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Kava CM, Watkins SL, Gilbert PA, Villhauer TJ, Welter TL, Afifi RA. E-cigarettes in college: Associations between mental health and e-cigarette use with other substances. Tob Prev Cessat 2024; 10:TPC-10-24. [PMID: 38828438 PMCID: PMC11141061 DOI: 10.18332/tpc/188712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION College students are a priority population for substance use prevention, and other studies have reported associations between mental health and e-cigarette use. This study described the association of mental health to e-cigarette and other substance use (ECIG+ use) among US college students. METHODS We used Fall 2018 and Spring 2019 National College Health Assessment data among undergraduate students aged 18-24 years (n=55654) at 138 institutions. We characterized substance use patterns and used multinomial regression to model adjusted odds of past 30-day ECIG use type [no substance use (reference); sole e-cigarette use; e-cigarette use and other substance use (ECIG+ use); no e-cigarette use but other substance use] by mental health characteristics, past 12-month diagnosis/treatment and psychological distress, individual characteristics, and college characteristics. RESULTS Alcohol was the most prevalent substance (58%) used, followed by cannabis (23%) and e-cigarettes (15%). Nearly all (95%) students who used e-cigarettes reported using another substance. Adjusted odds of ECIG+ use (vs no substance use) were higher among students with past 12-month mental health diagnosis/treatment (AOR=1.5; 95% CI: 1.4-1.6) and higher psychological distress (AOR=1.1; 95% CI: 1.1-1.2). Other characteristics significantly associated with ECIG+ use included gender identity, sexual orientation, race and ethnicity, self-rated health, year in school, cumulative grade average, fraternity/sorority membership, and current residence. CONCLUSIONS Most students who used e-cigarettes also reported other substance use, and this pattern of use was associated with poorer mental health outcomes than no substance use. Clarifying the relationship between mental health and ECIG+ use may enhance health interventions for college students.
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Affiliation(s)
- Christine M. Kava
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, United States
| | - Shannon L. Watkins
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, United States
| | - Paul A. Gilbert
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, United States
| | - Tanya J. Villhauer
- The Office of the Dean of Students, University of Iowa, Iowa Memorial Union, Iowa City, United States
| | | | - Rima A. Afifi
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, United States
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Ruleman AM, Clendennen SL, Chen B, Harrell MB. Reasons for multiple tobacco product and cannabis co-use among Texas young adults. Addict Behav 2024; 156:108063. [PMID: 38824720 DOI: 10.1016/j.addbeh.2024.108063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users. METHODS Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use. RESULTS 26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users. CONCLUSIONS Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.
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Affiliation(s)
- Ashlynn M Ruleman
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA.
| | - Stephanie L Clendennen
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
| | - Baojiang Chen
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
| | - Melissa B Harrell
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
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Nguyen N, Islam S, Llanes KD, Koester KA, Ling PM. Classification of patterns of tobacco and cannabis co-use based on temporal proximity: A qualitative study among young adults. Addict Behav 2024; 152:107971. [PMID: 38281461 PMCID: PMC10923078 DOI: 10.1016/j.addbeh.2024.107971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/19/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Co-use of tobacco and cannabis is a common and complex behavior. The lack of harmonized measures of co-use yields confusion and inconsistencies in synthesizing evidence about the health effects of co-use. We aimed to classify co-use patterns based on temporal proximity and describe preferred products and motives for each pattern in order to improve co-use surveillance. METHODS We conducted semi-structured interviews