Past 30-day Alcohol Use Research Articles

Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults.

BackgroundTobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time.ObjectiveThe aim of this study was to describe two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies for the US Food and Drug Administration’s This Free Life campaign evaluation targeting LGBT young adults who smoke cigarettes occasionally.MethodsWe recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads (N=1709, mean age 20.94, SD 1.94) or intercept in LGBT social venues (N=2348, mean age 21.98, SD 1.69) for the baseline evaluation survey. Covariates related to recruitment strategy were age; race or ethnicity; LGBT identity; education; pride event attendance; and alcohol, cigarette, and social media use.ResultsLesbian or gay women (adjusted odds ratio, AOR 1.88, 95% CI 1.54-2.29, P<.001), bisexual men and women (AOR 1.46, 95% CI 1.17-1.82, P=.001), gender minorities (AOR 1.68, 95% CI 1.26-2.25, P<.001), and other sexual minorities (AOR 2.48, 95% CI 1.62-3.80, P<.001) were more likely than gay men to be recruited via social media (than intercept). Hispanic (AOR 0.73, 95% CI 0.61-0.89, P=.001) and other or multiracial, non-Hispanic participants (AOR 0.70, 95% CI 0.54-0.90, P=.006) were less likely than white, non-Hispanic participants to be recruited via social media. As age increased, odds of recruitment via social media decreased (AOR 0.76, 95% CI 0.72-0.80, P<.001). Participants with some college education (AOR 1.27, 95% CI 1.03-1.56, P=.03) were more likely than those with a college degree to be recruited via social media. Participants reporting past 30-day alcohol use were less likely to be recruited via social media (AOR 0.33, 95% CI 0.24-0.44, P<.001). Participants who reported past-year pride event attendance were more likely to be recruited via social media (AOR 1.31, 95% CI 1.06-1.64, P=.02), as well as those who used Facebook at least once daily (AOR 1.43, 95% CI 1.14-1.80, P=.002). Participants who reported using Instagram at least once daily were less likely to be recruited via social media (AOR 0.73, 95% CI 0.62-0.86, P<.001). Social media recruitment was faster (incidence rate ratio, IRR=3.31, 95% CI 3.11-3.52, P<.001) and less expensive (2.2% of combined social media and intercept recruitment cost) but had greater data quality issues—a larger percentage of social media respondents were lost because of duplicate and low-quality responses (374/4446, 8.41%) compared with intercept respondents lost to interviewer misrepresentation (15/4446, 0.34%; P<.001).ConclusionsSocial media combined with intercept provided access to important LGBT subpopulations (eg, gender and other sexual minorities) and a more diverse sample. Social media methods have more data quality issues but are faster and less expensive than intercept. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods’ promise for accessing hard-to-reach populations.

An Algorithm for Creating Virtual Controls Using Integrated and Harmonized Longitudinal Data.

We introduce a strategy for creating virtual control groups-cases generated through computer algorithms that, when aggregated, may serve as experimental comparators where live controls are difficult to recruit, such as when programs are widely disseminated and randomization is not feasible. We integrated and harmonized data from eight archived longitudinal adolescent-focused data sets spanning the decades from 1980 to 2010. Collectively, these studies examined numerous psychosocial variables and assessed past 30-day alcohol, cigarette, and marijuana use. Additional treatment and control group data from two archived randomized control trials were used to test the virtual control algorithm. Both randomized controlled trials (RCTs) assessed intentions, normative beliefs, and values as well as past 30-day alcohol, cigarette, and marijuana use. We developed an algorithm that used percentile scores from the integrated data set to create age- and gender-specific latent psychosocial scores. The algorithm matched treatment case observed psychosocial scores at pretest to create a virtual control case that figuratively "matured" based on age-related changes, holding the virtual case's percentile constant. Virtual controls matched treatment case occurrence, eliminating differential attrition as a threat to validity. Virtual case substance use was estimated from the virtual case's latent psychosocial score using logistic regression coefficients derived from analyzing the treatment group. Averaging across virtual cases created group estimates of prevalence. Two criteria were established to evaluate the adequacy of virtual control cases: (1) virtual control group pretest drug prevalence rates should match those of the treatment group and (2) virtual control group patterns of drug prevalence over time should match live controls. The algorithm successfully matched pretest prevalence for both RCTs. Increases in prevalence were observed, although there were discrepancies between live and virtual control outcomes. This study provides an initial framework for creating virtual controls using a step-by-step procedure that can now be revised and validated using other prevention trial data.

