictive behaviors  2016;62:114-121.
To determine longitudinal associations between patterns of comorbid cigarette, alcohol, and marijuana use and Antisocial Personality Disorder (ASPD), Major Depressive Episode (MDE), and Generalized Anxiety Disorder (GAD) in adulthood.
A random community-based sample [X̄ age=36.6 (SD=2.8)] from the Children and Adults in the Community Study, an on-going investigation of substance use and psychiatric disorders. Data were collected at six time waves. Conjoint trajectories of cigarette, alcohol, and marijuana use spanning adolescence to adulthood were determined; multivariable logistic regression analyses assessed associations between trajectory group membership and having ASPD, MDE, or GAD in adulthood.
Five conjoint trajectory groups were obtained: HHH (chronic cigarette, alcohol, and marijuana use), DDD (delayed/late-starting cigarette, alcohol, and marijuana use), LML (low/no smoking, moderate alcohol use, occasional marijuana use), HMN (chronic smoking, moderate alcohol use, no marijuana use), and NON (occasional alcohol use only). Compared with members of the NON group, those in the HHH group had significantly greater odds for having ASPD (Adjusted Odds Ratio [AOR]=28.52, 95% Confidence Interval [CI]=9.44–86.17), MDE (AOR=2.67, 95% CI=1.14–6.26), and GAD (AOR=6.39, 95% CI=2.62–15.56). Members of the DDD, LML, and HMN groups had weaker and less consistent associations with the three psychiatric outcomes.
In a large, community-based sample, long-term concurrent use of more than one substance was associated with both externalizing and internalizing psychiatric disorders in adulthood. Prevention and treatment programs might target individuals in the community and general clinical populations with comorbid substance use, even if they haven’t been identified as having a substance use disorder.
PMCID: PMC4955839  PMID: 27344118
Longitudinal trajectories of comorbid substance use; Comorbid substance use and psychopathology; Comorbid substance use and Antisocial Personality Disorder; Comorbid substance use and Major Depressive Episode; Comorbid substance use and Generalized Anxiety Disorder
10.  Mixing Alcohol with Artificially Sweetened Beverages: Prevalence and Correlates among College Students 
Addictive behaviors  2016;62:79-82.
Mixing alcohol with diet beverages, as compared to mixing the same amount of alcohol with a regular beverage, is associated with greater intoxication. This may occur because diet mixers increase alcohol absorption rates. Thus, it is plausible that the use of diet mixers may increase the risk of alcohol-related harms. The current study sought to (1) determine the rate/frequency of use in among college students, (2) examine the relationship between mixing alcohol with diet beverages and alcohol-related problems, above typical alcohol use and sensation seeking, and (3) explore key traits (gender, restricting food while drinking, and body mass index [BMI]) that may characterize users. Participants were 686 (73% female) undergraduate students who completed self-reports of alcohol use (including diet mixer use), alcohol-related problems, eating behaviors while drinking, sensation seeking, and demographic information. Results revealed that about 36% of the sample reported consuming alcohol with diet mixers, and users typically consumed this beverage at least once a month. Students who reported mixing alcohol with diet beverages experienced more alcohol-related problems. And, the more frequently one consumed this beverage, the more problems were reported. These associations were found after controlling for typical level of alcohol use and sensation seeking. No differences were observed between user-status on gender, eating behaviors while drinking, and BMI. Our findings suggest that mixing alcohol with diet beverages could be a risk factor for experiencing more alcohol-related harms. Further research is needed to understand this relationship, as it may help guide intervening efforts aimed to reduce alcohol-related risks.
PMCID: PMC4989236  PMID: 27344010
alcohol consumption; artificial sweeteners; diet; alcohol problems
11.  History of Abuse and Risky Sex among Substance Users: The Role of Rejection Sensitivity and the Need to Belong 
Addictive behaviors  2016;62:73-78.
