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1.  Assessment Reactivity: A Randomized Controlled Trial of Alcohol-Specific Measures on Alcohol-Related Behaviors 
Addictive behaviors  2016;67:44-48.
Completion of alcohol assessments influences treatment outcomes, yet little is known about the aspects of assessment that may contribute to this response. The present study is a randomized controlled trial examining how the themes of alcohol assessments (e.g., assessment of alcohol-related consequences as opposed to drinking patterns) may affect drinking behaviors.
Undergraduate students (N = 290, Mage = 19.97, SDage = 1.81, 61.7% female), reporting at least one binge drinking episode during the past month, completed one of five baseline assessment batteries that varied thematically: (a) Control (e.g., minimal drinking quantity and frequency questions), (b) Consequences (e.g., College Alcohol Problems Scale; CAPS-r), (c) Norms (e.g., Drinking Norms Rating Form), (d) Diagnostic (e.g., Alcohol Use Disorders Identification Test), and (e) Combined (all themes). Participants completed a one-month follow-up of drinking quantity/frequency and the CAPS-r.
All groups decreased their self-reported peak drinks consumed (p < .001, ηp2 =.05) and past month frequency of drinking (p=.002, ηp2 =.03; except for the consequences group) from baseline to follow-up. There were no between-group differences. No changes emerged in drinks per week (p=.09, ηp2 =.01) or alcohol-related consequences (p=.06, ηp2=.03) from baseline to follow-up.
Minimal assessment of drinking quantity and frequency may result in assessment reactivity. Reductions in markers of risky drinking behaviors did not differ as a function of the type of assessments completed (e.g., consequences vs diagnostic). Continued research is needed to determine what other important variables (e.g., treatment seeking) may affect assessment reactivity.
PMCID: PMC5798432  PMID: 27992833
drinking; young adult; intervention; assessment reactivity
2.  Documenting the Emergence of Electronic Nicotine Delivery Systems as a Disruptive Technology in Nicotine and Tobacco Science 
Addictive behaviors  2016;65:179-184.
The emergence of the electronic nicotine delivery systems (ENDS, or “e-cigarettes”) has resulted in nicotine and tobacco scientists committing increased resources to studying these products. Despite this surge of research on various topics related to e-cigarettes, it is important to characterize the evolving e-cigarette research landscape as a way to identify important future research directions. The purpose of this review was to broadly categorize published scholarly work on e-cigarettes using a structured, multi-level coding scheme.
A systematic literature search was conducted to collect articles on e-cigarettes that were published in peer-reviewed journals from 2006 through 2014. Studies were classified through 3 coding waves. Articles were first divided into research reports, literature reviews and opinions/editorials. Research reports were further categorized to determine the proportion of these studies using human participants. Finally, human studies were classified based on their methodologies: descriptive, predictive, explanatory, and intervention.
Research reports (n = 224) and opinions/editorials (n = 248) were published at similar rates during this time period. All types of articles showed exponential rates of increase in more recent years. 76.3% of human research studies tended to be descriptive in nature, with very little research employing experimental (6.8%) or intervention-based methodologies (5.4%).
This review reinforces the idea that e-cigarettes are a disruptive technology exerting substantial influence on nicotine and tobacco science. This review also suggests that opinions on e-cigarettes may be outpacing our scientific understanding of these devices. Our findings highlight the need for more e-cigarette research involving experimental, intervention, and longitudinal designs.
PMCID: PMC5140675  PMID: 27816664
electronic cigarettes; literature review; research methods; study design
4.  Is the Deliberate Self-Induction of Alcohol Tolerance Associated with Negative Alcohol Outcomes? 
Addictive behaviors  2016;65:98-101.
Research indicates 10% of college student drinkers report deliberately training to increase alcohol tolerance (a diagnostic criterion for alcohol use disorder) to avoid passing out early or to keep up with peers. Given that tolerance training may be considered a harm reduction technique designed to reduce acute aversive consequences, we examined the associations between tolerance training and the use of protective behavioral strategies (PBS) more generally. A cross-sectional survey of 1,080 lifetime drinkers was conducted at a large Midwestern university. Of this sample, 5.6% (n=60) reported training to increase their tolerance. Drinkers who endorsed having trained to increase tolerance reported notably more alcohol-related problems than those who reported never training (Madj=51.80 versus Madj=39.30; p<.0001). Further, participants who endorsed tolerance training reported utilizing significantly fewer PBS (e.g., avoid drinking games) on the Protective Behavioral Strategies Scale (PBSS, Martens et al., 2005) than participants who had never trained (Madj=16.89 versus Madj=18.90; p<.01). An exception was that drinkers who trained to avoid passing out early used significantly more PBS (e.g., using a designated driver, knowing where your drink is at all times). Despite this, these trainers consumed more alcohol and experienced more alcohol-related harms. The present findings support previous research demonstrating that trainers consume more alcohol than non-trainers, and provide further evidence that deliberately training to increase tolerance is indicative of problematic drinking behavior. Prevention efforts might aim to inform drinkers of the problems associated with deliberately inducing alcohol tolerance, and focus on developing alternative strategies for minimizing acute harm from drinking.