Familial alcohol supply, adolescent drinking and early alcohol onset in 45 low and middle income countries

AimsThis study estimated the extent of familial alcohol supply in 45 low and middle income countries (LMIC), and examined the country-level effects of familial alcohol supply on adolescents’ alcohol use. MethodWe used data from 45 LMICs that participated in the Global School-Based Student Health Survey (GSHS) between 2003 and 2013 (n = 139,840). The weighted prevalence of familial alcohol supply in each country was estimated. Multilevel binary and ordinal logistic regression analyses were used to examine the country-level effect of familial alcohol supply on early onset of alcohol use (first alcohol before 12), past 30-day alcohol use, lifetime drunkenness and alcohol-related social problems. ResultsThere were large variations between LMICs in the prevalence of familial alcohol supply and pattern of adolescent alcohol use. The prevalence of familial supply ranged from 0.1% in Tajikistan to 23.8% in St Lucia. It was estimated that a one percentage change in prevalence of familial alcohol supply was associated with 10%, 12% and 12% change in the odds of lifetime drunkenness (OR = 1.10, 95% CI = [1.04, 1.16]), early onset of alcohol use (OR = 1.12, 95% CI = [1.07, 1.08]) and more frequent drinking in the past month (OR = 1.12, 95% CI = [1.04, 1.20]). ConclusionThere were large variations in the prevalence of familial alcohol supply and adolescent alcohol use among LMICs. Adolescents in countries with higher prevalence of familial alcohol supply were more likely to start using alcohol at an earlier age, to have used alcohol in the past 30 days and experience intoxication.

Age-Specific Associations Between Violence Exposure and Past 30-Day Marijuana and Alcohol Use.

Using data from a cohort study of students at risk for high school dropout, we examined associations between violence exposure and past 30-day alcohol and marijuana use. We used varying-coefficient regression with person-level fixed effects to estimate how those associations changed within-person across ages approximately 14-23. Generally, violence perpetration was most strongly associated with substance use, within-person. Substance use became increasingly associated with both observed violence and violence perpetration during early/middle adolescence; this increase continued longer into development (age 18+) for alcohol use. Across most of the age range studied here, violence victimization was minimally associated with within-person changes in substance use. Results indicate age-specific associations between violence exposure and alcohol and other drug use, which may be useful for informing prevention strategies.

Race/Ethnicity Differences in Trends of Marijuana, Cigarette, and Alcohol Use Among 8th, 10th, and 12th Graders in Washington State, 2004-2016.

Accurate estimates of substance use in the teenage years by race/ethnicity may help identify when to intervene to prevent long-term substance use disparities. We examined trends in past 30-day use of marijuana, cigarette, and alcohol among 8th, 10th, and 12th graders in Washington State, which passed a recreational marijuana law in 2012 and initiated retail marijuana sales in 2014. Data are from the 2004-2016 Washington Healthy Youth Surveys (n = 161,992). We used time series regression models to assess linear and quadratic trends in substance use for the full sample and stratified on race/ethnicity and grade level and examined relative differences in prevalence of use by race/ethnicity. In Washington, across all racial/ethnic groups, marijuana use peaked in 2012. Although there was not a significant overall change in marijuana use for the full sample across the study period, there was a statistically significant increase in use among 12th graders and a statistically significant decrease among 8th graders. Relative to Whites, Asians had a lower prevalence of marijuana use, whereas all other race/ethnicity groups had a higher prevalence of use. Prevalence of marijuana use is particularly high among American Indian/Alaska Native and Black youth and has increased most rapidly among 12th grade Hispanic/Latinx youth. There were large and statistically significant decreases in alcohol and cigarette use across the study period for the full sample, as well as for each race/ethnicity group. These findings highlight the need for continued monitoring of trends in use among these groups and potentially warrant consideration of selective interventions that specifically focus on students of color and that include developmentally-appropriate strategies relevant to each grade.