in a sample of 34 young adults (Mage = 22.8 years, 32.4 % female) during 2017-2019 in California, USA. We employed a qualitative thematic analysis to identify timing, reasons, and contexts for tobacco and cannabis co-use and classify co-use patterns. RESULTS Four emergent patterns of co-use with increasing temporal proximity between tobacco use and cannabis use were: Same-month different-day co-use (Pattern 1); Same-day different-occasion co-use (Pattern 2); Same-occasion sequential co-use (Pattern 3); and Same-occasion simultaneous co-use (Pattern 4). Participants used various product combinations within each pattern. Similar motives for all patterns were socialization, product availability, and coping with stress/anxiety. Unique motive for temporally distant patterns (Patterns 1 and 2) was seeking substance-specific effects (e.g., stimulant effect from nicotine, relaxation effects from cannabis), while unique motives for temporally close patterns (Patterns 3 and 4) were seeking combined effects from both substances (e.g., more intense psychoactive effects, mitigating cannabis adverse effects) and behavioral trigger (e.g., cannabis use triggers tobacco use). CONCLUSIONS Our classification of co-use patterns can facilitate consistency for measuring co-use and assessing its health impacts. Future research should also measure product types and motives for different patterns to inform intervention efforts.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - Sabrina Islam
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Karla D Llanes
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
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Waring JJC, Nguyen N, Ling PM, Thrul J. Quantity of cigarettes smoked when co-used with alcohol and cannabis: Consideration of different definitions of co-use based on daily diary data. Drug Alcohol Depend 2024; 258:111264. [PMID: 38547786 PMCID: PMC11163876 DOI: 10.1016/j.drugalcdep.2024.111264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Cigarettes are frequently co-used with alcohol and cannabis. However, definitions of co-use vary and the extent to which cigarette use changes on days with different patterns of co-use is unclear. We compared the number of cigarettes smoked on different days based on co-use patterns of cigarettes and alcohol or cannabis. METHODS This study analyzed 2408 smoking days collected in a 30-day smartphone-based daily diary study among 146 young adults (aged 18-26) with an oversample from sexual minority groups. Two separate multilevel models were estimated: one for cigarette and alcohol co-use and the other for cigarette and cannabis co-use. Both models examined day-level associations between the number of cigarettes smoked and 3 different types of days (smoking-only days, same-occasion co-use days, different-occasion co-use days), controlling for demographic characteristics. RESULTS More cigarettes were smoked on same-occasion co-use days compared to cigarette-smoking-only days for both alcohol (b=1.474, SE=0.136, t=10.8, p<.001) and cannabis (b=0.822, SE=0.209, t=3.9, p<.001). There were no significant differences in cigarettes smoked on days with co-use on the same day, but on different occasions, compared to days with smoking only. CONCLUSIONS Compared to days with cigarette smoking only, more cigarettes are smoked on days when cigarettes are co-used with alcohol or cannabis on the same occasion, while the same is not true for days with co-use on different occasions. Conflating different definitions of co-use may impact findings on associations between co-use and smoking behavior.
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Affiliation(s)
- Joseph J C Waring
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA; Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.
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Vargees C, Stroup AM, Niznik T, Dunn D, Wyatt R, Hoetger C, Taleb ZB, Cohn AM, Cobb CO, Fetterman JL. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review. BMC Public Health 2023; 23:2357. [PMID: 38017396 PMCID: PMC10685631 DOI: 10.1186/s12889-023-17216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.
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Affiliation(s)
- Comreen Vargees
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA
| | | | - Taylor Niznik
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
- Institute for Integrative Health Care and Health Promotion (IGVF), Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA.
