Escalation Of Substance Use Research Articles

Food insecurity and substance use among young adults in the United States

PurposeThe purpose of this study was to examine the association between food insecurity and substance use among young adults aged 18–25 in the U.S. MethodsA cross-sectional online survey was completed by a diverse sample of 1024 young adults (50.2 % female; 62 % non-white; m age = 21.7[SD = 2.26]) between January–April 2022. Logistic regression analyses were used to examine the association between food insecurity and current cigarette use, Electronic Nicotine Delivery System (ENDS) use, cannabis use, alcohol use, and binge drinking controlling for socio-demographic and economic factors, mental health, and experiences of discrimination. ResultsNearly 70 % of participants reported being food insecure over the past year. Substance use was also common: 45.9 % of participants reported current cigarette use, 50.9 % ENDS use, 57 % cannabis use, 65.9 % alcohol use, and 50.4 % engaged in binge drinking in the past two weeks. Being food insecure was associated with greater odds of cigarette use (OR = 2.49, 95 % CI = [1.77, 3.50]), ENDS use (OR = 2.18, 95 % CI = [1.58, 3.01]), cannabis use (OR = 1.73, 95 % CI = [1.26, 2.37]), alcohol use (OR = 1.60, 95 % CI = [1.16, 2.19]) and binge drinking (OR = 1.98, 95 % CI = [1.44, 2.72]), controlling for all other factors. ConclusionFood insecurity may serve as an important indicator of substance use among young adults. Practitioners should consider screening for food insecurity, providing information about food access, and developing interventions to address food insecurity among the young adults with whom they work. Future research should examine these associations prospectively to better understand how food insecurity may contribute to the initiation and/or escalation of substance use.

Continuity and Change in Substance Use Patterns During the Transition from Adolescence to Young Adulthood: Examining Changes in Social Roles

AbstractThis study offers a model for using multidimensional growth mixture models to identify polysubstance use trajectories by examining transitions among conjoint substance use trajectories from adolescence to young adulthood and exploring potential moderators that may facilitate transitions towards healthier substance use trajectories in young adulthood. Longitudinal mixture modeling was used to examine six waves of data collected during adolescence (ages 13, 14, 15) and young adulthood (ages 25, 29, 31) in Seattle, Washington. Data were drawn from the International Youth Development Study, a longitudinal, cross-national study examining the life course patterns of substance use and development among youth. Participants (N = 961) completed questionnaires on six occasions that assessed demographics (sex, race, highest parent education), suspension and expulsion, individual substance use, partner substance use, and social role transitions (education, marriage, childbearing, employment). Four substance use classes were identified in adolescence and included low use (n = 572, 59.6%), alcohol dominant (n = 177, 18.4%), increasing use (n = 103, 10.7%), and poly-use (n = 109, 11.3%). Five substance use classes were identified in young adulthood and included low use (n = 134, 15.3%), alcohol only (n = 349, 39.8%), alcohol and tobacco (n = 97, 11.0%), alcohol and cannabis (n = 162, 18.5%), and poly-use (n = 135, 15.4%). The transition from adolescence to young adulthood showed the strongest continuity in the poly-use class and the weakest in the low use class, with a general trend toward adding substances rather than reducing them. College graduation moderated the transition in substance use patterns from adolescence to young adulthood for low use and alcohol dominant adolescent classes but not for the poly-use class. Delays in adult role assumptions were not consistently associated with substance use classes during this transition. However, where significant, delayed marriage and parenthood acted as protective factors against the progression of substance use leading into young adulthood. The findings underscore the need for early detection and tailored prevention efforts among adolescents. By identifying pivotal periods and specific substance use patterns, these findings inform the timing and focus of targeted interventions designed to reduce the escalation of substance use leading into young adulthood.

Searching for biomarkers in the fluidity of mental ill-health.

Searching for biomarkers in the fluidity of mental ill-health.

Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework.

Major research breakthroughs over the past 30years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."