PMCID: PMC5140678  PMID: 27816046
alcohol tolerance training; risky alcohol use; protective behavioral strategies; alcohol consequences
5.  Daily sleep quality affects drug craving, partially through indirect associations with positive affect, in patients in treatment for nonmedical use of prescription drugs 
Addictive behaviors  2016;65:275-282.
Sleep disturbance has been identified as a risk factor for relapse in addiction to a range of substances. The relationship between sleep quality and treatment outcome has received relatively little attention in research on nonmedical use of prescription drugs (NMUPD). This study examined the within-person association between sleep quality and craving in medically detoxified patients in residence for the treatment of NMUPD.
Participants (n= 68) provided daily reports of their sleep quality, negative affect (NA), positive affect (PA), and craving for an average of 9.36 (SD= 2.99) days. Within-person associations of sleep quality and craving were examined using multilevel modeling. Within-person mediation analyses were used to evaluate the mediating roles of NA and PA in the relationship between sleep quality and craving.
Greater cravings were observed on days of lower than usual sleep quality (γ10 = −0.10, p = .003). Thirty-one percent of the overall association between sleep quality and craving was explained by PA, such that poorer sleep quality was associated with lower PA and, in turn, lower PA was associated with greater craving. No evidence emerged for an indirect association between sleep quality and craving through NA.
Daily fluctuations in sleep quality were associated with fluctuations in craving, an association partially explained by the association between sleep quality and daily PA. These data encourage further research on the relationship between sleep, affect, and craving in NMUPD patients, as well as in patients with other substance use disorders.
PMCID: PMC5140682  PMID: 27544697
opioids; affect; sleep; experience sampling; craving
6.  Impact of quitting smoking and smoking cessation treatment on substance use outcomes: An updated and narrative review 
Addictive behaviors  2016;65:161-170.
Historically, smoking cessation was thought to negatively impact substance use outcomes among smokers who use other substances. We sought to synthesize recent reports on this association.
Google Scholar, PubMed, and Cinahl were searched for studies published from 2006 to March 29, 2016 that reported impact of smoking cessation treatment or quitting smoking on substance use or substance use disorder treatment outcomes in the general population and among those in substance abuse treatment. Studies were grouped by reported impact as follows: “positive” (i.e. improved), “null” (i.e. no change), or “negative” (i.e. worsened).
Twenty-four studies were included. Eighteen reported the impact of quitting smoking and six reported the impact of smoking cessation treatment intervention, independent of quitting, on substance use outcomes. Eleven studies (46%) reported solely positive impact; four (17%) reported solely null impact; eight (33%) reported mixed positive and null impact by analysis (combined and subgroup, n = 1); substance (n = 4); length of follow-up (n = 2); and comparison group (n = 1). One study (4%) reported mixed negative and null impact by ethnic group. No studies reported increased substance use.
Smoking cessation does not appear to have a negative effect, and often has a positive effect on substance use outcomes. Smoking cessation advice should be offered, without hesitation, to smokers who report substance use and those in treatment for substance use disorder.
PMCID: PMC5140700  PMID: 27816663
smoking cessation; smoking cessation treatment; substance use; substance use disorder; substance use treatment
8.  Anxiety Sensitivity and Nonmedical Benzodiazepine Use among Adults with Opioid Use Disorder 
Addictive behaviors  2016;65:283-288.
Nonmedical benzodiazepine use is common among adults with opioid use disorder; however, little is known about this co-occurrence. Anxiety sensitivity--the fear of anxiety symptoms and sensations--motivates behaviors to escape and avoid distressing states, and accordingly is associated with coping motives for substance use. This might be particularly relevant among women, who report using substances to cope with negative emotions more often than men. The aim of the current study was to examine whether nonmedical benzodiazepine use was associated with higher anxiety sensitivity among treatment-seeking adults diagnosed with opioid use disorder, and to investigate whether gender moderated this association. A sample of adults (ranging in age from 18–81 years) receiving inpatient treatment for opioid use disorder (N=257) completed measures of anxiety, anxiety sensitivity, and benzodiazepine use frequency. Results of an analysis of variance indicated that frequency of past-month nonmedical benzodiazepine use was associated with significantly higher anxiety sensitivity. This effect remained when controlling for the effect of anxiety symptoms (F[1, 251] = 3.91, p = .049, ηp2=.02). Gender moderated this association, and post-hoc analyses found a strong association between nonmedical benzodiazepine use and anxiety sensitivity in women, and not men. Anxiety sensitivity, which can be reduced with treatment, might be a candidate therapeutic target in this population, particularly in women.