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Le D, Ciceron AC, Romm KF, Clausen ME, Abroms LC, Evans WD, Graham AL, Berg CJ. E-cigarette cessation interest and quit attempts among young adults reporting exclusive e-cigarette use or dual use with other tobacco products: How can we reach them? Tob Prev Cessat 2023; 9:33. [PMID: 38026820 PMCID: PMC10652571 DOI: 10.18332/tpc/172416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION There is limited evidence to inform e-cigarette quitting interventions. This mixed-methods study examined: 1) e-cigarette and other tobacco product perceptions and cessation-related factors; and 2) potential behavioral intervention strategies among young adults reporting exclusive e-cigarette use or dual use with other tobacco products. METHODS We analyzed Fall 2020 survey data from 726 participants reporting past 6-month e-cigarette use (mean age=24.15 years, 51.1% female, 38.5% racial/ethnic minority) from 6 US metropolitan areas and Spring 2021 qualitative interview data from a subset (n=40), comparing tobacco-related perceptions and cessation-related factors among those reporting exclusive use versus dual use. RESULTS Among survey participants (35.5% exclusive e-cigarette use, 64.5% dual use), those reporting dual use indicated greater importance of quitting all tobacco or nicotine products (mean=5.28, SD=3.44 vs mean=4.65, SD=3.75, p=0.033), whereas those reporting exclusive use expressed greater confidence in quitting e-cigarettes (mean=7.59, SD=3.06 vs mean=7.08, SD=3.01, p=0.029) and all tobacco and nicotine products (mean=7.00, SD=3.16 vs mean=6.31, SD=3.13, p=0.008), as well as less favorable perceptions (i.e. more harmful to health and addictive, less socially acceptable) of cigarettes, cigars, and smokeless tobacco (p<0.05). Interview participants (50.0% exclusive e-cigarette use; 50.0% dual use) attributed previous failed e-cigarette quit attempts to their inability to cope with social influences, stress, and withdrawal symptoms. Although most expressed disinterest in quitting due to belief of eventually outgrowing e-cigarettes (among those reporting exclusive use) or unreadiness to abstain from nicotine (among those reporting dual use), many acknowledged the need for quitting interventions. CONCLUSIONS Young adult e-cigarette cessation interventions should target risk perceptions, cessation barriers, and social influences/support.
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Affiliation(s)
- Daisy Le
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington DC, United States
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, United States
- George Washington Cancer Center, George Washington University, Washington DC, United States
| | - Annie C. Ciceron
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington DC, United States
| | - Katelyn F. Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, OK, United States
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, OK, United States
| | - Michelle E. Clausen
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington DC, United States
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, United States
- George Washington Cancer Center, George Washington University, Washington DC, United States
| | - W. Douglas Evans
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, United States
- George Washington Cancer Center, George Washington University, Washington DC, United States
| | - Amanda L. Graham
- Innovations Center, Truth Initiative, Washington DC, United States
- Department of Medicine, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, United States
- George Washington Cancer Center, George Washington University, Washington DC, United States
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Lalwani K, Whitehorne-Smith P, McLeary JG, Albarus N, Abel W. Investigating the associations of age of initiation and other psychosocial factors of singular alcohol, tobacco and marijuana usage on polysubstance use: analysis of a population-based survey in Jamaica. BMJ Open 2023; 13:e076111. [PMID: 37963690 PMCID: PMC10649390 DOI: 10.1136/bmjopen-2023-076111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances. DESIGN A secondary data analysis. SETTING Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old. OUTCOME MEASURES Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use. RESULTS Approximately 58%-66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p<0.001). Respondents who did not believe that smoking tobacco sometimes (p=0.049), and smoking marijuana sometimes and often was harmful, had increased odds of concurrent polysubstance use (p=0.047 and p<0.001, respectively). Respondents who indicated access to marijuana as easy were significantly more likely to report past month concurrent polysubstance use compared with those who reported access as difficult (p=0.002). Participants who indicated that friends or family members get drunk and take illegal drugs were associated with 1.722 and 1.864 increased odds of reporting past month concurrent polysubstance use (p=0.004 and p=0.017, respectively). CONCLUSIONS Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members' drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.