Bidirectional associations between depressive symptoms and cigarette, e-cigarette, cannabis, and alcohol use: Cross-lagged panel analyses among young adults before and during COVID-19

BackgroundThe literature regarding bidirectional relationships of depressive symptoms to cigarette and alcohol use is mixed, and limited regarding e-cigarette and cannabis use. Moreover, COVID-19 has significantly impacted mental health and substance use, especially among young adults. Thus, this is a critical period for focused research on these relationships among young adults. MethodsWe analyzed longitudinal data (assessments in Fall 2018, 2019, and 2020) from 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 71.6% White, 5.3% Black, 12.2% Asian, 11.4% Hispanic) from 6 US metropolitan statistical areas. Cross-lagged panel models were conducted to examine bidirectional associations between depressive symptoms and past 30-day use of cigarettes, e-cigarettes, cannabis, and alcohol (respectively), controlling for sociodemographics. ResultsDuring the study period, depressive symptoms decreased before the pandemic but increased during, cigarette and e-cigarette use decreased in both periods, alcohol use showed no change before but increases during the pandemic, and cannabis use increased in both periods. Additionally, each outcome demonstrated greater stability before versus during COVID-19. Finally, greater antecedent depressive symptoms correlated with more days of subsequent cigarette (β = 0.03, SE = 0.01, p =.011) and e-cigarette use (β = 0.03, SE = 0.01, p =.021), but fewer days of alcohol use (β = -0.02, SE = 0.01, p =.035). W2 cannabis use and alcohol use, respectively, were related to W3 depressive symptoms (cannabis: β = 0.09, SE = 0.02, p <.001; alcohol: β = 0.06, SE = 0.02, p =.002). No other cross-lagged associations were significant. ConclusionsIntervention efforts targeting depression and substance use should explicitly address the potential for onset and escalation of substance use and depressive symptoms, respectively, especially during societal stressors.

Cognitions mediate the influence of personality on adolescent cannabis use initiation

AimsMuch research indicates that an individual’s personality impacts the initiation and escalation of substance use and problems in youth. The acquired-preparedness model suggests that personality influences substance use by modifying learning about substances, which then affects substance use. The current study used longitudinal data to test whether automatic cannabis-related cognitions (memory associations and outcome expectancy liking) mediate the relationship between four personality traits with later cannabis use. MethodsThe study focused on initiation of use in a sample of adolescents who had not previously used (n = 670). ResultsA structural equation model supported a full mediation effect and the hypothesis that personality affects cannabis use in youth by influencing automatic memory associations and outcome expectancy liking. Further findings from the same model also indicated a mediation effect of these cognitions in the relationship between age and cannabis use. ConclusionThe findings of the study support the acquired-preparedness model where personality influences automatic associations in the context of dual-processing theories of substance use.

Sexually Transmitted Infection Testing After Brief Intervention for Risk Behaviors in School-Based Health Centers

PurposeThe initiation and escalation of substance use and sex behaviors is prevalent during adolescence. School-based health centers (SBHCs) are well-equipped to provide interventions for risky behaviors and offer sexually transmitted infection (STI) testing services. This study examined receipt of STI testing following brief intervention (BI) among sexually active adolescents. MethodsThis is a secondary analysis of data from a randomized trial comparing computer versus nurse practitioner–delivered BI approaches among adolescents (ages 14–18) with risky alcohol and/or cannabis use at two SBHCs within two urban high schools. Associations were examined among receipt of STI testing and participant characteristics, BI format, site, and frequency of substance use/sexual behaviors. ResultsAmong sexually active participants (N = 254), 64.2% received STI testing at their SBHC within 6 months of receiving a BI. Participants receiving nurse practitioner–delivered BI had higher odds of getting STI testing than participants receiving computer-delivered BI (adjusted odds ratio 2.51, 95% confidence interval 1.41–4.47, p = .002). Other variables associated with STI testing in multivariable logistic regression included female sex (p = .001), being in a serious relationship (p = .018), and SBHC site (p < .001). Frequency of substance use and sexual risk behaviors were not independently associated with receipt of STI testing services. ConclusionSexually active adolescents who received in-person BI from a nurse practitioner were more likely to get STI testing than adolescents who received BI via computer. Nurse practitioners working in SBHCs can successfully engage adolescents in additional sexual health services subsequent to BI for risky behaviors.