PMCID: PMC5140702  PMID: 27575980
opioid use disorder; benzodiazepines; anxiety sensitivity; gender differences
9.  Complexities in understanding and addressing the serious public health issues related to the nonmedical use of prescription drugs 
Addictive behaviors  2016;65:215-217.
The nonmedical use of prescription drugs (NMUPD) is not only a serious public health problem, but also a complex one. The articles presented in this special issue underscore that complexity by describing multiple classes of prescription drugs (e.g., opioid analgesics, benzodiazepines, stimulants, anxiolytics, and sedatives) and examining multiple aspects of their patterns of use. Collectively, the articles examine epidemiologic use patterns in the United States, risk factors, clinical characteristics of individuals in treatment for dependence, and consequences. The key to addressing NMUPD is to construct a solid understanding of the issues through scientific research, and to translate the scientific evidence into action. The articles in this issue build upon a large body of literature that has accumulated during the last two decades. Dramatic increases in overdoses from prescription opioids and the transition to heroin use among nonmedical users of prescription opioids has captured the attention of community leaders across the nation. Yet, less well known is the co-occurrence of multiple substances among those using prescription drug nonmedically. This represents a common theme across these articles which document that nonmedical users were observed to have a history of using alcohol, marijuana, tobacco, and other psychoactive substances. In addition, the articles dispel certain ideas that appear to have gained traction in the popular discourse that have little scientific evidence behind them. First, the notion that prescription drug problems arise in cases of drug naïve individuals who are first exposed through a physician’s prescription for pain medication is widespread, but is not rooted in scientific evidence. Second, despite the popular notion that nonmedical use of stimulants confers an “academic edge”, nonmedical users have lower grade point averages (GPAs) than non-users. NMUPD was also shown to be associated with sexual aggression victimization and perpetration and regretted sex. In addition, several of the articles in this issue point to innovative targets for prevention of NMUPD. It is only through high-quality research can we gain a clearer understanding of the problem and how to address it.
PMCID: PMC5140704  PMID: 27639956
10.  Correspondence Between Adolescent and Informant Reports of Substance Use: Findings from the Philadelphia Neurodevelopmental Cohort 
Addictive behaviors  2016;65:13-18.
Inclusion of collateral informant reports is common in adolescent psychopathology research and clinical assessment, yet few studies have examined agreement on ratings of adolescent substance use or factors that may be associated with reporter agreement. The present study aimed to extend prior work on the correspondence between adolescent and informant reports of adolescent substance use with data from a large (n=5,214), diverse, community-based sample of youth aged 11–17 (mean age=14.53, SD=1.98; 52% female). Specifically, we examined: (a) agreement between adolescent and collateral informant reports of adolescent use of alcohol, marijuana, cocaine, inhalants, and stimulants and (b) potential correlates of reporter agreement. Agreement ranged from low (κ=.007, p=.053) for inhalant use to moderate (κ=.414, p<.001) for marijuana use. Disagreements were mainly driven by collateral underestimation of adolescent substance use. Older adolescent age was associated with poorer agreement across all substances (Odds Ratios [ORs] ≤ .80, ps<.05) except inhalants (OR=1.28, p<.001). Reporter agreement on alcohol and marijuana use was lower for male than female adolescents (ORs≤.85, ps<.05). Adolescent psychopathology was associated with poorer agreement on all substances (ORs≤.62, ps<.01). For alcohol and marijuana, past year frequency of use was associated with better reporter agreement (ORs≥1.54, ps<.001). For marijuana, older age at first use was related to poorer agreement (OR=.81, p=.01). Our results suggest that collateral reports of adolescent substance use may be ineffective proxies for adolescent self-reports in community samples, particularly for low base rate substances. Findings also highlight important factors to consider when collecting substance use information from multiple informants.
PMCID: PMC5140708  PMID: 27701026
adolescent substance use; reporter agreement; collateral informants; substance use assessment; Philadelphia Neurodevelopmental Cohort
11.  Adolescents’ Future Orientation and Nonmedical Use of Prescription Drugs 
Addictive behaviors  2016;65:269-274.
How adolescents think about their future (i.e., future orientation) impacts their risk-taking behavior. The purpose of the present analysis was to explore whether future orientation (future planning, perceived risk to future goals, and positive future expectations) was associated with nonmedical use of stimulants and analgesics in a sample of high school students.
Information on future orientation and nonmedical use of prescription drugs (NMUPD) were collected using a paper-and-pencil survey from a sample of 9th-12th grade students in a Midwestern school.