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Affiliation(s)
- Kunal Lalwani
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | | | - Joni-Gaye McLeary
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | - Neena Albarus
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Wendel Abel
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
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Rabinowitz JA, Reboussin BA, Sosnowski DW, Kuo SIC, Strickland JC, García-Marín LM, Rentería ME, Gillespie N, Maher B, Ialongo NS, Thorpe RJ, Uhl G. Associations of polygenic risk scores for smoking heaviness and lifetime cannabis use with tobacco and cannabis co-use trajectories among African Americans. Drug Alcohol Depend 2023; 250:110895. [PMID: 37517263 PMCID: PMC10495192 DOI: 10.1016/j.drugalcdep.2023.110895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND We aimed to identify distinct trajectories of tobacco, cannabis, and their co-use among African Americans, and to investigate whether these patterns were associated with polygenic risk scores (PRS) for tobacco and cannabis use. METHOD Participants (N=428 participants; 50.9% male) were initially recruited for an elementary school-based prevention in a Mid-Atlantic city when they were in first grade. From ages 14-26, participants reported on their frequency of tobacco and cannabis use in the past year during annual assessments. DNA was collected from participants at age 21. PRS for smoking heaviness (i.e., cigarettes per day) and lifetime cannabis use were created based on genome-wide association study results derived from Liu et al. (2019) and Pasman et al. (2018), respectively. RESULTS We identified five distinct trajectories of tobacco and cannabis co-use, including (1) Low Tobacco and Cannabis Use, (2) Adolescent Limited Tobacco and Cannabis Use, (3) Experimental Cannabis, Young Adult Increasing Tobacco, (4) Experimental Tobacco, Young Adult Increasing Cannabis, and (5) High, Chronic Tobacco and Cannabis Use. Compared to the Low Tobacco and Cannabis Use subgroup, individuals in the High, Chronic Tobacco and Cannabis Use subgroup had greater PRS for smoking heaviness, and individuals in the Experimental Cannabis, Young Adult Increasing Tobacco subgroup had higher PRS for lifetime cannabis use. CONCLUSIONS Polygenic risk for lifetime cannabis use and smoking heaviness is associated with the developmental progression of tobacco and cannabis co-use among African Americans, furthering knowledge on the etiology of co-use in this population.
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Affiliation(s)
- Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David W Sosnowski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Services, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Luis M García-Marín
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland4006, Australia; School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland4012, Australia
| | - Miguel E Rentería
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland4006, Australia; School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland4012, Australia
| | - Nathan Gillespie
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, USA
| | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Department of Psychiatry and Behavioral Services, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George Uhl
- New Mexico VA Health Care SystemAlbuquerque, NMUSA
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Khan N, Shah M, Malik MO, Badshah H, Habib SH, Shah I, Shah FA. The effects of tobacco and cannabis use on semen and endocrine parameters in infertile males. HUM FERTIL 2023; 26:564-572. [PMID: 34583622 DOI: 10.1080/14647273.2021.1969042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Substances such as tobacco and cannabis can negatively modulate seminal parameters and sex hormones and lead to fertility problems in males. The present study aimed to determine the effect of cigarettes, dipping tobacco, and cannabis on semen parameters and sex hormones in infertile males. A total of 160 infertile healthy participants (cigarette smokers n = 40, dipping tobacco users n = 40, cannabis users n = 40 and infertile controls n = 40) were included in the study. Fasting blood samples were collected from all the participants using the aseptic technique, and semen samples were collected by masturbation following sexual abstinence of 2-7 days. The levels of serum testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were determined using ELISA. The serum level of FSH was significantly higher in cannabis users relative to the control group (p = 0.043). A mild non-significant decrease in sperm count, serum LH and testosterone levels were observed in all drug users compared to controls. In conclusion, chronic use of tobacco and cannabis mildly modulates semen and hormonal parameters in infertile males.