This study investigates abuse and rejection sensitivity as important correlates of risky sexual behavior in the context of substance use. Victims of abuse may experience heightened sensitivity to acute social rejection and consequently engage in risky sexual behavior in an attempt to restore belonging. Data were collected from 258 patients at a substance use treatment facility in Washington, D.C. Participants' history of abuse and risky sexual behavior were assessed via self-report. To test the mediating role of rejection sensitivity, participants completed a social rejection task (Cyberball) and responded to a questionnaire assessing their reaction to the rejection experience. General risk-taking propensity was assessed using a computerized lab measure. Abuse was associated with increased rejection sensitivity (B = .124, SE = .040, p = .002), which was in turn associated with increased risky sex (B = .06, SE = .028, p = .03) (indirect effect = .0075, SE = .0043; 95% CI [.0006, 0.0178]), but not with other indices of risk-taking. These findings suggest that rejection sensitivity may be an important mechanism underlying the relationship between abuse and risky sexual behavior among substance users. These effects do not extend to other risk behaviors, supporting the notion that risky sex associated with abuse represents a means to interpersonal connection rather than a general tendency toward self-defeating behavior.
PMCID: PMC5040462  PMID: 27344009
risky sex; abuse; substance use; social rejection; rejection sensitivity
12.  Engagement and abstinence among users of a smoking cessation text message program for veterans 
Addictive behaviors  2016;62:47-53.
SmokefreeVET is a text messaging smoking cessation program available to veterans enrolled in the Veterans Health Administration. SmokefreeVET was developed in collaboration with the National Cancer Institute as part of the SmokefreeTXT initiative.
To evaluate the real world use of and effectiveness of the SmokefreeVET program for SmokefreeVET users who enrolled between 2013 and 2014.
Demographics and smoking behavior of 1,470 SmokefreeVET users who enrolled between 2013 and 2014 were analyzed. Latent growth mixture modeling was used to identify discrete classes of SmokefreeVET users based on engagement patterns. Multi-level modeling determined class differences in abstinence.
The average age of the SmokefreeVET user was 48, 75% of users were male, and 84% were daily smokers. After five weeks, 13% of all users reported abstinence from smoking. Five statistically distinct engagement classes of SmokefreeVET users were identified. Highly engaged classes were significantly less likely to opt-out and more likely to report abstinence. Over 60% of users who were classified as high engagers throughout the program reported abstinence 5 weeks after their quit date. Users were more likely to report abstinence after two weeks if they used smoking cessation medication than those that did not use medication (OR=9.01, p<.001).
SmokefreeVET may be effective at supporting abstinence among a real world group of highly engaged users. Smoking cessation medication use was also associated with abstinence in SmokefreeVET users. Engagement appears to be a critical component when assessing the efficacy of a text messaging smoking cessation intervention.
PMCID: PMC5144826  PMID: 27318948
smoking; tobacco; cessation; mHealth; engagement; veteran
13.  Preference for gain- or loss-framed electronic cigarette prevention messages 
Addictive behaviors  2016;62:108-113.
Effective electronic cigarette (e-cigarette) prevention messages are needed to combat the rising popularity/uptake of e-cigarettes among youth. We examined preferences for e-cigarette prevention messages that either emphasized gains (e.g., You save money by not using e-cigarettes) or losses (e.g., You spend money by using e-cigarettes) among adolescents and young adults.
Using surveys in two middle schools, four high schools, and one college in CT (N = 5405), we assessed students' preferences for gain- or loss-framed e-cigarette prevention messages related to four themes: financial cost, health risks, addiction potential, and social labeling as a smoker. We also assessed whether preferences for each message framing theme differed by sex, school level, cigarette-use status, and e-cigarette use-status. We also examined whether preference for message framing differed by cigarette and e-cigarette susceptibility status among never e-cigarette users.
Overall, loss-framing was preferred for message themes related to health risks, addiction potential, and social labeling as a smoker, whereas gain-framing was preferred for message themes related to financial cost. Logistic regression analyses showed that 1) females preferred loss-framed messages for all themes relative to males, 2) lifetime e-cigarette users preferred loss-framed health risks and social labeling messages relative to never users, and 3) high school students preferred gain-framed social labeling messages relative to college students. The preference for message framing did not differ by cigarette or e-cigarette susceptibility. Conclusions: Preference for message framing differed by themes and individual characteristics. This formative research could inform the construction of persuasive e-cigarette prevention messages.
PMCID: PMC5512445  PMID: 27344117
Message framing; Electronic cigarettes; Gender; Prevention; Adolescents; Young adults
14.  Longitudinal pathways from unconventional personal attributes in the late 20s to cannabis use prior to sexual intercourse in the late 30s 
Addictive behaviors  2017;74:148-152.