Higher perceived risk to future goals and positive future expectations were associated with a lower likelihood of self-reported nonmedical use of stimulants (n = 250; OR = 0.46, 95% CI: 0.26, 0.83; OR = 0.15, 95% CI: 0.05, 0.47, respectively). Only higher perceived risk to future goals was associated with a lower likelihood of self-reported nonmedical use of analgesics (n = 250; OR = 0.40, 95% CI: 0.24, 0.68). In a follow-up analysis limited to students who endorsed alcohol or marijuana use, perceived risk to future goals remained associated with a lower likelihood of nonmedical use of stimulants and analgesics.
Results suggest that risk perception might be a salient protective factor against both nonmedical use of stimulants and analgesics. Overall, the differential impact of conceptualizations of future orientation might depend on the class of prescription drug used, demonstrating a need to consider prescription drugs individually in the development of future studies and interventions.
PMCID: PMC5140717  PMID: 27592055
future orientation; stimulants; analgesics; high school
12.  Alcohol Detoxification Completion, Acceptance of Referral to Substance Abuse Treatment, and Entry into Substance Abuse Treatment Among Alaska Native People 
Addictive behaviors  2016;65:25-32.
Little is known about factors associated with detoxification treatment completion and the transition to substance abuse treatment following detoxification among Alaska Native people. This study examined 3 critical points on the substance abuse continuum of care (alcohol detoxification completion, acceptance of referral to substance abuse treatment, entry into substance abuse treatment following detoxification).
The retrospective cohort included 383 adult Alaska Native patients admitted to a tribally owned and managed inpatient detoxification unit. Three multiple logistic regression models estimated the adjusted associations of each outcome separately with demographic/psychosocial characteristics, clinical characteristics, use related behaviors, and health care utilization.
Seventy-five percent completed detoxification treatment. Higher global assessment functioning scores, longer lengths of stay, and older ages of first alcohol use were associated with completing detoxification. A secondary drug diagnosis was associated with not completing detoxification. Thirty-six percent accepted a referral to substance abuse treatment following detoxification. Men, those with legal problems, and those with a longer length of stay were more likely to accept a referral to substance abuse treatment. Fifty-eight percent had a confirmed entry into a substance abuse treatment program at discharge. Length of stay was the only variable associated with substance abuse treatment entry.
Services like motivational interviewing, counseling, development of therapeutic alliance, monetary incentives, and contingency management are effective in linking patients to services after detoxification. These should be considered, along with the factors associated with each point on the continuum of care when linking patients to follow-up services.
PMCID: PMC5140722  PMID: 27705843
Alcohol detoxification; Alaska Native; American Indian; substance abuse treatment referral; substance abuse treatment entry; detoxification completion
13.  Perceived Risk of Heroin Use among Nonmedical Prescription Opioid Users 
Addictive behaviors  2016;65:218-223.
The prevalence of heroin use among nonmedical prescription opioid (NMPO) users has increased in recent years. Identifying characteristics associated with heroin use in this population can help inform efforts to prevent heroin initiation and maintenance. The aim of this study was to evaluate differences in perceived risk of heroin among NMPO users with and without histories of heroin use, and to examine temporal trends in perceived risk of heroin among this population.
Data are from the 2002–2013 National Survey on Drug Use and Health, and included all past-year NMPO users (N=49,045). Participants reported perceived risk of trying heroin once or twice and regular heroin use. Responses were coded dichotomously (great risk vs. other risk) and logistic regression analyses were used to evaluate the association between lifetime heroin use and perceived risk of heroin, and to determine temporal changes in perceived risk.
Results indicated a significant association between lifetime heroin use and lower likelihood of reporting great risk of trying heroin (OR = 0.38, 95% CI: 0.33, 0.44, p < .001), and of regular use of heroin (OR = 0.39, 95% CI: 0.32, 0.48, p < .001). There was a significant, yet modest, trend toward decreasing perception of great risk from 2002–2013.
Findings from this analysis of nationally representative data indicate that NMPO users with a history of heroin use perceive heroin to be less risky. Perception of risk has decreased from 2002–2013 in this population, consistent with increasing rates of heroin initiation.
PMCID: PMC5140726  PMID: 27544695
Heroin; Opioid; Nonmedical Prescription Opioid Use; Perceived Risk; National Survey on Drug Use and Health
14.  Maternal Trajectories of Cigarette Use as a Function of Maternal Age and Race 
Addictive behaviors  2016;65:33-39.
Patterns of smoking vary as a function of age and race. The goals of this study were to identify trajectories of maternal cigarette use over a 17-year span, and to determine if maternal age at first birth and race were associated with smoking trajectories.
