Self-reported Past Year Research Articles

Greater social jetlag predicts poorer NIH Toolbox crystallized cognitive and academic performance in the Adolescent Brain Cognitive Development (ABCD) study

ABSTRACT Academic performance plays a crucial role in long-term educational attainment and occupational function. Chronotype refers to an individual’s daily tendencies for times for waking, activity, and sleep. Social jetlag reflects the mismatch between an individual’s chronotype and their social schedule. Because school typically starts early in the morning, later chronotype is often associated with daytime sleepiness, insufficient sleep, and poor academic performance. However, the relationship between academic performance, chronotype, and social jetlag has not been extensively examined in large samples like the Adolescent Brain Cognitive Development (ABCD) study. We hypothesized that greater social jetlag would predict poorer cognitive and academic performance. Year 2 (ages 11–14) cross-sectional data from the ABCD cohort (n = 6,890 adolescents) were used to evaluate academic performance (i.e. self-reported past year grades), NIH Toolbox cognitive performance measures, chronotype, and social jetlag from the Munich Chronotype Questionnaire. We found that later chronotype and greater social jetlag predicted poorer cognitive and academic performance with small effect sizes. Our findings emphasize the importance of individual differences in chronotype and social jetlag when designing class schedules, as aligning school activities with student optimal sleep-wake times may contribute to improved academic performance.

Adolescent nonmedical use of prescription pain relievers: an examination of primary socialization theory

ABSTRACT Objective The purpose of the present study was to examine the links between primary socialization sources and the past year non-medical use of prescription pain relievers among adolescents. Methods The data for the study came from the National Survey on Drug Use and Health (NSDUH) (2016–2019). Specifically, self-reported past year non-medical use of prescription pain relievers, Primary Socialization Theory (PST) constructs, and control measures was used. Results The results from binomial complex survey logistic regression indicated poor parental bonds, poor school bonds, and associating with substance using peers had links with past year non-medical use of prescription pain relievers. Conclusion Further, the results indicated associating with substance using peers had the strongest link with past year non-medical use of prescription pain relievers hypothesized by the theory. The limitations and implications for future research are noted.

Lean/Sizzurp Ingredients, Use, and Coping With Mental Health Symptoms.

The substance combination of codeine and promethazine, commonly termed lean/sizzurp, has been identified as a method that some individuals use to cope with PTSD and other mental health symptomology. A sample of 1423 adults with self-reported past year lean use was recruited from substance-related Reddit pages to complete a survey about lean, including information about using lean to cope with emotions, thoughts, or feelings. To be included in the sample, persons needed to: (1) be ⩾18 years old, (2) report past year lean use, (3) complete lean use screeners, and (4) pass data quality checks (eg, bot detection). As Reddit is an online forum, no geographic restrictions were placed on study participation. Data on demographic characteristics, lean use, and mental health disorder symptomology were captured from participants. Logistic regression models included anxiety, depression, and trauma as independent variables along with covariates to examine using lean to cope with emotions, thoughts, or feelings in the past 30 days. Most participants were male (n = 1102; 77.4%), with an average age of 26.9 (SD = 5.2) years. Most participants used included codeine as an ingredient in lean (n = 1060; 74.5%); promethazine was added as an ingredient by 31.7% of the sample (n = 451), and the combination of codeine and promethazine was included as ingredients by 13.5% (n = 192) of the sample. Participants with anxiety, lifetime trauma exposure, and who were female had increased odds of using lean to cope with emotions, thoughts, or feelings in the past 30 days. Those with depression and unstable housing exhibited decreased odds of using lean to cope with emotions, thoughts, or feelings in the past 30 days. This study recruited persons via social media to learn more about lean use, especially lean use to cope with mental health symptoms; future population-level studies are needed.

Alcohol use and its association with suicide attempt, suicidal thoughts and non-suicidal self-harm in two successive, nationally representative English household samples.