Heterogeneity of state medical marijuana laws and adolescent recent use of alcohol and marijuana: Analysis of 45 states, 1991–2011

Objective: To assess associations between enactment of state medical marijuana laws (MMLs), MML restrictiveness, and past-30-day youth alcohol use overall, and in relation to marijuana use. Method: This quasi-experimental difference-in-difference designed study used state-level Youth Risk Behavior Survey data of 9th–12th grade students in 45 states from 1991–2011 (N D 715,014). We conducted bivariate (unadjusted) and multivariable (adjusted for state, year, individual characteristics) logistic regression analyses to examine the effect of MML enactment (yes/no) and less restrictive vs. more restrictive MMLs on five varying measures of past 30-day alcohol use (i.e., any use or binge) and alcohol and marijuana use behaviors. Results: In the final adjusted analyses, MML enactment was associated with lower odds of adolescent past 30-day (1) alcohol use (OR D 0.92, [0.87, 0.97], p < .01) and (2) use of both alcohol and marijuana (OR D 0.93, [0.87, 0.99], p < .05). States with less restrictive MMLs had lower odds of past 30-day (1) alcohol use (OR D 0.94, [0.92, 0.97], p < .001), (2) binge drinking (OR D 0.96, [0.93, 0.97], p < .05), (3) alcohol use without any marijuana use (OR D 0.96, [0.93, 0.99], p < .01), and (4) use of both alcohol and marijuana (OR D 0.96, [0.92, 0.99], p < .05). Conclusions: This study found that enactment of any MML, and of less restrictive MMLs, was associated with lower odds of past 30-day adolescent alcohol use among adolescents. With continued change in state marijuana laws, it is important to monitor the effect of their enactment and implementation, as well as their specific provisions (e.g. dispensaries, home cultivation), which may differentially affect adolescent behaviors.

Prevalence and correlates of binge drinking among older adults with multimorbidity

BackgroundBinge drinking among older adults has increased in the past decade. Binge drinking is associated with unintentional injuries, medical conditions, and lower health-related quality of life. No studies have characterized multimorbidity among older binge drinkers. MethodsWe examined past 30-day binge alcohol use and lifetime medical conditions among adults age ≥50 from the National Survey on Drug Use and Health from 2005 to 2014. Self-reported lifetime prevalence of 13 medical conditions and medical multimorbidity (≥2 diseases) among binge drinkers were compared to non-binge drinkers. Multivariable logistic regression models were used to examine correlates of binge alcohol use among older adults with medical multimorbidity. ResultsAmong adults aged ≥50, 14.4% reported past-month binge drinking. Estimated prevalence of medical multimorbidity was lower (21.4%) among binge drinkers than non-binge drinkers (28.3%; p < 0.01). Binge drinkers were more likely to use tobacco and illegal drugs than non-binge drinkers (ps < 0.001). In the adjusted model, among older adults with multimorbidity, higher income (AOR = 1.44, p < 0.05), past-month tobacco use (AOR = 2.55, p < 0.001) and substance use disorder for illegal drugs (AOR = 1.80, p < 0.05) was associated with increased odds of binge alcohol use. ConclusionThe prevalence of multimorbidity was lower among current binge drinkers compared to non-binge drinkers, possibly because older adults in good health are apt to drink more than adults in poorer health. Current use of tobacco and substance use disorder were associated with an increased risk for binge drinking among older adults with multimorbidity. Binge drinking by older adults with multimorbidity may pose significant health risks especially with the concurrent use of other substances.

Marijuana use predicts onset of current little cigar use in a national sample of US young adults

BackgroundThis study examined whether young adult marijuana use increases risk of subsequent large cigar (LC) and little cigar/cigarillo (LCC) use among naïve users. MethodsData were from 8 waves of the Truth Initiative Young Adult Cohort, a national sample of US young adults aged 18–34 assessed every 6 months. Discrete-time survival analyses examined whether baseline ever marijuana use among never cigar users predicted onset of past 30-day LC and LCC use and whether baseline ever LC and LCC use among never marijuana users predicted onset of past 30-day marijuana use. Models adjusted for demographics, past 30-day alcohol use, past 30-day tobacco product use, and menthol tobacco use. ResultsIn adjusted models, baseline ever marijuana use predicted onset of past 30-day LCC but not LC use. Cumulative risk ratios showed that 23% of ever marijuana users at baseline reported past 30-day use of LCCs by the end of wave 8 compared to just 3% of baseline never marijuana users. Race and past 30-day use of specific tobacco products also predicted onset of past 30-day LC and LCC use. Past 30-day use of alcohol uniquely predicted onset of past 30-day LCC use but not LC use. Baseline ever LC and LCC use did not predict onset of past 30-day marijuana use in models that adjusted for demographics, alcohol, and specific tobacco product use. ConclusionsEver marijuana use among US young adults may be an important predictor of onset of regular LCC use. Findings suggest different pathways linking marijuana to different cigar sub-types.