Pregnant women (N = 690) were recruited at an urban prenatal clinic. The women (13–42 years old; 62% African-American, 38% White) were interviewed about cigarette use during pregnancy and 6, 10, 14, and 16 years postpartum. Growth mixture modeling (GMM) was used to identify trajectories. Regressions were used to determine if maternal age at first birth and race predicted trajectory class membership.
A GMM of maternal cigarette use delineated 5 groups: none/unlikely to use (33%), decreasing likelihood of use (6%), late desistance (5%), increasing likelihood of use (17%), and chronic use (39%). Women who became mothers at a younger age were more likely to be classified as late desisters or increasingly likely to smoke. White mothers were more likely to be chronic smokers. Different smoking trajectories and predictors of trajectories were identified for the African-American and White mothers. Covariates including prenatal substance use, hostility, education, and economic hardship also differentiated smoking trajectories.
Both prevention and treatment of smoking should be targeted to specific groups by age of first pregnancy and race. Pregnant smokers should be provided with more information and resources to help them avoid cigarettes during pregnancy and maintain abstinence after pregnancy.
Graphical Abstract
PMCID: PMC5140727  PMID: 27716477
tobacco; smoking; maternal; mother; women; desistance
15.  Psychosocial Problems in Children of Women Entering Substance Use Disorder Treatment: A Longitudinal Study 
Addictive behaviors  2016;65:193-197.
While parental substance use disorder (SUD) has been recognized as a risk factor for child outcomes, past research seldom focused specifically on children whose mothers suffer from alcohol and drug use disorders. Are these children at risk for elevated psychosocial problems, and would such risk be reduced if maternal substance use was reduced?
Children of substance-abusing mothers (COSAM, N = 130) were compared to a demographically matched comparison sample, and examined soon after their mothers entered SUD treatment and in the 18 months after treatment entry. We expected to observe elevated symptomatology among COSAM soon after their mothers’ entered treatment, followed by a decreasing trend after maternal treatment in general, and remission in particular.
Children’s psychosocial problems were assessed through maternal reports on the Pediatric Symptom Checklist. Soon after their mothers entered SUD treatment, COSAM exhibited significantly greater overall and clinical-level psychosocial problems than the children from the matched comparison sample. However, at the end of the 18-months study period, these two groups no longer differed in terms of problems. Results from the longitudinal growth models revealed reductions in COSAM’s overall and clinical-level problems following their mothers’ SUD treatment. However, these reductions were similar for all COSAM, regardless of whether their mothers relapsed or remitted.
Psychosocial problems were significantly reduced in COSAM following maternal SUD treatment, such that COSAM did not significantly differ from children from the matched comparison sample by the end of the 18-month study period.
PMCID: PMC5140731  PMID: 27835858
Maternal SUD; psychosocial symptoms
16.  Facebook dethroned: Revealing the more likely social media destinations for college students’ depictions of underage drinking 
Addictive behaviors  2016;65:63-67.
Studies examining representations of college drinking on social media have almost exclusively focused on Facebook. However, recent research suggests college students may be more influenced by peers’ alcohol-related posts on Instagram and Snapchat, two image-based platforms popular among this demographic. One potential explanation for this differential influence is that qualitative distinctions in the types of alcohol-related content posted by students on these three platforms may exist. Informed by undergraduate focus groups, this study examined the hypothesis that, of the three platforms, students tend to use Instagram most often for photos glamourizing drinking and Snapchat for incriminating photos of alcohol misuse and negative consequences. Undergraduate research assistants aided investigators in developing hypothetical vignettes and photographic examples of posts both glamorizing and depicting negative consequences associated with college drinking. In an online survey, vignette and photo stimuli were followed by counterbalanced paired comparisons that presented each possible pair of social media platforms. Undergraduates (N=196) selected the platform from each pair on which they would be more likely to see each post. Generalized Bradley-Terry models examined the probabilities of platform selections. As predicted, Instagram was seen as the most probable destination (and Facebook least probable) for photos depicting alcohol use as attractive and glamorous. Conversely, Snapchat was selected as the most probable destination (and Facebook least probable) for items depicting negative consequences associated with heavy drinking. Results suggest researchers aiming to mitigate the potential influences associated with college students’ glamorous and consequential alcohol-related photos posted social media posts should shift their focus from Facebook to Instagram and Snapchat.
PMCID: PMC5140737  PMID: 27776267
17.  Do college students improve their grades by using prescription stimulants nonmedically? 
Addictive behaviors  2016;65:245-249.
Many college students engage in nonmedical use of prescription stimulants (NPS) because they believe it provides academic benefits, but studies are lacking to support or refute this belief.