Alcohol use is a risk factor for suicidal behaviour, yet the nature of the relationship is unclear. Most research on the topic is conducted in clinical populations, with few studies exploring this association across the general population. We investigated the association between specific domains of alcohol use and suicide attempt, suicidal thoughts and non-suicidal self-harm in a general population sample. A total of 14 949 adults who completed the 2007 or 2014 Adult Psychiatric Morbidity Survey were included. We measured alcohol use with the Alcohol Use Disorders Identification Test (AUDIT). Domains of alcohol use relating to risk categories, weekly consumption, binge drinking, dependence symptoms, harmful effects and concern from others were derived from relevant AUDIT items. Self-reported past year suicide attempt, suicidal thoughts and non-suicidal self-harm were measured with the Clinical Interview Schedule, Revised. We found a linear association between total AUDIT score and outcomes. Three of six specific domains of alcohol use (dependence symptoms, harmful effects of drinking and binge drinking) were associated with increased odds of all three outcomes. There was no association of outcomes with the other domains of alcohol use. We found evidence of a linear association between total AUDIT score and suicide attempt, suicidal thoughts and non-suicidal self-harm in a representative English general population sample. Our analyses suggest that where alcohol use significantly disrupts day-to-day functioning, this may underpin the relationship between alcohol use and suicide-related outcomes to a greater extent than higher alcohol consumption. Longitudinal research is needed to further understand these relationships.

Associations between MDMA/ecstasy use and physical health in a U.S. population-based survey sample.

3,4-Methylenedioxymethamphetamine (MDMA/"ecstasy") is an empathogen that can give rise to increased pleasure and empathy and may effectively treat post-traumatic stress disorder. Although prior research has demonstrated associations between ecstasy use and favorable mental health outcomes, the associations between ecstasy and physical health have largely been unexplored. Thus, the goal of this study was to examine the associations between ecstasy use and physical health in a population-based survey sample. This study utilized data from the National Survey on Drug Use and Health (2005-2018), a yearly survey that collects information on substance use and health outcomes in a nationally representative sample of U.S. adults. We used multinomial, ordered, and logistic regression models to test the associations between lifetime ecstasy use and various markers of physical health (self-reported body mass index, overall health, past year heart condition and/or cancer, past year heart disease, past year hypertension, and past year diabetes), controlling for a range of potential confounders. Lifetime ecstasy use was associated with significantly lower risk of self-reported overweightness and obesity (adjusted relative risk ratio range: 0.55-0.88) and lower odds of self-reported past year heart condition and/or cancer (adjusted odds ratio (aOR): 0.67), hypertension (aOR: 0.85), and diabetes (aOR: 0.58). Ecstasy use was also associated with significantly higher odds of better self-reported overall health (aOR: 1.18). Ecstasy shares protective associations with various physical health markers. Future longitudinal studies and clinical trials are needed to more rigorously test these associations.

Trends in risk behaviors and sexually transmitted infections among youth presenting to a sexually transmitted infection clinic in the United States, 2013-2017.

Background: Sexually transmitted infections (STIs) are increasing among adolescents and young adults (AYA) across the United States. However, data are scarce on trends in condom use, number of partners, and other STI risk factors among AYA. The present study evaluated associations between sexual behaviors and STI diagnoses over time among AYA. Methods: We evaluated linked encounters of AYA aged 13-26 attending an urban Northeast public STI clinic from 2013-2017. Demographics, risk behaviors, self-reported past year and lifetime STI, and STI diagnosis during clinic encounter (positive test for urine, oral, or anal chlamydia; urine, oral, or anal gonorrhea; urine trichomonas; HIV; and syphilis) were extracted from electronic health records. We estimated prevalence and performed trend analyses of the repeated cross-sectional data. Cochran-Armitage and Kruskal-Wallis trend test were conducted for categorical and continuous variables, respectively. Results: Among 3822encounters, clinical STIs demonstrated statistically significant increases including chlamydia (+9%, p = 0.001), gonorrhea (+5%, p = 0.008), and syphilis (+3%, p = 0.006) all of which significantly increased over time, as did any STI (+10%, p < 0.001). HIV and trichomonas rates remained low and unchanged. Self-reported STI increased as well, both past year (+9%) and lifetime (+14%). Greater proportions of AYA reported multiple partners (+9%, p < 0.001), and condomless oral (+12%, p = 0.001) and vaginal/anal (+7%, p = 0.001) sex. Conclusion: Among AYA presenting to a STI clinic, the proportion who engaged in condomless sex and had multiple partners increased over a 5year period, which corresponded to increased STI prevalence during this period. Preventions efforts for AYA should continue to emphasize the importance of condoms and partner selection.

