Development and initial validation of a marijuana cessation expectancies questionnaire

The Association of Global and Disease-Related Stress With Susceptibility to and Use of E-Cigarettes and Marijuana Among Adolescents With Congenital Heart Disease

OBJECTIVE

Adolescents with congenital heart disease (CHD) are exposed to disease-related stressors and have elevated risk for cardiovascular and cognitive complications that are exacerbated by e-cigarettes and marijuana. The aims of this cross-sectional study are to: (1) identify the association between perceived global and disease-related stress and susceptibility to e-cigarettes and marijuana, (2) determine if the association between stress and susceptibility differs by gender, and (3) explore the association between stress and ever use of e-cigarettes and marijuana among adolescents with CHD.

METHODS

Adolescents with CHD (N = 98; aged 12-18 years) completed self-report measures of susceptibility to/ever use of e-cigarettes and marijuana and global and disease-related stress.

RESULTS

Susceptibility to e-cigarettes and marijuana was reported by 31.3% and 40.2% of adolescents, respectively. Ever use of e-cigarettes and marijuana was reported by 15.3% and 14.3% of adolescents, respectively. Global stress was associated with susceptibility to and ever use of e-cigarettes and marijuana. Disease-related stress was associated with susceptibility to marijuana. Females reported more global and disease-related stress than males, but the association of stress with susceptibility to e-cigarettes and marijuana did not differ by gender.

CONCLUSIONS

Susceptibility to e-cigarettes and marijuana is common among adolescents with CHD and is associated with stress. Future work to examine the longitudinal associations between susceptibility, stress, and use of e-cigarettes and marijuana is warranted. Global stress may be an important consideration in the development of strategies to prevent these risky health behaviors among adolescents with CHD.

A psychometric evaluation of the Marijuana Problems Index among college students: Confirmatory factor analysis and measurement invariance by gender

Although the Marijuana Problems Index (MPI) is widely used in studies with college student samples to reflect a unidimensional measure of cannabis-related problems, no studies have assessed the psychometric properties of the MPI in a college student population. The present study sought to resolve this gap in a sample of 879 college students reporting past-year cannabis use. Confirmatory factor analyses were used to test the factor structure of the unidimensional 23- and 18-item MPI and measurement invariance across gender. Bivariate correlations between the final factors, cannabis use history/frequency, and other substance use outcomes were used to examine concurrent and discriminant validities (i.e., vs. noncannabis outcomes). The 18-item (but not the 23-item) MPI demonstrated good model fit, measurement invariance across gender, adequate internal reliability, as well as concurrent and discriminant validities. Results support the use of the 18-item MPI over the 23-item MPI for conceptualizing problematic cannabis use, including the testing of gender-specific differences, among college students. Findings also reinforce the importance of evaluating the psychometric properties of widely used measures across samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cannabis use as a moderator of cognitive behavioral therapy for insomnia

STUDY OBJECTIVES

Cannabis use is common among young adults and has been proposed as a potential treatment for insomnia. However, controlled studies examining the impact of cannabis use on insomnia symptoms are rare. This secondary analysis of published trial data tested cannabis use during cognitive behavioral treatment for insomnia (CBT-I) as a moderator of treatment efficacy.

METHODS

Young adults (ages 18-30 years) who reported past-month binge drinking (4/5+ drinks for women/men) and met DSM-5 and research diagnostic criteria for Insomnia Disorder were randomized to CBT-I (n=28) or sleep hygiene (SH; n=28). Interaction effects were tested using multilevel models. Outcomes included insomnia severity, actigraphy-assessed sleep efficiency, diary-assessed sleep quality, drinking quantity, and alcohol-related consequences.

RESULTS

Twenty-six participants (46%; 12 SH and 14 CBT-I) reported using cannabis during the treatment phase of the study, on an average of 23% of treatment days (range=3-100%). Relative to those who did not use cannabis, participants who used cannabis during treatment reported heavier drinking and more frequent cigarette use. Approximately 1 in 4 cannabis users (27%) reported using cannabis to help with sleep; however, cannabis and non-cannabis users did not differ in use of alcohol as a sleep aid. Controlling for sex, race, drinking quantity, cigarette use, symptoms of depression, and symptoms of anxiety, use of cannabis during treatment did not moderate CBT-I effects on insomnia severity (b= -.002, p=.99) or other outcomes (all p >.20).