Using a longitudinal design, 898 undergraduates who did not have an ADHD diagnosis were studied. Year 3 GPA (from college records) of four groups was compared: Abstainers (did not engage in NPS either year; 68.8%); Initiators (NPS in Year 3 but not Year 2; 8.7%); Desisters (NPS in Year 2 but not Year 3; 5.8%); and Persisters (NPS in both years; 16.7%). Generalized estimating equations regression was used to estimate the association between NPS and change in GPA, controlling for sex and Year 2 GPA.
GPA increased significantly within Abstainers (p<.05), but did not change significantly within the other groups. Overall, the relationship between NPS pattern group and change in GPA was not statistically significant (p=.081). NPS was generally infrequent, but Persisters used more frequently than Desisters (11.7 versus 3.4 days in Year 2) and Initiators (13.6 versus 4.0 days in Year 3, both ps<.001), controlling for sex and Year 2 GPA.
We cannot rule out the possibility that NPS prevented declines in GPA, but we can conclude that students who engaged in NPS showed no increases in their GPAs and gained no detectable advantages over their peers. The results suggest that prevention and intervention strategies should emphasize that the promise of academic benefits from NPS is likely illusory.
PMCID: PMC5140739  PMID: 27469455
Academic performance; College students; drug abuse; prescription drug abuse; substance use
18.  Knowledge about nicotine among HIV-positive smokers: Implications for tobacco regulatory science policy 
Addictive behaviors  2016;65:81-86.
The present paper describes the general knowledge of smoking and nicotine among a sample of current smokers living with HIV (n=271) who were recruited via Amazon Mechanical Turk. Descriptive statistics were used to report sociodemographic and smoking characteristics, as well as knowledge about smoking and nicotine. The sample was comprised of relatively light smokers, both in terms of cigarettes per day (M=8.1, SD=9.7) and dependence (67.5% had low dependence according to the Heaviness of Smoking Index). The majority of participants correctly identified smoking as being a potential cause of various smoking-related conditions and correctly identified constituents in cigarette smoke. However, a majority of participants also misattributed nicotine as being a potential cause of smoking-related illness. Accurate knowledge about nicotine was low. These misperceptions are of particular concern for vulnerable populations, such as persons living with HIV, who are disproportionately burdened by the prevalence of smoking and associated morbidities and mortality. These misperceptions could have unintended consequences in the wake of a potential nicotine reduction policy, such that reduced nicotine content products are perceived as safer than normal nicotine content products currently available for sale. Additionally, incorrect knowledge about nicotine has implications for the uptake and continued use of nicotine replacement therapy.
PMCID: PMC5140741  PMID: 27792909
knowledge; nicotine; smoking; comorbidity; HIV
19.  “It’s how we deal”: Perceptions of LGB peers’ use of alcohol and other drugs to cope and sexual minority adults’ own coping motivated substance use following the Pulse nightclub shooting 
Addictive behaviors  2016;65:51-55.
Sexual minority stress experiences (e.g. prejudice, victimization, etc.) and peer substance use norms (e.g. peers’ frequency of use and quantity consumed) are important correlates of alcohol and drug use in sexual minority populations. The current study incorporates both of these by examining LGB individuals’ perceptions of peers’ use of alcohol and other drugs to cope with a sexual minority stressor, and whether perceptions of peer coping norms relate to one’s own coping-motivated substance use in response to the stressor. Three-hundred and seven sexual minority males and females who identified as gay, lesbian, or bisexual completed an online survey approximately 1 month following the Pulse Nightclub Shooting, the deadliest incident of violence against LGBT people in U.S. history, and a stressor experienced within LGB communities throughout the U.S. Results revealed that LGB peers were widely perceived as likely to have coped with alcohol (68%) and drugs (41%) following the Pulse Shooting; however only small proportions of participants themselves reported coping with alcohol (26%) and drugs (7%). Further, multivariate models revealed that even after controlling for other factors including the stress impact of the Pulse shooting, the odds of using alcohol to cope with this event were 15 times greater among participants who held the perception that LGB peers likely used alcohol to cope relative to those who did not share this perception. Similarly, the odds of using drugs to cope with this event were 9 times greater among participants who perceived LGB peers likely to use drugs to cope with Pulse compared to those who did not. Importantly, these findings suggest that personalized normative feedback designed to correct perceptions of peers’ coping motivated substance use may have utility as a motivational component in larger interventions seeking to reduce LGBs’ substance use.
PMCID: PMC5140745  PMID: 27728830
Alcohol use; Social norms; Drinking motives; Sexual minorities
20.  Prescription opioids prior to injection drug use: comparisons and public health implications 
Addictive behaviors  2016;65:224-228.
The intertwining prescription opioid and heroin epidemic is a major public health problem in the United States, with increasing morbidity and mortality among persons who use these substances. We examined differences between persons who reported being hooked on prescription opioids prior to injecting for the first time and those who did not by demographics, injection and non-injection characteristics, and overdose.