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Affiliation(s)
- Nawabzada Khan
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Muhammad Omar Malik
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Haroon Badshah
- Department of Pharmacology, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Syed Hamid Habib
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Inayat Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Fawad Ali Shah
- Department of Pharmacology, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
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Buu A, Yang JJ, Ou TS, Kyung Nam J, Suh G, Lin HC. An ecological momentary assessment study to examine covariates and effects of concurrent and simultaneous use of electronic cigarettes and marijuana among college students. Addict Behav 2023; 141:107662. [PMID: 36805815 PMCID: PMC10226867 DOI: 10.1016/j.addbeh.2023.107662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The prevalence of concurrent and simultaneous use of e-cigarette and marijuana among college students is high. Yet, the literature was mainly based on cross-sectional surveys with emphasis on the smoking route. This is the first ecological momentary assessment (EMA) study that examined the vaping route of nicotine-marijuana co-use and the associated short-term psychological effects. METHODS This study recruited 686 college student e-cigarette users to participate in an on-line survey and 7-day EMA. Frequent marijuana users (247) - using marijuana weekly or daily - were compared with infrequent/non-users (439) on academic performance, e-cigarette use patterns, and dependence and respiratory symptoms. EMA data from the frequent users were used to study the association between marijuana vaping and e-cigarette consumption and the short-term psychological effects of e-cigarette and marijuana use. RESULTS The results show that e-cigarette users who frequently used marijuana tended to have lower academic performance, be involved in higher-risk use patterns, and have higher levels of e-cigarette dependence, marijuana problems, and respiratory symptoms, compared to infrequent/non-users. Marijuana vaping was associated with a higher level of e-cigarette consumption. E-cigarette use and marijuana use were both associated with higher levels of positive affect, physiological sensation, and craving for e-cigarettes. While marijuana use was linked to a lower level of negative affect, e-cigarette use did not have a significant effect. Further, none of the interaction effects between e-cigarette and marijuana use on psychological states were significant. CONCLUSIONS The results showed additive effects of e-cigarette and marijuana use although the hypothesized synergistic effects were not supported.
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Affiliation(s)
- Anne Buu
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center, 7000 Fannin St., Houston, TX 77030, USA.
| | - James J Yang
- Department of Biostatistics and Data Science, University of Texas Health Science Center, 1200 Pressler St., Houston, TX 77030, USA.
| | - Tzung-Shiang Ou
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, 1025 E. 7(th) Street, SPH 116, Bloomington, IN 47405, USA.
| | - Joon Kyung Nam
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center, 7000 Fannin St., Houston, TX 77030, USA.
| | - Ganghui Suh
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, 1025 E. 7(th) Street, SPH 116, Bloomington, IN 47405, USA.
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, 1025 E. 7(th) Street, SPH 116, Bloomington, IN 47405, USA.
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Nguyen N, Thrul J, Neilands TB, Ling PM. Associations Between Product Type and Intensity of Tobacco and Cannabis Co-use on the Same Day Among Young Adult Smokers: Smartphone-Based Daily-Diary Study. JMIR Mhealth Uhealth 2023; 11:e40736. [PMID: 36806440 PMCID: PMC9989918 DOI: 10.2196/40736] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Co-use of tobacco and cannabis is highly prevalent among young US adults. Same-day co-use of tobacco and cannabis (ie, use of both substances on the same day) may increase the extent of use and negative health consequences among young adults. However, much remains unknown about same-day co-use of tobacco and cannabis, in part due to challenges in measuring this complex behavior. Nuanced understanding of tobacco and cannabis co-use in terms of specific products and intensity (ie, quantity of tobacco and cannabis use within a day) is critical to inform