A quarter of people living with human immunodeficiency virus (HIV) infection in the United States are women. Furthermore, African American and Hispanic/Latina women continue to be disproportionately affected by HIV, compared with women of other races/ethnicities. Cannabis use prior to intercourse may be associated with increased risky sexual behaviors which are highly related to HIV. The ultimate goal of this research is to better understand the relationships between unconventional personal attributes (e.g., risk-taking behaviors) in the late 20s, substance use (e.g., alcohol) in the mid 30s, and cannabis use prior to intercourse in the late 30s using a community sample; such an understanding may inform interventions. This study employing data from the Harlem Longitudinal Development Study includes 343 female participants (50% African Americans, 50% Puerto Ricans). Structural equation modeling indicated that unconventional personal attributes in the late 20s were associated with substance use in the mid 30s (β=0.32, p<.001), which in turn, was associated with cannabis use prior to sexual intercourse in the late 30s (β=0.64, p<.001). Unconventional personal attributes in the late 20s were also directly related to cannabis use prior to sexual intercourse in the late 30s (β=0.39, p<.01). The findings of this study suggest that interventions focused on decreasing unconventional personal attributes as well as substance use may reduce sexual risk behaviors among urban African American and Puerto Rican women. Also, the implications of this study for health care providers and researchers working in HIV prevention are that these precursors may be useful as patient screening tools.
PMCID: PMC5595245  PMID: 28648991
Harlem Longitudinal Development Study; structural equation modeling; unconventional personal attributes; substance use; sexual risk behaviors
15.  The within-person association between alcohol use and sleep duration and quality in situ: An experience sampling study 
Addictive behaviors  2016;61:68-73.
Despite evidence for detrimental effects of alcohol on sleep quality in laboratory studies, alcohol is commonly used as a self-prescribed sleep aid. This study examined the within-person associations of alcohol use with sleep duration and quality in everyday life to gain insight into the ecological validity of laboratory findings on the association between sleep and alcohol.
A sample of 150 adults (age 19–89 years) were followed for 60+ days as part of an intensive experience sampling study wherein participants provided daily reports of their alcohol use, sleep duration, and sleep quality. Within-person and between-person associations of daily sleep duration and quality with alcohol use were examined using multilevel models.
A significant, negative within-person association was observed between sleep quality and alcohol use. Sleep quality was lower on nights following alcohol use. Sleep duration did not vary as a function of within-person variation in alcohol use.
In line with laboratory assessments, alcohol use was associated with low sleep quality but was not associated with sleep duration, suggesting that laboratory findings generalize to everyday life. This examination of individuals’ daily lives suggests that alcohol does not systematically improve sleep quality or duration in real life.
PMCID: PMC4915974  PMID: 27249804
alcohol; sleep; experience sampling; substance use; longitudinal analysis
16.  Minority stress is longitudinally associated with alcohol-related problems among sexual minority women 
Addictive behaviors  2016;61:80-83.
Compared to sexual minority men and heterosexual women, sexual minority women report elevated alcohol use in young adulthood. Heavy alcohol use and alcohol use disorders disproportionately affect sexual minority women across the lifespan, yet there is limited research investigating reasons for such associations. The present study investigates longitudinal relationships between minority stress and both alcohol use as well as self-rated drinking consequences. Participants (N = 1,057) were self-identified lesbian (40.5%) and bisexual (59.5%) women between the ages of 18 to 25 recruited from across the U.S. using online advertisements. Participants completed four annual surveys. Hurdle mixed effects models were used to assess associations between minority stress and typical weekly drinking and drinking consequences one year later. Minority stress was not significantly associated with subsequent typical drinking. However, minority stress was significantly associated with having any alcohol consequences as well as the count of alcohol consequences one year later after controlling for covariates. Consistent with extant literature, this study provides evidence for a prospective relationship between minority stress experienced by sexual minority women and drinking consequences. This study also provides support for the potential impact of efforts to reduce minority stress faced by sexual minority women.
PMCID: PMC4915988  PMID: 27249806
lesbian; bisexual; alcohol use; drinking consequences; discrimination; minority stress
17.  Emerging adulthood themes and hookah use among college students in Southern California 
Addictive behaviors  2016;61:16-19.