Between June and December 2015, persons who inject drugs were recruited using respondent-driven sampling as part of the National HIV Behavioral Surveillance system in Denver, Colorado.
Of 599 participants (median age, 40: IQR, 19–69; 71% male; 58% white, non-Hispanic), 192 (32%) reported being hooked on prescription opioids before they injected for the very first time. Compared to participants who were not hooked before they injected, participants who reported being hooked were significantly more likely to be younger, more recent injectors, report a slightly older age at first injection, and report heroin as the first drug injected as well as the drug most frequently injected. Those who reported being hooked were also more likely to be more frequent users of benzodiazepines, non-injection prescription opioids, and non-injection heroin as well as report injecting on a daily or more than daily basis. Being hooked on prescription opioids prior to injection drug use was associated with a 1.55 (95% CI: 1.14, 2.10) fold increase in the risk of at least one overdose in the past 12 months.
Being hooked on prescription opioids prior to injection might result in a higher risk profile for persons who inject drugs.
PMCID: PMC5140757  PMID: 27569698
21.  Using Facebook ads with traditional paper mailings to recruit adolescent girls for a clinical trial 
Addictive behaviors  2016;65:207-213.
Clinical trials require sufficient samples recruited within limited time and budget constraints. Trials with minors are additionally burdened by the requirement for youth assent and parental permission. This paper details the use of Facebook ads and traditional paper mailings to enroll 797 adolescent girls for a longitudinal, web-based, drug abuse prevention trial. Data on sample representativeness and retention are also provided.
Facebook ads appeared on the pages of females aged 13 or 14 years who reside in the U.S. Ads linked girls to a recruitment website. Girls who wanted more information submitted contact information and were mailed information packets to their homes containing, among other things, youth assent and parent permission forms. Returned forms were verified for accuracy and validity.
The Facebook ad campaign reached 2,267,848 girls and had a unique click-through rate of 3.0%. The campaign cost $41,202.37 with an average cost of $51.70 per enrolled girl. Information packets were mailed to 1,873 girls. Approximately one-half of girls returned the forms, and 797 girls were enrolled. The Facebook campaign's success varied by ad type, month, and day of the week. Baseline data revealed comparability to national data on demographic and substance use variables.
Results suggest that Facebook ads provide a useful initial point of access to unparalleled numbers of adolescents. Clinical trials may benefit from a two-fold recruitment strategy that uses online ads to attract interested adolescents followed by traditional recruitment methods to communicate detailed information to adolescents and parents.
PMCID: PMC5142762  PMID: 27835860
Facebook; Recruitment; Adolescent; Parental permission; Clinical trial Mail
22.  Combined Treatment for At-Risk Drinking and Smoking Cessation among Puerto Ricans: A Randomized Clinical Trial 
Addictive behaviors  2016;65:185-192.
Tobacco and alcohol use are linked behaviors that individually and synergistically increase the risk for negative health consequences. This study was a two-group, randomized clinical trial evaluating the efficacy of a behavioral intervention, “Motivation And Problem Solving Plus” (MAPS+), designed to concurrently address smoking cessation and the reduction of at-risk drinking. Targeted interventions may promote coaction, the likelihood that changing one behavior (smoking) increases the probability of changing another behavior (alcohol use). Puerto Ricans (N=202) who were smokers and at-risk drinkers were randomized to standard MAPS treatment focused exclusively on smoking cessation (S-MAPS), or MAPS+, focused on cessation and at-risk drinking reduction. Drinking outcomes included: number of at-risk drinking behaviors, heavy drinking, binge drinking, and drinking and driving. MAPS+ did not have a significant main effect on reducing at-risk drinking relative to S-MAPS. Among individuals who quit smoking, MAPS+ reduced the number of drinking behaviors, the likelihood of meeting criteria for heavy drinking relative to S-MAPS, and appeared promising for reducing binge drinking. MAPS+ did not improve drinking outcomes among individuals who were unsuccessful at quitting smoking. MAPS+ showed promise in reducing at-risk drinking among Puerto Rican smokers who successfully quit smoking, consistent with treatment enhanced coaction. Integrating an alcohol intervention into cessation treatment did not reduce engagement in treatment, or hinder cessation outcomes, and positively impacted at-risk drinking among individuals who quit smoking. Findings of coaction between smoking and drinking speak to the promise of multiple health behavior change interventions for substance use treatment and chronic disease prevention.
PMCID: PMC5358923  PMID: 27825036
smoking; at-risk drinking; coaction; multiple health risk behaviors; Latinos
23.  Self-reported attentional and motor impulsivity are related to age at first methamphetamine use 
Addictive behaviors  2016;65:7-12.