Effectiveness of a neuroscience-based, harm reduction program for older adolescents: A cluster randomised controlled trial of the Illicit Project

The prevention of risky adolescent substance use is critical. Limited age-appropriate, school-based programs target adolescents aged 16–19 years, despite this representing the age of initiation and escalation of substance use. The Illicit Project is a neuroscience-based, harm reduction program targeting late adolescents, designed to address this gap. The current study aims to evaluate the program’s effectiveness in reducing risky substance use and related harms among late adolescents. A cluster randomised controlled trial was conducted involving 950 students (Mage = 15.9 years SD = 0.68; 60% Female) from eight secondary schools in Australia. Five schools received The Illicit Project program, and three schools were randomised into the active control group (health education as usual). All students completed a self-report survey at baseline and 6-months post-baseline and intervention students completed a program evaluation survey. Outcomes include alcohol and substance use, alcohol related harms and drug literacy levels (knowledge and skills). At 6-months post baseline, individuals in the intervention group were less likely to engage in weekly binge drinking (OR = 0.56), high monthly alcohol consumption (OR = 0.56), early onset cannabis use (OR = 0.35), risky single occasion cannabis use (OR = 0.48), MDMA use (OR = 0.16) or nicotine product use (OR = 0.59) compared to the control group. Students in the intervention group were less likely to have experience alcohol related harms (OR = 0.57) and more likely to have higher drug literacy scores (β = 2.44) at follow-up. These preliminary results support the effectiveness of The Illicit Project. Further follow-up is required to determine the durability of the results over time.

Pain Management and Risks Associated With Substance Use: Practice Recommendations

Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. Opioid use disorder is used as an exemplar for substance use disorders and clinical recommendations are included with expanded attention to risk assessment and mitigation with interventions targeted to minimize the risk for relapse or escalation of substance use. Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.

A Mobile Phone-Based Life-Skills Training Program for Substance Use Prevention Among Adolescents: Cluster-Randomized Controlled Trial.

BackgroundLife skills are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life. Life-skills training programs conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones may provide a more economic and scalable approach.ObjectiveThe goal of this study was to test the appropriateness (ie, acceptance, use, and evaluation) and short-term efficacy of a mobile phone–based life-skills training program to prevent substance use among adolescents within a controlled trial.MethodsThe study design was a two-arm, parallel-group, cluster-randomized controlled trial with assessments at baseline and follow-up assessments after 6 and 18 months. This report includes outcomes measured up to the 6-month follow-up. The efficacy of the intervention was tested in comparison to an assessment-only control group. The automated intervention program SmartCoach included online feedback and individually tailored text messages provided over 22 weeks. The contents were based on social cognitive theory and addressed self-management skills, social skills, and substance use resistance skills. Linear mixed models and generalized linear mixed models, as well as logistic or linear regressions, were used to investigate changes between baseline and 6-month follow-up in the following outcomes: 30-day prevalence rates of problem drinking, tobacco use, and cannabis use as well as quantity of alcohol use, quantity of cigarettes smoked, cannabis use days, perceived stress, well-being, and social skills.ResultsA total of 1759 students from 89 Swiss secondary and upper secondary school classes were invited to participate in the study. Of these, 1473 (83.7%) students participated in the study; the mean age was 15.4 years (SD 1.0) and 55.2% (813/1473) were female. Follow-up assessments at 6 months were completed by 1233 (83.7%) study participants. On average, program participants responded to half (23.6 out of 50) of the prompted activities. Program evaluations underlined its appropriateness for the target group of secondary school students, with the majority rating the program as helpful and individually tailored. The results concerning the initial effectiveness of this program based on 6-month follow-up data are promising, with three of nine outcomes of the intention-to-treat analyses showing beneficial developments of statistical significance (ie, quantity of alcohol use, quantity of tobacco use, and perceived stress; P<.05) and another three outcomes (ie, problem drinking prevalence, cannabis use days, and social skills) showing beneficial developments of borderline significance (P<.10).ConclusionsThe results showed good acceptance of this intervention program that could be easily and economically implemented in school classes. Initial results on program efficacy indicate that it might be effective in both preventing or reducing substance use and fostering life skills; however, data from the final 18-month follow-up assessments will be more conclusive.Trial RegistrationISRCTN Registry ISRCTN41347061; https://doi.org/10.1186/ISRCTN41347061