Sex and orientation identity matter in the substance use behaviors of sexual minority adolescents in the United States

BackgroundHealth sciences researchers are beginning to understand the differing experiences and health risks among sexual minority subgroups (i.e., those who describe themselves as homosexual/gay/lesbian, bisexual, or unsure/questioning). Such research can promote the allocation of resources to high-risk groups and the development of interventions tailored to their needs. The present study extends this line of research to substance use among adolescents. MethodsThe lifetime and/or past 30-day alcohol, tobacco, cigarette, e-cigarette, marijuana, prescription drug, and illicit drug use of sexual minority and heterosexual adolescents was analyzed using data from the 2015 National Youth Risk Behavior Survey. Controlling for confounders, separate logistic regression models were fit for each substance use outcome. A simulation-based strategy was employed to report adjusted risk ratios for each substance use outcome for each sexual minority subgroup. ResultsSexual minority females, particularly bisexual females, were at an elevated risk for substance use. For example, compared to heterosexual females, sexual minority females were 1.35 (95%CI 1.16–1.56) times more likely to have used a substance in the past 30 days, and bisexual females had an even further elevated risk ratio (RR: 1.48, 95%CI 1.28–1.69). ConclusionsStudying the variance among sexual minority subgroups will help practitioners, advocates, and policymakers identify high risk subgroups. In the case of substance use, this study suggests sexual minority females, particularly bisexual females, should become a target population for prevention and other interventions. The study conducts post-hoc analyses on secondary data, and so these results should be verified in more targeted studies.

Prevalence of Substance Use among Lesbian, Gay, Bisexual, and Transgender Youth in Military Families: Findings from the California Healthy Kids Survey

ABSTRACTBackground: In addition to the challenges associated with military life, lesbian, gay, bisexual, and transgender (LGBT) youth in military families may face stressors associated with having a stigmatized sexual orientation and/or gender identity or expression, placing them at risk of substance use. To the authors' knowledge, this is the first study exploring substance use outcomes among LGBT youth in military families. Objectives: This study assessed the role of military connection, LGB identity, and transgender identity on lifetime and past 30-day substance use. Methods: This study is a secondary data analysis of the 2013–2015 California Healthy Kids Survey (CHKS). The study's participants (n = 634,978) were students attending middle and high schools in nearly all school districts in California. The study outcomes were lifetime and past 30-day cigarette, alcohol, tobacco, and marijuana use. Chi-square tests of associations (including cross-tabulations) and multivariate logistic regressions were conducted to address the study aims. Results: Multivariate logistic regression results indicated that military connection, LGB identity, and transgender identity were significantly associated with an increased odd of lifetime and past 30-day substance use. Compared to military non-transgender youth, military transgender youth had an increased likelihood of past 30-day cigarette use and past 30-day alcohol use. In addition, military LGB youth were 3.62 times as likely as military non-LGB youth to report past 30-day cigarette use. Conclusions/Importance: This study provides researchers with knowledge about the behavioral health of LGBT youth in military families, a vulnerable subgroup within the military-connected youth population, thus informing substance use prevention programs.

School-Based Health Centers and Adolescent Substance Use: Moderating Effects of Race/Ethnicity and Socioeconomic Status.