Hookah (or waterpipe) use is increasing worldwide with implications for public health. Emerging adults (ages 18 to 25) have a higher risk for hookah use relative to younger and older groups. While research on the correlates of hookah use among emerging adults begins to accumulate, it may be useful to examine how transition-to-adulthood themes, or specific thoughts and feelings regarding emerging adulthood, are associated with hookah use. This study determined which transition-to-adulthood themes were associated with hookah use to understand the risk and protective factors for this tobacco-related behavior.
Participants (n=555; 79% female; mean age 22) completed surveys on demographic characteristics, transition-to-adulthood themes, hookah, and cigarette use.
Past-month hookah use was more common than past-month cigarette use (16% versus 12%). In logistic regression analyses, participants who felt emerging adulthood was a time of experimentation/possibility were more likely to report hookah use. However, transition-to-adulthood themes were not statistically significantly related to cigarette use.
The profile for hookah use may differ from that of cigarettes among emerging adults. Themes of experimentation/possibility should be addressed in prevention programs on college campuses and popular recreational spots where emerging adults congregate. These findings can inform future studies of risk and protective factors for hookah use among emerging adults.
PMCID: PMC4915989  PMID: 27208879
Hookah use; waterpipe use; cigarette use; Emerging Adults; Young Adults; Prevention
18.  Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample 
Addictive behaviors  2016;61:99-103.
Cannabis has been legalized for medical use in almost half of the states in the U.S. Although laws in these states make the distinction between medical and recreational use of cannabis, the prevalence of people using medical cannabis and how distinct this group is from individuals using cannabis recreationally is unknown at a national level.
Data came from the 2013 National Survey on Drug Use and Health (NSDUH). All adults endorsing past year cannabis use who reported living in a state that had legalized medical cannabis were divided into recreational cannabis use only and medical cannabis use. Demographic and clinical characteristics were compared across these two groups.
17% of adults who used cannabis in the past year used cannabis medically. There were no significant differences between those who used medically versus recreationally in race, education, past year depression and prevalence of cannabis use disorders. In adjusted analyses, those with medical cannabis use were more likely to have poorer health and lower levels of alcohol use disorders and non-cannabis drug use. A third of those who reported medical cannabis use endorsed daily cannabis use compared to 11% in those who reported recreational use exclusively.
Adults who use medical and recreational cannabis shared some characteristics, but those who used medical cannabis had higher prevalence of poor health and daily cannabis use. As more states legalize cannabis for medical use, it is important to better understand similarities and differences between people who use cannabis medically and recreationally.
PMCID: PMC4915997  PMID: 27262964
19.  Problematic Internet use, well-being, self-esteem and self-control: Data from a high-school survey in China 
Addictive behaviors  2016;61:74-79.
Given the prevalence of Internet use among youth, there is concern that a subset of Internet-using youth may exhibit problematic or addictive patterns of Internet use. The present study examines the association between problematic Internet use (PIU), demographic variables, and health-related measures among Chinese adolescents. Survey data from 1552 adolescents (male = 653, mean age = 15.43 years) from Jilin Province, China, were collected. According to the Young Diagnostic Questionnaire for Internet Addiction (YDQ), 77.8% (n=1,207), 16.8% (n=260), and 5.5% (n=85) showed adaptive, maladaptive, and problematic Internet use, respectively. Multinomial logistic regression analysis revealed that gender and family income per month differed between youth showing problematic and adaptive patterns of Internet use. Well-being, self-esteem, and self-control were related to severity of problematic Internet use, with greater severity typically associated with poorer measures in each domain. The findings that severity of problematic Internet use is associated with specific socio-demographic features and temperamental and well-being measures suggest that specific groups of youth may be particularly vulnerable to developing problematic Internet use. Early prevention/intervention programs targeting at-risk groups may help improve public health.
PMCID: PMC4916009  PMID: 27249805
Problematic Internet use; well-being; self-esteem; self-control
20.  Ethical considerations and potential threats to validity for three methods commonly used to collect geographic information in studies among people who use drugs 
Addictive behaviors  2016;61:84-90.