Psychosocial predictors of substance use in adolescents and young adults: Longitudinal risk and protective factors

Many psychosocial factors have been implicated in the onset and escalation of substance use in adolescence and young adulthood. Typically, each factor explains a small amount of the variance in substance use outcomes, and effects are typically applied across a broad range of ages or computed from cross-sectional data. The current study evaluated the association of factors including social influence (e.g., peer substance use), cognitive features (e.g., alcohol expectancies), and personality and emotional characteristics (e.g., impulsivity and typical responses to stress) in substance use throughout adolescence and emerging adulthood (ages 13–25; N = 798). Mixed-effects models tailored for the accelerated longitudinal design employed in this study were constructed with psychosocial and developmental factors predicting alcohol and cannabis use. As most participants in the sample exhibited little or no substance use at baseline by design, we excluded baseline assessments and examined data from follow-up years 1, 2, 3, and 4. Interactions between age cohort, change in age, and psychosocial predictors of substance use revealed differing associations over the developmental window for alcohol and cannabis use. For example, positive alcohol expectancies and sensation seeking were most strongly associated with greater drinking after age 18, whereas sensation seeking was associated with increased cannabis use as early as age 15. Higher emotion regulation skills led to less cannabis use in younger ages (i.e., shallower slopes below age 17), but this protective effect diminished after age 17. Results highlight developmentally important factors that differentially contribute to substance use in adolescence and young adulthood. We also demonstrate the importance of developmentally sensitive analyses that maximize the value of data from accelerated longitudinal designs.

Adolescent emotional disorder symptoms and transdiagnostic vulnerabilities as predictors of young adult substance use during the COVID-19 pandemic: mediation by substance-related coping behaviors

ABSTRACT The COVID-19 pandemic presents unique stressors (e.g. social isolation) that may increase substance use risk among young adults with a history of emotional disturbance. This study examined whether emotional disorder symptoms and transdiagnostic vulnerabilities during adolescence predicted young adult substance use during COVID-19, and whether using substances to cope with the pandemic’s social conditions mediated these associations. Adolescents (N = 2,120) completed baseline surveys assessing transdiagnostic emotional vulnerabilities (anhedonia, distress intolerance, anxiety sensitivity, negative urgency) and symptoms (major depression[MD], generalized anxiety[GAD], panic disorder[PD], social phobia[SP], obsessive-compulsive disorder[OCD]) in adolescence (September–December 2016; M[SD] age = 17.45[0.38]). At follow-up (May–August 2020; M[SD] age = 21.16[0.39]), past 30-day substance use and using substances to cope with social isolation during the pandemic were reported. Adjusted models showed that baseline distress intolerance, anxiety sensitivity, negative urgency, and MD symptoms each significantly predicted higher number of past-month single-substance using days and number of substances used at follow-up (βs = 0.04–0.06). In each case, associations were mediated by tendency to use substances to cope with the pandemic (βindirect range: 0.028–0.061). To mitigate disproportionate escalation of substance use in young adults with a history of certain types of emotional disturbance, interventions promoting healthy coping strategies to deal with the pandemic’s social conditions warrant consideration.