prevention and intervention efforts. OBJECTIVE We used a daily-diary data collection method via smartphone to capture occurrence of tobacco and cannabis co-use within a day. We examined (1) whether the same route of administration would facilitate co-use of 2 substances on the same day and (2) whether participants would use more tobacco on a day when they use more cannabis. METHODS This smartphone-based study collected 2891 daily assessments from 147 cigarette smokers (aged 18-26 years, n=76, 51.7% female) during 30 consecutive days. Daily assessments measured type (ie, cigarette, cigarillo, or e-cigarette) and intensity (ie, number of cigarettes or cigarillos smoked or number of times vaping e-cigarettes per day) of tobacco use and type (ie, combustible, vaporized, or edible) and intensity (ie, number of times used per day) of cannabis use. We estimated multilevel models to examine day-level associations between types of cannabis use and each type of tobacco use, as well as day-level associations between intensities of using cannabis and tobacco. All models controlled for demographic covariates, day-level alcohol use, and time effects (ie, study day and weekend vs weekday). RESULTS Same-day co-use was reported in 989 of the total 2891 daily assessments (34.2%). Co-use of cigarettes and combustible cannabis (885 of the 2891 daily assessments; 30.6%) was most commonly reported. Participants had higher odds of using cigarettes (adjusted odds ratio [AOR] 1.92, 95% CI 1.31-2.81) and cigarillos (AOR 244.29, 95% CI 35.51-1680.62) on days when they used combustible cannabis. Notably, participants had higher odds of using e-cigarettes on days when they used vaporized cannabis (AOR 23.21, 95% CI 8.66-62.24). Participants reported a greater intensity of using cigarettes (AOR 1.35, 95% CI 1.23-1.48), cigarillos (AOR 2.04, 95% CI 1.70-2.46), and e-cigarettes (AOR 1.48, 95% CI 1.16-1.88) on days when they used more cannabis. CONCLUSIONS Types and intensities of tobacco and cannabis use within a day among young adult smokers were positively correlated, including co-use of vaporized products. Prevention and intervention efforts should address co-use and pay attention to all forms of use and timeframes of co-use (eg, within a day or at the same time), including co-use of e-cigarettes and vaporized cannabis, to reduce negative health outcomes.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
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West JC, Burt KB, Klemperer EM, Chen HL, Villanti AC. Latent Classes of Perceived Addictiveness Predict Marijuana, Alcohol, and Tobacco Use in Youth and Young Adults. Subst Use Misuse 2023; 58:454-464. [PMID: 36692093 PMCID: PMC10227722 DOI: 10.1080/10826084.2023.2167497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Mass media substance use prevention efforts target addiction perceptions in young people. This study examined youth and young adults' (YAs) perceived addictiveness across several substances and the associations between addiction perceptions and substance use. Methods: Data were collected in 2019 in an online cohort study of Vermonters aged 12-25. Latent class analyses grouped participants by perceived addictiveness of nicotine, caffeine, alcohol, marijuana, cigarettes, electronic vapor products (EVPs), and opioids. Bivariate multinomial logistic and modified Poisson regression estimated associations between sociodemographics, substance use correlates, and subsequent use across latent classes. Results: Four latent classes captured addiction perceptions: high perceived addictiveness of EVPs, cigarettes, marijuana, and alcohol (Class 1: n = 317; 31.3%), low perceived addictiveness of marijuana, alcohol, and caffeine (Class 2: n = 151; 14.3%), low perceived addictiveness of marijuana (Class 3: n = 581; 46.5%), and low perceived addictiveness of nicotine, cigarettes, and EVPs (Class 4: n = 83; 7.9%). For each year increase in age, there was a 36% increased likelihood of being in Class 2 (vs. Class 1) and a 148% increased likelihood of belonging to Class 3 (vs. Class 1). Low perceived addictiveness classes were associated with ever and past 30-day marijuana and alcohol use and predicted past 30-day alcohol use at three-month follow-up. Membership in Classes 2 and 3 also predicted past 30-day marijuana use at Wave 3. Discussion: The strong association between age and latent classes defined by low perceived addictiveness suggests age group differences in addiction perceptions. Findings suggest that YAs may benefit from prevention messaging on addictiveness.