CONCLUSIONS

CBT-I is effective in reducing insomnia symptoms among young adult drinkers with insomnia, regardless of cannabis use.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Identifier: NCT03627832.

Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

The Anticipated Effects of Cannabis Scale (AECS): Initial development and validation of an affect- and valence-based expectancy measure

Prior research suggests that cannabis expectancies are related to cannabis misuse and problems. Although there are established measures of cannabis expectancies, existing measures have psychometric limitations and/or are lengthy. Existing measures typically have a two-factor structure of positive and negative expectancies, but recent conceptualizations of alcohol expectancies support a valence- (positive vs. negative) and arousal-based (high vs. low arousal) structure. Thus, the present study sought to test a similar structure for cannabis. Cannabis expectancy items underwent 2 preliminary studies, assessing item valance/arousal (n = 233) and relevance to cannabis (n = 124). A final pool of 76 items underwent exploratory factor analysis (n = 303), and remaining items underwent confirmatory factor analysis in a separate sample (n = 469). Lastly, an additional sample (n = 435) examined validity. Results suggested a 3-factor structure (general positive, high arousal negative, low arousal negative) for the 17-item Anticipated Effects of Cannabis Scale (AECS), which was invariant across cannabis use frequency, sex, and race/ethnicity. Positive expectancies were strongly associated with cannabis use, whereas low arousal negative expectancies were protective against cannabis frequency; high arousal negative expectancies were strongly associated with more negative consequences and dependence symptoms. In addition, the proposed interpretation of AECS test scores showed evidence of incremental validity relative to another abbreviated measure. The current study provides initial support for the AECS, a brief, psychometrically sound cannabis expectancies measure. The AECS captures the full range of cannabis effects and may be suited to test discrepancies between cannabis expectancies and subjective response. Additional research is needed to validate its structure and predictive utility. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development and Validation of an Item Bank for Drug Dependence Measurement Using Computer Adaptive Testing

Currently, measurement tools to assess patient-reported outcomes for drug dependence are limited in their latent trait to adapt to the needs of individual patients while also maintaining comparability of scores across patients. Purpose/Objectives: To develop an item bank for computer adaptive testing (CAT) to measure severity of drug dependence. Methods: There were four phases: (1) review the literature of drug dependence measurement; (2) formulate an item list to be assessed by experts; (3) pretest our item list in two substance dependence treatment centers; and (4) field-test and conduct psychometric performance analysis with the final item bank. Additionally, based on our response data, a CAT simulation was used to validate the item bank, Drug Dependence CAT (DD-CAT). Results: The final drug dependence item bank - with a unidimensional configuration - contained 56 items with good item-fit, high discrimination, no differential item functioning, and covered all symptoms of diagnostic criteria for drug dependence. These results revealed that the final item bank was of good quality. Additionally, the results of a simulation CAT procedure with real response data indicated that the DD-CAT item bank exhibited acceptable and reasonable test reliability, content validity, and criterion-related validity. Conclusions/Importance: The proposed item bank for DD-CAT contained acceptable reliability and validity, and exhibited a shorter but efficient assessment of drug dependence. These psychometric properties can result in shorter test times, less information loss, and a reduction in the testing burden of patients.

Correlates of lifetime cannabis use and cannabis use severity in a Canadian university sample

This study aimed to broaden previous investigations of correlates of lifetime cannabis use and problematic cannabis use among post-secondary students by examining the novel and contemporary issues of medicinal use and deep inhalation practices. The sample included 2212 undergraduate and graduate post-secondary students from Alberta, Canada, who completed the University of Calgary's Campus Experience with Cannabis Survey (average age 23.2, SD = 5.2). Nine variables were entered into the binary logistic regression to examine their differentiation of lifetime users from non-users. A multiple regression model was completed with past six-month users (n = 697), where the continuous dependent variable was cannabis use severity as measured by total scores on the Cannabis Use Disorder Identification Test-Revised. Twenty independent variables were entered simultaneously. Varsity athlete status, family mental illness, severity of alcohol use, greater support for legalization and lower perceived risk associated with regular cannabis use, differentiated lifetime users from non-users. Higher rates of religiosity and living with parents or relatives were associated with lower-lifetime rates. Male gender, earlier age of first cannabis use, cannabis use motives (including coping, enhancement and expansion), past six-month medicinal use and increased frequency of deep inhalation during consumption, were found to be significant correlates of severity. Different factors seem to predict lifetime cannabis use versus severity, and these differences may help inform the development and delivery of prevention efforts. Given that medicinal use and male gender were the largest correlates of severity, populations representing these groups may benefit most from targeted education and prevention.