First results on the efficacy of a digital life-skills program for substance use prevention

Abstract Background Life-skills trainings conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones might represent a more economic and scalable approach. Methods The efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents is currently tested in comparison to an assessment only control group, within a cluster-randomised controlled trial with follow-up assessments after 6 and 18 months. The fully automated program is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Participants of the intervention group receive up to 4 individually-tailored text messages per week for a period of 6 months. The study started in 2019 and aims for 1,312 study participants between the ages of 14 and 16 years from approx. 100 secondary school classes in Switzerland. Outcomes are 1) problem drinking, 2) cigarette smoking, 3) perceived stress and 4) interpersonal competences. Results So far, 1'611 students within 88 secondary school classes were invited to participate in the study. Of these, 1,450 (90.0%) consented to participate. To date, 24 out of 726 (3.3%) participants of the intervention group discontinued the program and 945 (65.2%) were invited for 6-month follow-up. Of these, 752 (79.6%) completed the assessment. Preliminary analyses showed a beneficial effect of the intervention for the subscale negative assertion, assessed by the brief version of the Interpersonal Competence Questionnaire. Conclusions A large proportion of adolescents participated in this first study testing the efficacy of a mobile phone-based life-skills training for substance use prevention and the majority of them participated at 6-month follow-up. Key messages A novel, mobile phone-based life-skills training seems widely accepted by secondary students. Given its effectiveness, it could be economically implemented within secondary schools.

Screened Attention Deficit/Hyperactivity Disorder as a Predictor of Substance Use Initiation and Escalation in Early Adulthood and the Role of Self-Reported Conduct Disorder and Sensation Seeking: A 5-Year Longitudinal Study with Young Adult Swiss Men

Background: Attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and sensation seeking (SS) have been consistently related to a higher risk of substance use (SU) and substance use disorder (SUD). Objectives: To investigate the relationship between ADHD and prevalence rates in males at age 20 and age 25, the initiation of SU and SUD after age 20, and the escalation of SU from age 20 to age 25, and to explore the role of CD and SS in the relation of ADHD with SU and SUD initiation and escalation. Method: Data were obtained as part of the Cohort Study on Substance Use Risk Factors (C-SURF), which focused on young Swiss men aged 20 years at baseline and 25 years at follow-up. Results: Participants who screened positive for ADHD at baseline exhibited a higher rate of SU and SUD than participants who screened negative. The presence of ADHD symptoms at age 20 predicted initiation of all SU between age 20 and age 25, except for alcohol and smoking. After controlling for self-reported CD and SS, ADHD still predicted this late initiation of use of hallucinogens, meth-/amphetamines, and ecstasy/MDMA; non-medical use of ADHD medication and sedatives, and alcohol use disorder (AUD). No escalation of weekly drinking and smoking or annual cannabis use was observed from age 20 to age 25. Conclusion: Screened-positive ADHD is an independent predictor of late SU and AUD, along with self-reported CD and SS. From a public health perspective, identifying ADHD is not only important in childhood and adolescence but also in early adulthood to guide specific interventions to lower risks of drug use initiation and the development of AUD in early adulthood.

Impaired cognitive performance under psychosocial stress in cannabis-dependent men is associated with attenuated precuneus activity

Deficient regulation of stress plays an important role in the escalation of substance use, addiction and relapse. Accumulating evidence suggests dysregulations in cognitive and reward-related processes and the underlying neural circuitry in cannabis dependence. However, despite the important regulatory role of the endocannabinoid system in the stress response, associations between chronic cannabis use and altered stress processing at the neural level have not been systematically examined. Against this background, the present functional MRI study examined psychosocial stress processing in cannabis-dependent men (n = 28) and matched controls (n = 23) using an established stress-induction paradigm (Montreal Imaging Stress Task) that combines computerized (adaptive) mental arithmetic challenges with social evaluative threat. During psychosocial stress exposure, but not the no-stress condition, cannabis users demonstrated impaired performance relative to controls. In contrast, levels of experienced stress and cardiovascular stress responsivity did not differ from controls. Functional MRI data revealed that stress-induced performance deteriorations in cannabis users was accompanied by decreased precuneus activity and increased connectivity of this region with the superior frontal gyrus. Only male cannabis-dependent users were examined; the generalizability in female users remains to be determined. Together, the present findings provide first evidence for exaggerated stress-induced cognitive performance deteriorations in cannabis users. The neural data suggest that deficient stress-related recruitment of the precuneus may be associated with the deterioration of performance at the behavioural level.