Analyses with geographic data can be used to identify “hot spots” and “health service deserts”, examine associations between proximity to services and their use, and link contextual factors with individual-level data to better understand how environmental factors influence behaviors. Technological advancements in methods for collecting this information can improve the accuracy of contextually-relevant information; however, they have outpaced the development of ethical standards and guidance, particularly for research involving populations engaging in illicit/stigmatized behaviors. Thematic analysis identified ethical considerations for collecting geographic data using different methods and the extent to which these concerns could influence study compliance and data validity.
In-depth interviews with 15 Baltimore residents (6 recruited via flyers and 9 via peer-referral) reporting recent drug use explored comfort with and ethics of three methods for collecting geographic information: (1) surveys collecting self-reported addresses/cross-streets, (2) surveys using web-based maps to find/confirm locations, and (3) geographical momentary assessments (GMA), which collect spatiotemporally referenced behavioral data.
Survey methods for collecting geographic data (i.e., addresses/cross-streets and web-based maps) were generally acceptable; however, participants raised confidentiality concerns regarding exact addresses for illicit/stigmatized behaviors. Concerns specific to GMA included burden of carrying/safeguarding phones and responding to survey prompts, confidentiality, discomfort with being tracked, and noncompliance with study procedures. Overall, many felt that confidentiality concerns could influence the accuracy of location information collected for sensitive behaviors and study compliance.
Concerns raised by participants could result in differential study participation and/or study compliance and questionable accuracy/validity of location data for sensitive behaviors.
PMCID: PMC4922643  PMID: 27249807
21.  Perceived Role of Motivation and Self-Efficacy in Smoking Cessation: A Secondary Data Analysis 
Addictive behaviors  2016;61:58-61.
This secondary analysis tested whether smokers’ perceived importance of willpower, ability to quit (i.e., self-efficacy), and use of treatment would prospectively predict occurrence of a quit attempt, duration of abstinence, or use of cessation aids
Smokers (n= 143) who planned to quit sometime in the next 3 months were asked whether, for most smokers, a) willpower is necessary for quitting, b) willpower is sufficient for quitting, c) they could quit anytime, d) they were too addicted to quit, and e) they thought use of aids indicated weakness of character. Smokers then reported quit attempts and abstinence daily for 3 months. No treatment was provided.
The two willpower beliefs were often endorsed (78% and 60% each); the can quit any time and being too addicted beliefs were endorsed less consistently (12% and 35% each); and the belief that use of aids indicates a weakness was rarely endorsed (8%). The beliefs were only modestly correlated. Those who more strongly endorsed the two willpower beliefs or use of aids as a weakness were less likely to make a quit attempt. None of the constructs predicted duration of quit attempt. Seeing treatment as a weakness predicted less use of treatment.
The large majority of smokers believe willpower is necessary and sufficient for quitting and this belief appears to impede quit attempts. Given this is a post-hoc finding, replication tests are needed. If replicated, clinical and media interventions to combat willpower beliefs may increase quit attempts.
PMCID: PMC4943656  PMID: 27240212
Quit attempts; self-efficacy; smoking cessation; treatment use; willpower
22.  Examining daily variability in willingness to drink in relation to underage young adult alcohol use 
Addictive behaviors  2016;61:62-67.
A key component of the Prototype Willingness Model is willingness, which reflects an openness to opportunity to perform a behavior in situations that are conducive to that behavior. Willingness has traditionally been tested using global, hypothetical assessments, and has not been examined at the daily level. We expected to find within-person variability in willingness to drink, such that on days with greater willingness, individuals would report greater drinking. A national sample (N = 288) of young adults aged 18 to 20 (31.60% female) completed a Web-based survey that was comprised of measures of drinking and sexual behavior, including the Timeline Follow-Back (Sobell & Sobell, 1992). Findings show daily variability in willingness to drink (ICC = 0.54), which suggests that there are substantial differences from day-to-day in this drinking-related cognition. Participants drank more on days when individuals also reported feeling more willing to drink than their own average level across the two weeks. Daily process level mechanisms allow greater insight into factors contributing to increased risk in-the-moment, which may point to targets for interventions aimed at improving adolescents' and young adults' abilities to make healthier choices in moments when they may be at greater risk for engaging in risky behaviors.