School-based health centers (SBHCs) have been associated with many positive health and academic outcomes. The current study extends previous research and examines possible differences in the association between SBHC exposure and adolescent alcohol, tobacco, and other drug use by race/ethnicity, sex, and socioeconomic status (SES). California Healthy Kids Survey data from 504 traditional high schools in California were linked with publicly available data on SBHCs and school demographics. Multilevel logistic regression analyses were conducted controlling for school and individual characteristics. Significant interactions suggest that SBHC exposure was inversely associated with past 30-day alcohol use, binge drinking, and cigarette and e-cigarette use among African American youth and negatively associated with cigarette and marijuana use among Asian youth, relative to whites. There was also a significant interaction between SBHC exposure and parent education for past 30-day alcohol use and binge drinking. No significant sex interactions were observed. SBHC exposure appears to be inversely related to substance use among youth in some ethnic minority groups and youth of lower SES. This may have implications regarding SBHC placement and investment. Additional research is necessary to understand the mechanisms through which SBHCs may influence adolescent substance use and other health behaviors.

The relationship between family-based adverse childhood experiences and substance use behaviors among a diverse sample of college students

IntroductionResearch suggests that college students are an especially vulnerable subset of the population for substance use and misuse. However, despite evidence of the high prevalence of adverse childhood experiences (ACE) among students and the link between family-based ACE and substance use among older adults, this relationship remains understudied in college populations. Moreover, whether ACE represents a shared risk across substance use behaviors and ethnic groups is unknown. MethodsData are student responses (n=2953) on the 2015 American College Health Association's National College Health Assessment II (ACHA-NCHA II) administered at one of the largest, most diverse public universities in California. Multivariable logistic and negative binomial regression models tested the association between individual and accumulated ACE and past 30-day alcohol, tobacco, marijuana, and illicit drug use, past 12-month prescription medication misuse and polysubstance use. ResultsBetween 50% and 75% of students involved in substance use were ACE exposed. There was a significant dose-response relationship between ACE and substance use and polysubstance use. Although accumulated ACE increased risk for substance use, there was considerable ethnic variability in these associations. ConclusionsThe graded effects of ACE for substance use underscore the link between family-based stressors and these behaviors in emergent adult college students. Our findings make a compelling case for investing in health initiatives that prioritize ACE screening and access to trauma-informed care in campus communities. Continued research with college populations is needed to replicate findings and clarify the role of ethnicity and culture in trauma response and help seeking behaviors.

Treating Smoking in Adults With Co-occurring Acute Psychiatric and Addictive Disorders.

Tobacco use is undertreated in individuals with psychiatric and substance use disorders (SUDs), with concerns that quitting smoking may compromise recovery. We evaluated outcomes of a tobacco intervention among psychiatric patients with co-occurring SUDs. Data from 2 randomized tobacco treatment trials conducted in inpatient psychiatry were combined; analyses focused on the subsample with co-occurring SUDs (n = 216). Usual care provided brief advice to quit and nicotine replacement therapy during the smoke-free hospitalization. The intervention, initiated during hospitalization and continued 6 months after hospitalization, was tailored to readiness to quit smoking, and added a computer-assisted intervention at baseline, and 3 and 6 months; brief counseling; and 10 weeks of nicotine replacement therapy after hospitalization. Outcomes were 7-day point prevalence abstinence from 3 to 12 months and past 30-day reports of alcohol and illicit drug use. The sample consisted of 34% women, among which 36% were Caucasian, averaging 19 cigarettes/d prehospitalization; the groups were comparable at baseline. At 12 months, 22% of the intervention versus 11% of usual care participants were tobacco-abstinent (risk ratio 2.01, P = 0.03). Past 30-day abstinence from alcohol/drugs did not differ by group (22%); however, successful quitters were less likely than continued smokers to report past 30-day cannabis (18% vs 42%) and alcohol (22% vs 58%) use (P < 0.05), with no difference in other drug use. Tobacco treatment in psychiatric patients with co-occurring SUDs was effective and did not adversely impact recovery. Quitting smoking was associated with abstinence from alcohol and cannabis at follow-up. The findings support addressing tobacco in conjunction with alcohol and other drugs in psychiatric treatment.

Age-Specific Prevalence of Binge and High-Intensity Drinking Among U.S. Young Adults: Changes from 2005 to 2015.