Profiles of Childhood Trauma in Women With Substance Use Disorders and Comorbid Posttraumatic Stress Disorders

Background: It is increasingly becoming accepted that substance use disorders, including substance abuse and substance dependence, are closely related to childhood trauma and posttraumatic stress disorders. Among women with substance use disorders, the majority report sexual, physical or emotional abuse, or neglect. However, it is poorly understood which types of childhood trauma co-occur in women with substance use disorders and how combinations of different types and severities of childhood trauma are related to clinical characteristics. This information is important to inform treatment of substance use disorders. Aim: The first aim of this research was to investigate profiles of childhood trauma in female patients with substance use disorders and posttraumatic stress disorders. The second aim was to examine relationships between these childhood trauma profiles and addiction characteristics or current clinical symptoms. Methods: We includeda 343 treatment-seeking women with substance use disorders and comorbid posttraumatic stress disorders according to DSM-IV. Five types of childhood trauma (sexual abuse, physical abuse, emotional abuse) were measured using the Childhood Trauma Questionnaire. Addiction characteristics were assessed by using the Addiction Severity Index-lite. Current severity of clinical symptoms was determined by the Symptom-Checklist-27. Latent profile analysis was conducted to distinguish profiles of childhood trauma. Analysis of variance was applied to examine the relationship between childhood trauma profiles and addiction characteristics or severity of clinical symptoms. Results: Nine out of ten women reported at least one type of childhood abuse or neglect. Four different childhood trauma profiles could be distinguished that characterized different types and severities of childhood trauma: ‘Low trauma’; ‘Moderate sexual abuse and emotional abuse’; ‘Severe sexual abuse and emotional abuse’; and ‘Severe levels of all types of trauma’. Profiles with more severe levels of childhood trauma showed an earlier age at initiation and escalation of substance use. Furthermore, childhood trauma profiles were related to current severity of depressive symptoms, dysthymic symptoms, sociophobic symptoms, and distrust. Conclusion: In women with substance use disorders and posttraumatic stress disorders, childhood trauma profiles can inform about addiction characteristics and severity of a wide range of clinical symptoms. This information is essential to understand current treatment needs and should be systematically assessed in women with substance use disorders and trauma exposure.

Sexual minority female youth and substance use disparities across development

Objectives: To estimate individual and group trajectories of substance use among heterosexual and sexual minority adolescent females (SMFs) and evaluate longitudinal substance use disparities.Methods: Annual self-reported substance use data (frequency of cigarette, alcohol, and marijuana use) across ages 13–20 years were used to estimate individual and group trajectories using the Pittsburgh Girls Study—a large population-based study of urban-living adolescents. Participants were 2263 females (ages 13–16 years at baseline of current analysis) who were 60% racial/ethnic minority, and 17% sexual minority (lesbian or bisexual). Multilevel models compared SMF versus heterosexual differences in substance use over time controlling for race, single parent status, public assistance status, and caregivers’ low education status.Results: SMFs reported higher frequencies of cigarette, alcohol, and marijuana use across the entire age continuum. SMFs demonstrated more rapid escalations in substance use during early adolescence resulting in larger substance use disparities by the time they reached emerging adulthood.Conclusions: Early adolescence is a critical period of risk for increases in substance use among SMFs. Early intervention and prevention efforts may help reduce the rapid escalation in substance use and decrease substance use disparities over time.