Developmental trajectories of Big Five personality traits among adolescents and young adults: Differences by sex, alcohol use, and marijuana use.

Individual differences in adolescent personality are related to a variety of long-term health outcomes. While previous studies have demonstrated sex differences and non-linear changes in personality development, these results remain equivocal. The current study utilized longitudinal data (n=831) from the National Consortium on Alcohol and Neurodevelopment in Adolescence to examine sex differences in the development of personality and the association between substance use and personality. Participants (ages 12-21 at baseline) completed the Ten-Item Personality Inventory and self-reported past year alcohol and marijuana use at up to 7 yearly visits. Data were analyzed using generalized additive mixed-effects models and linear mixed-effects models. Findings support linear increases in agreeableness and conscientious and decreases in openness with age and inform on timing of sex-specific non-linear development of extraversion and emotional stability. Further, results provide novel information regarding the timing of the association between substance use and personality, and replicate past reporting of differential associations between alcohol and marijuana use and extraversion, and sex-dependent effects of marijuana use on emotional stability. These findings highlight the importance of modeling sex differences in personality development using flexible non-linear modeling strategies, and accounting for sex- and age-specific effects of alcohol and marijuana use.

Sociodemographic and clinical correlates of gabapentin receipt with and without opioids among a national cohort of patients with HIV

ABSTRACT Gabapentin is commonly prescribed for chronic pain, including to patients with HIV (PWH). There is growing concern regarding gabapentin's potential for harm, particularly in combination with opioids. Among PWH, we examined factors associated with higher doses of gabapentin receipt and determined if receipt varied by opioid use. We examined data from the Veterans Aging Cohort Study, a national prospective cohort including PWH, from 2002 through 2017. Covariates included prescribed opioid dose, self-reported past year opioid use, and other sociodemographic and clinical variables. We used multinomial logistic regression to determine independent predictors of gabapentin receipt. Among 3,702 PWH, 902 (24%) received any gabapentin during the study period at a mean daily dose of 1,469 mg. In the multinomial model, high-dose gabapentin receipt was associated with high-dose benzodiazepine receipt (adjusted odds ratio [aOR], 95% confidence interval [CI]= 1.53, [1.03–2.27]), pain interference (1.65 [1.39–1.95]), and hand or foot pain (1.81, [1.45–2.26]). High-dose gabapentin receipt was associated with prescribed high-dose opioids receipt (2.66 [1.95–3.62]) but not self-reported opioid use (1.03 [0.89–1.21]). PWH prescribed gabapentin at higher doses are more likely to receive high-dose opioids and high-dose benzodiazepines, raising safety concerns.

Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability. Using data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the independent association of PTSD symptom severity, pain interference, non-PTSD psychiatric and substance use disorders (SUD), and medical illnesses with each of four domains of function: mental health-related quality of life and physical functioning assessed with the Mental Health Composite Score (MCS) and Physical Function Score (PFS) of the Short Form-12; perceived social support from the Interpersonal Support and Evaluation List-12 (ISEL-12); and self-reported past year employment. Among 1779 individuals representing 11 million U.S. adults who met the Diagnostic and Statistical Manual-5 (DSM-5) criteria for Past Year PTSD, the MCS (41.2; SD 12.5), PFS (44.8; SD 13.2) and ISEL-12 (33.6; SD 7.2) indicated substantial disability when compared to population norms, and only 63.6% were employed. Multiple regression showed the MCS had a modest negative association with PTSD symptoms, pain interference, psychiatric multimorbidity and medical comorbidity although not with SUD. PFS and employment had significant negative associations with pain interference and medical comorbidity. ISEL-12 had a weak negative association with PTSD symptoms and non-PTSD psychiatric comorbidity. Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms. PTSD treatment may require integrative multimorbidity management beyond a focus on PTSD symptoms.