Distress tolerance and cessation-related cannabis processes: The role of cannabis use coping motives

Robust evidence implicates perceived distress tolerance as a risk factor for maladaptive cannabis use and poorer cannabis cessation outcomes. Past work suggests that perceived distress tolerance may be related to an array of clinically-relevant cannabis processes and outcomes via cannabis coping motives. Although promising, the generalizability of this work to racially/ethnically diverse samples of adult cannabis users is unknown. Additionally, investigation into alternative cannabis processes has been limited and has not controlled for the effects of other cannabis motives. Thus, the present study investigated cannabis coping motives as an explanatory variable for the relation between perceived distress tolerance and cannabis use processes that may impede cessation (e.g., cannabis use cravings, perceived barriers to cannabis cessation, and withdrawal symptoms) among an ethnically diverse sample of current cannabis using adults. Participants included 131 adult cannabis users (M_age = 36.67 years; 29.8% female; 59.2% Black, 26.2% White, 16.0% Hispanic). Results indicated that perceived distress tolerance was indirectly associated with all criterion variables through cannabis coping motives after controlling for the variance attributable to four other motives. The current study builds upon previous theoretically-supported work by examining these models among an ethnically diverse sample of current cannabis using adults and testing alternative cessation-related cannabis processes while controlling for the independent effects of four other cannabis motives.

Total and differential white blood cell count in cannabis users: results from the cross-sectional National Health and Nutrition Examination Survey, 2005-2016

BACKGROUND

Elevated white blood cell (WBC) count in tobacco cigarette smokers compared to non-smokers has been well documented, but little is known on circulating WBC counts and cannabis use.

METHODS

The National Health and Nutrition Examination Survey (2005-2016) is designed to be nationally representative of United States non-institutionalized population. The current study includes adult participants 20-59 years of age (n= 16,430) who underwent a detailed examination in the mobile examination center (MEC). Cannabis use was measured using Audio Computer-Assisted Self-Interview. Cannabis use was classified into never, former, occasional (1-7 days of the past 30 days), and heavy (>7 days of the past 30 days). WBC count was measured using the Coulter Counter method.

RESULTS

Total WBC count was higher among heavy cannabis users when compared to never users (β = 189; 95% confidence interval: 74, 304, p = 0.001). Among circulating WBC types, modest differences were observed for neutrophil count. Neither former nor occasional cannabis use was associated with total or differential WBC counts.

CONCLUSIONS

A modest association between heavy cannabis use and WBC count was detected. Additional research is needed to understand the immune related effects of different modes of cannabis use and to elucidate the role of proinflammatory chemicals generated from smoking cannabis.

Affect and cannabis use in daily life: a review and recommendations for future research

BACKGROUND

Although cannabis is often used for the purposes of relieving negative affective states such as anxiety and depression, the associations between cannabis use and affect in daily life are unclear. Ecological momentary assessment (EMA) has been used to study these associations in individuals' natural environments, providing more ecological validity, minimizing retrospective bias, and allowing for the analysis of within-individual processes over time. This review focuses on studies that utilized EMA to examine daily-life associations of cannabis use and negative and positive affective states.

METHODS

We review the findings of the 19 articles that met inclusion criteria, including clinical and community samples.

RESULTS

Results provide equivocal evidence regarding relations between cannabis use and affect for community samples. Findings are mixed for clinical samples as well, but more consistent patterns emerge for general negative affect (NA) and anger/hostility at the momentary level; cannabis use may be more likely following increased NA and lead to decreases in NA and anger/hostility in psychiatric populations.

CONCLUSIONS

Findings support a negative reinforcement hypothesis for clinical samples in terms of general NA and anger/hostility. However, discrepancies among studies point to a need to thoroughly characterize samples, consider motives for and expectancies of use, improve quantification of cannabis use, and consider co-use with other substances. Additional design recommendations are also offered for future studies.