This study examined changes during the past decade, from 2005 to 2015, in binge and high-intensity drinking in 7 separate age groups of U.S. 12th graders and young adults. National longitudinal data (N=6,711) from Monitoring the Future were used to examine trends in consuming 5+, 10+, and 15+ drinks on the same occasion in the past 2weeks from ages 18 to 29/30 overall and by gender. Results were compared with trends in past 12-month and 30-day alcohol use for the same age groups. Between 2005 and 2015, binge (5+) and high-intensity drinking (10+, 15+) generally decreased for individuals in their early 20s, remained somewhat stable for individuals in their mid-20s, and increased for individuals at the end of young adulthood (age 29/30). The observed historical trends in binge and high-intensity drinking were similar to those for past 12-month and past 30-day alcohol use for those aged 18 to 20, but diverged for most other age groups in young adulthood. Trends were generally similar for men and women, except that the increase in prevalence began earlier in young adulthood for women than for men. Binge and high-intensity drinking among U.S. 12th graders and young adults are dynamic phenomena. Prevention and intervention efforts aimed at reducing the harms resulting from 5+, 10+, and 15+ drinking should acknowledge and focus on differences in trends in these behaviors by age and gender.

HIV-infected individuals who use alcohol and other drugs, and virologic suppression

ABSTRACTPeople living with HIV (PLWH) on antiretroviral therapy (ART) who use substances were examined to (a) describe those with virologic control and (b) determine which substance use-factors are associated with lack of virologic control. Participants were adult PLWH taking ART with either past 12-month DSM-IV substance dependence or past 30-day alcohol or illicit drug use. Substance use factors included number of DSM-IV alcohol or drug dependence criteria and past 30-day specific substance use. Associations with HIV viral load (HVL) (<200 vs. ≥200 copies/mL) were tested using logistic regression models. Multivariable analyses adjusted for age, sex, homelessness and anxiety or depression. Participants (n = 202) were median age 50 years, 66% male, 51% African American and 75% self-reported ≥90% past 30-day ART adherence. Though HVL suppression (HVL <200 copies/mL) was achieved in 78% (158/202), past 30-day substance use was common among this group: 77% cigarette use; 51% heavy alcohol use; 50% marijuana; 27% cocaine; 16% heroin; and 15% illicit prescription opioid use. After adjusting for covariates, specific substance use was not associated with a detectable HVL, however number of past 12-month DSM-IV drug dependence criteria was (adjusted odds ratio = 1.23 for each additional criterion, 95% CI: 1.04–1.46). Three-quarters of a substance-using cohort of PLWH receiving ART had virologic control and ≥90% ART adherence. Substance dependence criteria (particularly drug dependence), not specifically substance use, were associated with lack of virologic control. Optimal HIV outcomes can be achieved by individuals who use alcohol or drugs and addressing symptoms of substance dependence may improve HIV-related outcomes.

Lifetime and recent alcohol use and bone mineral density in adults with HIV infection and substance dependence.

Low bone mineral density (BMD) is common in people living with HIV infection (PLWH), increasing fracture risk. Alcohol use is also common in PLWH and is a modifiable risk factor for both HIV disease progression and low BMD. In PLWH, alcohol's effect on BMD is not well understood.We studied adult PLWH with substance dependence. We measured lifetime alcohol use (kg) and recent (i.e., past 30-day) alcohol use (categorized as: abstinent, low risk, or high risk). In adjusted multivariable regression analyses, we tested associations between lifetime and recent alcohol use and (i) mean BMD (g/cm) at the femoral neck, total hip, and lumbar spine and (ii) low BMD diagnosis (i.e., osteopenia or osteoporosis). We also examined associations between 2 measures of past alcohol use (i.e., total consumption [kg] and drinking intensity [kg/year]) and BMD outcome measures during 3 periods of the HIV care continuum: (i) period before first positive HIV test, (ii) period from first positive HIV test to antiretroviral therapy (ART) initiation, and (iii) period following ART initiation.We found no significant associations between lifetime alcohol use and mean femoral neck (β -0.000, P = .62), total hip (β -0.000, P = .83) or lumbar spine (β 0.001, P = .65) BMD (g/cm), or low BMD diagnosis (adjusted odds ratio [aOR] = 0.98, 95% Confidence Interval [CI]: 0.95-1.01). There was no significant correlation between past 30-day alcohol use and mean BMD (g/cm). Past 30-day alcohol use was associated with low BMD diagnosis (P = .04); compared to abstainers, the aOR for high risk alcohol use was 1.94 (95% CI: 0.91-4.12), the aOR for low risk alcohol use was 4.32 (95% CI: 1.30-14.33). Drinking intensity (kg/year) between first positive HIV test and ART initiation was associated with lower mean BMD (g/cm) at the femoral neck (β -0.006, P = .04) and total hip (β -0.007, P = .02) and increased odds of low BMD (aOR = 1.18, 95% CI = 1.03-1.36).In this sample of PLWH, we detected no association between lifetime alcohol use and BMD. However, recent drinking was associated with low BMD diagnosis, as was drinking intensity between first positive HIV test and ART initiation. Longitudinal studies should confirm these associations.