Association Between Opioid Dose Reduction Against Patients' Wishes and Change in Pain Severity.

There is inadequate evidence of long-term benefit from opioid medications for chronic pain and substantial evidence of potential harms. For patients, dose reduction may be beneficial when implemented voluntarily and supported by a multidisciplinary team but experts have advised against involuntary opioid reduction. To assess the prevalence of self-reported involuntary opioid reduction and to examine whether involuntary opioid reduction is associated with changes in pain severity. Prospective observational cohort study. Primary care patients treated with long-term opioid therapy in the Veterans Health Administration (N = 290). The primary exposure was self-reported past year involuntary opioid reduction. The primary outcome was the three-item PEG scale, which measures past-week average pain intensity and interference with enjoyment of life and general activity. Past year opioid reduction or discontinuation was reported by 63% (184/290). Similar numbers reported involuntary (88/290) and voluntary (96/290) opioid reduction. At baseline, there were no significant differences in pain severity between the groups (mean PEG, 7.08 vs. 6.73 vs. 7.07 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.32). For the primary outcome of change in pain severity from baseline to 18 months, there were no significant differences between groups (mean PEG change, - 0.05 vs. - 0.44 vs. - 0.23 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.28). Self-reported past year involuntary opioid reduction was common among a national sample of veterans treated with long-term opioid therapy. Opioid dose reduction, whether involuntary or voluntary, was not associated with change in pain severity. Future studies should examine involuntary opioid reduction in different populations and trends over time and explore further patient- and provider-level factors that may impact patient experience and outcomes during opioid reduction.

Stepping Stones and Creating Futures Intervention to Prevent Intimate Partner Violence Among Young People: Cluster Randomized Controlled Trial

PurposeYoung people, not in formal employment or education, face exceedingly high levels of intimate partner violence (IPV). We evaluated whether Stepping Stones and Creating Futures, compared with a wait-list control, can reduce IPV and strengthen livelihoods. MethodsA cluster randomized controlled trial with 34 clusters in urban informal settlements in eThekwini Municipality, South Africa. Participant inclusion criteria were aged 18–30 years, resident in the informal settlement, and not working or in education. A total of 676 women and 646 men were recruited from September 2015 to September 2016. At recruitment, participants were not blinded to study arm. Endline data were collected from March to October 2018 (24 months postenrollment). Analyses were by intention-to-treat and separate for men and women. No clusters withdrew; endline retention was 74.9% (n = 505) men and 80.6% (n = 545) women. ResultsAt endline in the intervention arm, men's self-reported past year IPV perpetration was lower (physical IPV [adjusted odds ratio [aOR]: .71, 95% confidence interval [CI]: .51–.97], severe IPV [aOR: .70, 95% CI: .52–.94], and sexual IPV [aOR: .74, 95% CI: .54–1.03]). There was no difference in men's controlling behaviors (β = .06, 95% CI: −.51 to .63) or past month earnings (β = .21, 95% CI: −.42 to .83). For women, earnings were significantly higher in the intervention arm (β = .97, 95% CI: .43–1.51), but there were no differences for past year IPV experience (physical IPV [aOR: .92, 95% CI: .62–1.37]; sexual IPV [aOR: .90, 95% CI: .64–1.28], severe IPV [aOR: .93, 95% CI: .66–1.31]) or controlling behaviors (β = −.01, 95% CI: −.88 to .86). ConclusionStepping Stones and Creating Futures is effective in reducing men's self-reported perpetration of IPV and strengthening women's livelihoods, but not women's experiences of IPV. Trial registrationNCT03022370. Registered January 13, 2017.