Methamphetamine (MA) users report higher levels of impulsivity relative to healthy controls, which may either result from, or precede, their substance use. Further, there is evidence that female MA users may be more impulsive than male MA users prior to MA use. Thus, the goal of the current study was to determine whether different subtraits of self-reported impulsivity are significantly related to age at first MA use, controlling for total years of MA use.
A community sample of MA users was recruited for this study (N = 157; 113 males, 44 females). The Barratt Impulsiveness Scale (BIS-11) was used to assess self-reported impulsivity on three subscales (Attentional, Motor, Non-planning). Age at first MA use served as the dependent variable in a series of multiple regression models with BIS-11 subscales, sex, and their interaction as independent variables, controlling for total years of MA use.
Attentional and Motor impulsivity were significantly related to age at first MA use when controlling for total years of MA use (Attentional: p = 0.008; Motor: p = 0.003).
Individuals who reported higher Attentional and Motor impulsivity started using MA at an earlier age, which could suggest that impulsivity levels may be an important marker of vulnerability towards MA use. These findings indicate that prevention efforts may be targeted towards individuals who report high levels of Attentional and Motor impulsivity, as they may be at greatest risk for earlier initiation of MA use.
PMCID: PMC5382019  PMID: 27701027
Impulsivity; Methamphetamine; Age; Initiation; Attention; Motor
24.  Beverage-Specific Patterns of 5+ Alcoholic Drink Consumption by Young Adults in the U.S 
Addictive behaviors  2016;65:19-24.
Young adult binge drinking prevalence has been widely researched. However, beverage-specific binge drinking rates for beer, liquor, wine, and wine coolers have not yet been documented for this age group. This study examines consumption of specific beverages (i.e., 5+ drinks in a row in the past two weeks) by young adults aged 19/20. Data from the national Monitoring the Future study were collected one or two years after high school from 2004–2014 (n=2004). Logistic regression was used to examine associations between beverage-specific 5+ drinking and gender, race/ethnicity, parent education, college status, and cohort year. Overall 5+ drinking in the past two weeks was reported by 31.4% of young adults. Beverage-specific 5+ drinking was most common with liquor (22.6%) and beer (22.4%), followed by wine (4.5%) and wine coolers (3.0%). Men were more likely than women to engage in 5+ drinking with beer and liquor; women were more likely than men to do so with wine and wine coolers. Beverage-specific patterns differed by college attendance. Compared to four-year college students, two-year college/votech students were less likely to have 5+ drinks of liquor or wine, and more likely to have 5+ wine coolers; those not in college were less likely to have 5+ drinks of liquor and more likely to 5+ wine coolers. Differences in beverage-specific 5+ drinking by gender and college enrollment suggest that intervention efforts should focus on the beverages that are most commonly consumed at high levels within specific early young adult populations.
PMCID: PMC5437705  PMID: 27705842
Young Adult; Binge Drinking; Beverage Type
25.  Medical and nonmedical use of prescription sedatives and anxiolytics: Adolescents’ use and substance use disorder symptoms in adulthood 
Addictive behaviors  2016;65:296-301.
This study assessed the longitudinal associations between medical and nonmedical use of prescription sedatives/anxiolytics (NMPSA) during adolescence (age 18) and substance use disorder (SUD) symptoms during adulthood (age 35).
Multiple cohorts of nationally representative samples of U.S. high school seniors (n = 8,373) were surveyed via self-administered questionnaires and followed longitudinally from adolescence (age 18, 1976–1996) to adulthood (age 35, 1993–2013).
An estimated 20.1% of adolescents reported lifetime medical or nonmedical use of prescription sedatives/anxiolytics. Among adolescents who reported medical use of prescription sedatives/anxiolytics, 44.9% also reported NMPSA by age 18. Based on multivariate analyses that included age 18 sociodemographic and other substance use controls, medical use of prescription sedatives/anxiolytics without any history of NMPSA during adolescence was not associated with SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use. In contrast, adolescents with a history of both medical and nonmedical use of prescription sedatives/anxiolytics and adolescents who reported only NMPSA had between two to three times greater odds of SUD symptoms in adulthood relative to adolescents with no prescription sedative/anxiolytic use and those who reported only medical use of prescription sedatives/anxiolytics.
One in every five U.S. high school seniors report ever using prescription sedatives/anxiolytics either medically or nonmedically. This study provides compelling evidence that the medical use of prescription sedatives/anxiolytics (without any NMPSA) during adolescence is not associated with increased risk of SUD symptoms in adulthood while any NMPSA during adolescence serves as a signal for SUDs in adulthood.
PMCID: PMC5462596  PMID: 27569697
Longitudinal; Medical use; Nonmedical use; Sedative; Anxiolytic; Substance Use Disorders

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