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Affiliation(s)
- Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
| | - Keith B Burt
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
| | - Elias M Klemperer
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
| | - Harry L Chen
- Department of Family Medicine, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, The University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Psychological Science, The University of Vermont, Burlington, Vermont, USA
- Rutgers Center for Tobacco Studies; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, New Brunswick, New Jersey, USA
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13
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Shephard A, Dölek Ş, Barrett SP. Investigating predictors of problematic alcohol, cannabis, and nicotine use among legal users of all three substances. Front Psychiatry 2023; 14:1110415. [PMID: 36911131 PMCID: PMC9996031 DOI: 10.3389/fpsyt.2023.1110415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The three most used substances-alcohol, cannabis, and nicotine-are frequently concurrently. Use of each substance has been connected to an increased probability of use of the other substances, and the problematic use of each substance has been linked to demographic factors, substance use factors, and personality. However, little is known about which risk factors are most important for consumers of all three substances. This study examined the extent to which various factors are associated with dependence on alcohol, cannabis, and/or nicotine in users of all three substances. METHODS 516 Canadian adults with past month use of alcohol, cannabis, and nicotine completed online surveys querying their demographics, personality, substance use history, and levels substance dependence. Hierarchical linear regressions were used to determine which factors best predicted levels of dependence on each substance. RESULTS Alcohol dependence was associated with levels of cannabis and nicotine dependence, and impulsivity, with 44.9% of variance explained. Cannabis dependence was predicted by alcohol and nicotine dependence levels, impulsivity, and the age of onset of cannabis use, with 47.6% of variance explained. Nicotine dependence was best predicted by alcohol and cannabis dependence levels, impulsivity, and dual use of cigarettes and e-cigarettes, with 19.9% of variance explained. CONCLUSIONS Alcohol dependence, cannabis dependence, and impulsivity were the strongest predictors for dependence on each of the substances. A strong relationship between alcohol and cannabis dependence was evident, warranting further research.
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Affiliation(s)
- Aaron Shephard
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Şimal Dölek
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sean P Barrett
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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14
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Osibogun O, Erinoso O, Gautam P, Bursac Z, Osibogun A. Marijuana use modifies the association between heavy alcohol consumption and tobacco use patterns among US adults: Findings from Behavioral Risk Factor Surveillance System, 2020. Addict Behav 2022; 135:107435. [DOI: 10.1016/j.addbeh.2022.107435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/01/2022]
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Colonna R, Knott M, Kim S, Bagajati R. Qualitative Research on Cannabis Use Among Youth: A Methodological Review. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221139420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recreational cannabis legalization has encouraged research regarding cannabis use among youth, especially the use of qualitative approaches. In fact, alcohol and drug use journals have recently encouraged qualitative submissions and provided criteria to ensure “high-quality” research. This study provides an objective account of the qualitative approaches used by researchers in this field and discusses implications for future research. A methodological review was conducted for studies published between January 2010 and November 2019. Targeted keyword searches in four research databases returned 1956 unique records. Pairs of reviewers independently screened records against eligibility criteria and charted data for study philosophical positioning, methodology, study aims, sampling, sample, data collection, and data analysis. 23 studies met the inclusion criteria. Several gaps in study quality criteria are observed: less than half of the studies specified the overarching methodology and just two stated philosophical positioning, with some methods unjustified. Implications for future research are discussed.
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Affiliation(s)
- Robert Colonna
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Melissa Knott
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Sean Kim
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Reem Bagajati
- School of Occupational Therapy, Western University, London, ON, Canada
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16