425. Longitudinal Trends in Risk Behaviors and Sexually Transmitted Diseases among Adolescents and Young Adults at a Sexually Transmitted Diseases Clinic, 2013–2017

BackgroundSexually transmitted disease (STD) rates continue to rise in the United States (US). Over half of all new STDs occur in adolescents and young adults (AYA). Few studies have evaluated how sexual behaviors such as number of partners or condom use may contribute to this increase. We aimed to determine the association of sexual behaviors and condom use with STD incidence over time among AYA.MethodsWe reviewed all AYA ages 13–26 years attending a public STD clinic in Rhode Island from 2013–2017. We reviewed demographic and behavioral data including age, gender identity, risk group, race, ethnicity, insurance status, sexual behaviors, substance use, self-reported STD/HIV diagnosis (lifetime, past year), condom use, and HIV/STD testing results. We report proportions in 2013 and 2017, and performed trend analyses (Cocharn-Armitage test for categorical variables and Kruskal–Wallis trend test for continuous variables) to determine trends over time.ResultsA total of 3,822 AYA visited the clinic during the study time period. An increasing trend was observed for: multiple (≥5) partners (29% of AYA in 2013 vs. 38% in 2017, P < 0.001), self-reported past year and lifetime STD diagnosis (12 vs. 21%, P < 0.001 and 19 vs. 33%, P < 0.001, respectively), and lab-documented diagnosis of any STD (15 vs. 25%, P < 0.001), syphilis (2 vs. 5%, P = 0.006), any chlamydia (11 vs. 20%, P = 0.001), and any gonorrhea (3 vs. 8%, P = 0.008). A decreasing trend was observed for: white race (66% in 2013 vs. 43% in 2017, P < 0.001), uninsured (73 vs. 53%, P < 0.001), condomless sex during oral as well as vaginal/anal sex (22 vs. 10%, P = 0.001 and 16 vs. 8%, P = 0.001, respectively), and self-reported HIV diagnosis (2.5% to 0.9%, P = 0.016).ConclusionAmong AYA, risk behaviors such as condomless sex and multiple partners increased significantly from 2013–2017, which may be contributing to an increase in STDs. Increased public health efforts are needed to promote education and other interventions to address behaviors associated with STD transmission.Disclosures All authors: No reported disclosures.

High-dose prescribed opioids are associated with increased risk of heroin use among United States military veterans

Despite evidence linking increased risk of opioid use disorder with specific opioid-prescribing patterns, the relationship between these patterns and heroin use is less understood. This study aimed to determine whether dose and duration of opioid prescriptions predict subsequent heroin use in United States veterans. We analyzed data from 2002 to 2012 from the Veterans Aging Cohort Study, a prospective cohort study. We used inverse probability of censoring weighted Cox regression to examine the relationship between self-reported past year heroin use and 2 primary predictors: (1) prior receipt of a high-dose opioid prescription (≥90 mg morphine equivalent daily dose), and (2) prior receipt of a long-term opioid prescription (≥90 days). Heroin use was ascertained using most recent value of time-updated self-reported past year heroin use. Models were adjusted for HIV and hepatitis C virus infection status, sociodemographics, pain interference, posttraumatic stress disorder, depression, and use of marijuana, cocaine, methamphetamines, and unhealthy alcohol use. In the final model, prior receipt of a high-dose opioid prescription was associated with past year heroin use (adjusted hazard ratio use = 2.54, 95% confidence interval: 1.26-5.10), whereas long-term opioid receipt was not (adjusted hazard ratio = 1.09, 95% confidence interval: 0.75-1.57). Patients receiving high-dose opioid prescriptions should be monitored for heroin use. These findings support current national guidelines recommending against prescribing high-dose opioids for treating pain.