PMCID: PMC4976632  PMID: 27243458
Prototype Willingness Model; Young adults; Alcohol use; Willingness to drink
23.  Electronic Nicotine Delivery System Dual Use and Intention to Quit Smoking: Will the Socioeconomic Gap in Smoking Get Greater? 
Addictive behaviors  2016;61:112-116.
Electronic nicotine delivery systems (ENDS) are popular among cigarette smokers; however, it is not known whether the use of ENDS assists or delays quitting cigarettes, especially among certain priority populations. We examined predictors of intention to quit smoking and patterns of dual use of ENDS and traditional cigarettes among priority populations.
This study used data from a 2014 survey of a national probability sample of 5,717 USA adults. Descriptive statistics were used to examine differences in intention to quit cigarette use among current cigarette smokers (n=1,014) and dual users of cigarettes and ENDS (n=248). Multivariable logistic regression analysis was conducted on the overall sample and the subsample of dual users to determine whether dual use (versus cigarette only use) and demographic characteristics predict self-reported intention to quit and having attempted to quit in the past year. Significance was set at p<0.05.
Compared to cigarette smokers, dual users were slightly more educated (p<0.05), more likely to intend to quit smoking (adjusted odds ratio [AOR]=1.8, p=0.001), and more likely to have attempted to quit smoking in the past year (AOR=1.7, p=0.003). Blacks reported higher intention to quit than Whites (AOR=1.8, p= 0.003). Compared with high school education or less, dual users with some college (AOR = 1.5, p = 0.007) or a college degree (AOR = 2.5, p ≤ 0.0001) had high intention to quit.
Dual users of ENDS and traditional cigarettes are more likely to intend to quit smoking and have recently made quit attempts. If using ENDS contributes to increased smoking cessation among more educated individuals, disparity in smoking by level of education will increase.
PMCID: PMC4981176  PMID: 27268063
Electronic nicotine delivery devices; disparity; quit intentions
24.  Reducing Drinking to Cope among Heavy Episodic Drinking College Women: Secondary Outcomes of a Web-Based Combined Alcohol Use and Sexual Assault Risk Reduction Intervention 
Addictive behaviors  2016;61:104-111.
College students are at high risk for engaging in heavy episodic drinking and for experiencing sexual assault. Further, drinking to cope with anxiety motives are associated with sexual assault history and drinking, and thus should be examined when targeting both sexual assault and drinking in college populations. The current study examined the effectiveness of decreasing coping with anxiety drinking motives among underage heavy episodic drinking college women (n = 264). Results indicate that the web-based combined alcohol use and sexual assault risk reduction intervention was effective at decreasing drinking to cope with anxiety motives among those with stronger drinking to cope with anxiety motives at baseline. However, the alcohol-only and sexual assault-only intervention were not. Decreases in drinking motives were associated with decreases in heavy episodic drinking. This suggests that alcohol interventions in college populations may not be effectively targeting drinking motives and this preliminary study provides evidence indicating that targeting alcohol and sexual assault together may decrease drinking to cope motives among a high risk population.
PMCID: PMC5004246  PMID: 27262965
alcohol use; drinking to cope with anxiety; sexual assault; college; heavy episodic drinking
25.  Relationships with parents and adult children’s substance use☆ 
Addictive behaviors  2016;65:198-206.
Previous research has indicated that parents impact minor children’s health behaviors and adult children’s self-rated health and psychological well-being. However, little is known about the long-term consequences of the parent-child relationship for adult children’s substance (i.e., smoking levels, low to moderate alcohol use) as adult children age. The present study uses growth curve analysis on longitudinal survey data (Americans’ Changing Lives, N = 907) to examine how multiple dimensions of the parent-child tie influence adult children’s substance use. Findings show that contact with mothers in adulthood has a health-enhancing effect on sons’ smoking. Fathers’ support is related to a decline in alcohol use for sons and daughters, but also an increase in smoking for sons only. Our findings for strain from parents are complex, suggesting that the ways in which adult children cope and manage strain with parents may result in multiple pathways of substance use. Our study raises new questions about whether and when family ties are “good” or “bad” for health and calls for a more multifaceted view of the long-lasting parent-child tie. We spotlight the need to look at the parent-child relationship as a dynamic social tie that changes over the life course and has consequences for health in adulthood.
PMCID: PMC5618443  PMID: 27835859
Alcohol use; Smoking; Parent-child tie

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