Housing mobility and adolescent mental health: The role of substance use, social networks, and family mental health in the moving to opportunity study

The Moving to Opportunity (MTO) experiment was a housing mobility program begun in the mid-nineties that relocated volunteer low income families from public housing to rental units in higher opportunity neighborhoods in 5 US cities, using the Section 8 affordable housing voucher program. Compared to the control group who stayed behind in public housing, the MTO voucher group exhibited a harmful main effect for boys’ mental health, and a beneficial main effect for girls’ mental health. But no studies have examined how this social experiment caused these puzzling, opposite gender effects. The present study tests potential mediating mechanisms of the MTO voucher experiment on adolescent mental health (n=2829, aged 12–19 in 2001–2002). Using Inverse Odds Ratio Weighting causal mediation, we tested whether adolescent substance use comorbidity, social networks, or family mental health acted as potential mediators. Our results document that comorbid substance use (e.g. past 30day alcohol use, cigarette use, and number of substances used) significantly partially mediated the effect of MTO on boys’ behavior problems, resulting in -13% to -18% percent change in the total effect. The social connectedness domain was a marginally significant mediator for boys’ psychological distress. Yet no tested variables mediated MTO's beneficial effects on girls’ psychological distress. Confounding sensitivity analyses suggest that the indirect effect of substance use for mediating boys’ behavior problems was robust, but social connectedness for mediating boys’ psychological distress was not robust. Understanding how housing mobility policies achieve their effects may inform etiology of neighborhoods as upstream causes of health, and inform enhancement of future affordable housing programs.

A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults

Homeless young adults ages 18–25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3month and past 30day alcohol use (ps≤0.05), motivation to change drug use (ps<0.05), and condom use self-efficacy (p=0.05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p<0.05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes.

Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: Evidence from the NSDUH 2005-2014.

Alcohol and tobacco use during pregnancy are among the strongest and most preventable risk factors for adverse neonatal health outcomes, but few developmentally sensitive, population-based studies of this phenomenon have been conducted. To address this gap, the present study examined the prevalence and correlates of alcohol and tobacco use among pregnant adolescents (aged 12-17) and adults (aged 18-44) in the United States. Data were derived from the population-based National Survey of Drug Use and Health (80,498 adolescent and 152,043 adult women) between 2005 and 2014. Findings show disconcerting levels of past-month use among pregnant women with 11.5% of adolescent and 8.7% of adult women using alcohol, and 23.0% of adolescent and 14.9% of adult women using tobacco. Compared to their non-pregnant counterparts, pregnant adolescents were less likely to report past 30-day alcohol use (AOR=0.52, 95% CI=0.36-0.76), but more likely to report past 30-day tobacco use (AOR=2.20, 95% CI=1.53-3.18). Compared to their non-pregnant adult counterparts, pregnant adults were less likely to report using alcohol (AOR=0.06, 95% CI=0.05-0.07) and tobacco (AOR=0.47, 95% CI=0.43-0.52). Compared to pregnant abstainers, pregnant women reporting alcohol/tobacco use were more likely to have had a major depressive episode in the past 12months, report criminal justice system involvement, and endorse comorbid alcohol/tobacco use. Given alcohol and tobacco's deleterious consequences during pregnancy, increased attention to reducing use is critical. Findings suggest that tobacco use is especially problematic for both adolescents and adults and is strongly linked with depression and criminal justice involvement, especially among adults.

Misperceptions of harm among Natural American Spirit smokers: results from wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013–2014)

IntroductionThis study estimated differences in cigarette harm perceptions among smokers of the Natural American Spirit (NAS) brand—marketed as ‘natural’, ‘organic’ and ‘additive-free’—compared to other smokers, and examined correlates of NAS...