Brief Report: Sex Differences in Substance Use, Mental Health, and Impaired Driving Among Rural DUI Offenders.

Studies have documented sex differences among driving under the influence (DUI) offenders, but none have examined rural DUI offenders. Rural DUI offenders (83 males and 34 females) self-reported past year and lifetime substance use, mental health problems, and impaired driving history. Substance use and impaired driving histories were similar, but significant disparities in mental health problems for female DUI offenders were found. This initial examination of sex differences among rural DUI offenders suggests additional research is needed to better understand their substance use and mental health problems and whether different treatment approaches are needed. (Am J Addict 2019;28:405-408).

Genetic and environmental influences on developmental trajectories of adolescent alcohol use.

Adolescent alcohol use demonstrates distinct developmental trajectories with different times of onset, levels, and rates of growth. Twin research on adolescent alcohol use has shown that genetic influences are consistent with a gradual growth of risks, whereas non-shared environmental influences are more consistent with an accumulation of risks over time. The current study investigated the relative contributions of genetic and environmental influences on shaping different developmental trajectories of alcohol use through adolescence. Self-reported past year alcohol use was collected from 877 Canadian twins (47.1% males) at age 13, 14, 15, and 17years. Growth mixture models were fit to examine different developmental trajectories of alcohol use, and biometric liability threshold models were fit to investigate genetic and environmental influences on the liability of belonging to identified trajectories. Three trajectories were identified: low (15.1%), early onset (8.2%), and normative increasing (76.7%). Memberships in the low and early-onset group were under genetic (27.6% and 34.7%), shared (42.4% and 21.5%), and non-shared environment influences (30.0% and 43.8%). Membership in the normative increasing group was under genetic (37.7%) and non-shared environment influences (62.3%). Non-shared environmental influences were significantly larger for the normative increasing trajectory than for the low trajectory. These findings provide a more refined picture of genetic and environmental influences in the development of alcohol use in subgroups of adolescents. Genetic and environmental influences both matter, but to different degrees in different trajectories. Future research should identify specific shared and non-shared environmental experiences that distinguish different trajectories.

Declining trends in drug dealing among adolescents in the United States

IntroductionThe link between drug selling and other delinquent behaviors in adolescence is well established. Less is known regarding the trends in drug selling among youth in the US and whether they are consistent with the recently observed decline in problem behaviors among this population. MethodsData were collected between 2002 and 2015 as part of the National Survey on Drug Use and Health (NSDUH). Participants included 233,435 US youth aged 12–17. The primary variable of interest was self-reported past year drug-selling. Logistic regression assessed trends in drug-selling among male and female subgroups. ResultsBetween 2002 and 2015, the prevalence of drug-selling decreased significantly across all youth (AOR = 0.970, p < .001). Analysis of gender differences revealed that the rate of drug-selling decreased significantly among boys (AOR = 0.962, p < .001), however, the trend remained stable for girls (AOR = 0.987, p > .05). The decrease in drug-selling was observed for nearly all male subgroups, African-American girls (0.946, p < .01) and girls reporting no illegal substance use in the past year (0.960, p < .05). ConclusionsThe prevalence of past year drug-selling among youth in the US is declining significantly, especially for boys.

Gender differences in the trends and correlates of major depressive episodes among juvenile offenders in the United States