The role of energy drink consumption in the intention to initiate marijuana use among adolescents

AimsThe current study aims to examine whether energy drink consumption is associated with intentions to try marijuana among adolescents who have never tried marijuana, and whether the effects of energy drink consumption on the intention to try marijuana vary between adolescents who have previously tried alcohol or cigarettes and those who have not. MethodsThis study employs a pooled cross-sectional design and uses a nationally representative sample of 8th (ages 13–14) and 10th (ages 15–16) grade adolescents from seven recent cohorts (2010–2016) of the Monitoring the Future (MTF) study. Logistic regression was employed to examine the association between energy drink consumption (none, light, moderate, heavy) and the odds of intending to initiate marijuana use in the next 12 months, controlling for sociodemographic factors and other health and social behaviors. ResultsThe results indicate that energy drink consumers are significantly more likely to intend to initiate marijuana use relative to non-consumers of energy drinks. Specifically, youth who heavily use energy drinks have significantly higher odds of having the intention to use marijuana in the near future than youth who consume energy drinks moderately or lightly. Additionally, evidence suggests that the relationship between energy drink consumption and the intention to use marijuana is moderated by use of other substances. ConclusionsThe current study suggests that energy drink consumption (particularly heavy consumption) may be one early precursor in the escalation of substance use. It may be beneficial to include energy drinks in drug education curriculums.

Efficacy of a mobile phone-based life-skills training program for substance use prevention among adolescents: study protocol of a cluster-randomised controlled trial

BackgroundLife-skills trainings conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones might represent a more economic and scalable approach. The main objective of the planned study is to test the efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents within a controlled trial.Methods/designThe efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents will be tested in comparison to an assessment only control group, within a cluster-randomised controlled trial with two follow-up assessments after 6 and 18 months. The fully automated program is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Participants of the intervention group will receive up to 4 weekly text messages over 6 months in order to stimulate (1) positive outcome expectations, e.g., on using self-management skills to cope with stress, (2) self-efficacy, e.g., to resist social pressure, (3) observational learning, e.g. of interpersonal competences, (4) facilitation, e.g., of strategies to cope with negative emotions, and (5) self-regulation, e.g., by self-monitoring of stress and emotions. Active program engagement will be stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collect credits with each interaction. Study participants will be 1312 students between the ages of 14 and 16 years from approximately 100 secondary school classes. Primary outcome criteria will be problem drinking according to the short form of the Alcohol Use Disorders Identification Test and cigarette smoking within the last 30 days preceding the follow-up assessment at month 18.DiscussionThis is the first study testing the efficacy of a mobile phone-based life-skills training for substance use prevention among adolescents within a controlled trial. Given that this intervention approach proves to be effective, it could be easily implemented in various settings and would reach large numbers of young people in a cost-effective way.Trial registrationISRCTN41347061 (registration date: 21/07/2018).

Polydrug use trajectories and differences in impulsivity among adolescents

Background/Objective: Although alcohol, tobacco and cannabis are the most widely consumed drugs, sparse data exist regarding polydrug use in adolescents and its relationship with impulsivity. This study aims to identify trajectories of polydrug use and analyze differences in impulsivity between them. Method: A total of 1,565 adolescents (54.4% males; mean age = 13.02, SD = 0.57) were annually assessed over three years using the Barratt Impulsiveness Scale, the Zuckerman Impulsive Sensation Seeking Scale, a Stroop Test and a Delay Discounting Task. Frequency of alcohol, tobacco, and cannabis use, intoxication episodes and problem drinking were also assessed. Polydrug trajectories were identified using latent class mixed modelling. To examine differences in self-reported and behavioral impulsivity two mixed multivariate analyses of covariance were used. Results: Three trajectories of substance use were found. The ‘Experimental use’ and the ‘Early use’ trajectories presented the lowest and highest impulsivity, respectively. Substance use increases in the ‘Telescoped used’ trajectory were associated with parallel increases in impulsivity. Conclusions: individuals with divergent patterns of substance use during adolescence differ in their impulsiveness, primarily in general impulsivity and sensation seeking. Present findings suggest the relevance of these facets as possible targets for interventions preventing the onset and escalation of substance use.