PurposeAlthough it is well-established that juvenile offenders are at an elevated risk for depression and that, within this group, females have the highest risk, little is known regarding the trends in the prevalence of depression among juvenile offenders in the United States. In the present study, we systematically examine secular trends in major depressive episodes (MDE) and their correlates among male and female juvenile offenders and non-offenders in the United States. MethodsData were collected between 2005 and 2014 as part of the National Survey on Drug Use and Health (NSDUH). The NSDUH uses multistage area probability sampling methods to select a representative sample of the civilian, non-institutionalized population in the United States. Participants included 171,118 youth aged 12–17 (159,449 non-offenders and 11,669 offenders). The primary variable of interest was self-reported past year MDE. Logistic regression assessed whether sociodemographic factors and psychosocial and behavioral correlates affected the risk of MDE. ResultsBetween 2005 and 2014, the prevalence of MDE among female youth increased for both offender and non-offender groups: from 24.4% to 33.0% for the offenders and from 12.4% to 16.7% for the non-offenders. No significant trend changes were observed among male youth. In both male and female juvenile offenders, MDEs were associated with increased risk of illicit drug use (males OR=1.61, 95% CI=1.18–2.18; females OR=1.83, 95% CI=1.45–2.31). Additional correlates include alcohol use among male offenders (OR=1.36, 95% CI=1.01–1.83), and binge drinking in female offenders (OR=1.24, 95% CI=1.02–1.49). ConclusionsThe prevalence of past year major depressive episodes is increasing for female juvenile offenders, highlighting a need for improved efforts to target these populations for prevention and treatment.

Association of physical activity in the past year and immediately after in vitro fertilization on pregnancy

To estimate the association of physical activity on in vitro fertilization (IVF). Prospective cohort study. Academic infertility clinic. Women (n = 121) undergoing nondonor IVF embryo transfer (fresh or frozen). The women completed a questionnaire on past year physical activity and wore an accelerometer from embryo transfer to serum pregnancy testing. Implantation, intrauterine gestation, and live birth. Based on self-reported past year physical activity, the adjusted odds of intrauterine gestation was higher among those that had higher continuous active living (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.09-3.50), sports/exercise (OR 1.48, CI 1.02-2.15), and total activity (OR 1.52, 95%CI 1.15-2.01) indices. After embryo transfer, women did almost no vigorous activity (median 0 min/d) as measured by the accelerometer. More of their time was spent in light activity (median 3.0 h/d) and sedentary behaviors (median 9.3 h/d). Accelerometer-measured physical activity and sedentary behavior after embryo transfer were not associated with any IVF outcome. An active lifestyle in the preceding year favorably impacted the IVF outcome. After embryo transfer, women engaged in mostly light physical activity and sedentary behaviors; therefore, the impact of vigorous physical activity on implantation could not be determined.

Associations between heavy episodic drinking and alcohol related injuries: a case control study

BackgroundAlcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries.MethodsWe applied a case – control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately.ResultsAn increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox.ConclusionThere is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.

Regulating a novel drug: An evaluation of changes in use of Salvia divinorum in the first year of Florida's ban

BackgroundA plant with dissociative and psychoactive properties began to attract the attention of the media and United States policymakers following a well-publicized suicide in 2006 and reports that the plant served as a ‘legal high’ and substitute for cannabis. As a result, Salvia divinorum and its active ingredient, salvinorin A, were classified as Schedule I substances by the Florida Legislature on July 1, 2008. As of yet, no research has explored the efficacy of this policy or similar policies in other jurisdictions. MethodsThree self-report studies collected from young adults both prior to and following the policy's implementation are employed to investigate the potential relationship between the policy and usage rates. In addition, law enforcement personnel from the state's most populated areas were interviewed to determine the extent to which they were encountering salvia in their work. ResultsIt was indicated that less than two-thirds of those surveyed were aware of the drug's legal status. Lifetime prevalence of salvia use was largely unchanged. However, the rates of self-reported past year and past month use in Florida were significantly lower following the scheduling. Though use of Salvia divinorum appears to have decreased, perceptions of peer use increased markedly. Law enforcement officers and laboratories reported rarely, if ever, dealing with cases of salvia possession. ConclusionsData suggests the classification of Salvia divinorum as a Schedule I drug was followed by a substantial reduction in recreational use. We caution that other factors may have influenced use, that the efficacy of scheduling novel substances is likely to vary by drug type, that such a reduction in reported use may only exist transiently until a sophisticated illicit market develops to replace the legitimate one, and that a state's success in regulating salvia may be related to their regulation of and enforcement of other drug prohibitions.