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Nguyen N, Neilands TB, Lisha NE, Lyu JC, Olson SS, Ling PM. Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment. J Addict Med 2022; 16:413-419. [PMID: 34619713 PMCID: PMC8980109 DOI: 10.1097/adm.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Cannabis use is common among people who use tobacco. However, little is known about the relationship between change in use of tobacco and cannabis over time. We examined the longitudinal associations between use of the two substances in a realworld smoking cessation context. METHODS This study analyzed data from a 3-month smoking cessation program delivered via Facebook in the San Francisco Bay Area, USA during 2016-2020. The sample included 487 participants who smoked cigarettes ( Mage = 25.4 years old, 39.6% Male, 40.3% White). The regressors (ie, frequency or number of days during the past 30 days using cigarettes, e-cigarettes, and cigars) and the outcome (ie, frequency of cannabis use) were measured at both baseline and 3-month follow-up. Random-effects modeling examined the longitudinal associations between the regressors and the outcome controlling for alcohol use and baseline demographics. RESULTS Participants who increased (or decreased) their frequency of use of cigarettes (β = 0.17, 95% confidence interval [CI] = 0.10, 0.24), e-cigarettes (β = 0.11, 95% CI = 0.05, 0.17), or cigars (β = 0.19, 95% CI = 0.06, 0.32) also increased (or decreased) their frequency of cannabis use after 3 months. Sexual minority participants (vs heterosexuals) (β = 2.12, 95% CI = 0.01, 4.24) and those whose education attainment being high school or less (vs higher education) (β = 3.89, 95% CI = 1.25, 6.53) were more likely to increase their frequency of cannabis use over time. CONCLUSIONS The findings indicated positive associations between change in use of tobacco and cannabis use. Promoting cessation among people who use tobacco may help to reduce their cannabis use.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA
| | - Nadra E. Lisha
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Sarah S. Olson
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
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Glasser AM, Nemeth JM, Quisenberry AJ, Shoben AB, Trapl ES, Klein EG. Cigarillo Flavor and Motivation to Quit among Co-Users of Cigarillos and Cannabis: A Structural Equation Modeling Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5727. [PMID: 35565122 PMCID: PMC9101063 DOI: 10.3390/ijerph19095727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
Flavored cigar restrictions have the potential to benefit public health. Flavor availability facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis, an increasingly prevalent behavior among young adults. Data were collected (2020-2021) in a cross-sectional online survey administered to a convenience sample of young adults who smoked cigarillos from 15 areas with high cigar use prevalence. We assessed the relationship between flavored cigarillo use and motivation to quit cannabis and cigarillo use among past 30-day co-users (N = 218), as well as several covariates (e.g., cigarillo price and flavor/cannabis policy). Flavored cigarillo perceived appeal and harm were hypothesized parallel mediators. Most co-users reported usually using flavored cigarillos (79.5%), which was not significantly associated with motivation to quit cigarillos or cannabis. Perceived cigarillo harm (β = 0.17, 95% CI = 0.00, 0.33), advertising exposure (β = 0.12, 95% CI = 0.00, 0.24), and income (among racial/ethnic minorities; β = -0.13, 95% CI = -0.25, -0.02) were significant predictors of motivation to quit cigarillos. There were no significant predictors of motivation to quit cannabis. Cigarillo flavor was not associated with motivation to quit, so findings could suggest that banning flavors in cigars may have a neutral impact on co-use with cannabis among young adults.
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Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abigail B. Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA;
| | - Erika S. Trapl
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Elizabeth G. Klein
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
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Davis DR, Bold KW, Kong G, Cavallo DA, Jackson A, Krishnan-Sarin S. Cannabis use among youth who vape nicotine E-cigarettes: A qualitative analysis. Drug Alcohol Depend 2022; 234:109413. [PMID: 35339972 PMCID: PMC9018562 DOI: 10.1016/j.drugalcdep.2022.109413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/13/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nicotine vaping and cannabis use are common among youth. Among youth who use e-cigarettes, little is known about how and why they use cannabis and patterns of cannabis and nicotine co-use. Given the popularity of both products among youth, the study aim is to utilize qualitative data to better understand cannabis use among youth who use e-cigarettes. METHOD Six focus groups of high schoolers who reported past-month e-cigarette use (N = 50; 52% male) were conducted to inform e-cigarette cessation programming. We conducted secondary data analysis examining report of cannabis use during focus groups. Transcripts were examined for report of cannabis use, reasons for use, and nicotine and cannabis co-use. RESULTS In focus groups, cannabis was commonly discussed. Youth reported vaping cannabis, however other forms of cannabis delivery were common (e.g. blunts, joints). Themes related to reasons for simultaneous use of nicotine and cannabis were to experience stronger psychoactive effects than using either product alone and needing to use less nicotine product overall. Reasons for liking cannabis were positive psychoactive effects and stress relief. Reasons for disliking were related to health concerns. Notably, when youth reported disliking cannabis due to health concerns, a common discussion was strategies to acquire and continue cannabis use in ways that they perceived mitigated health concerns. CONCLUSION Qualitative evidence identified associations between e-cigarette use and cannabis use among youth. Research and interventions targeting youth using e-cigarettes should consider how to address dual use of these products.
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Affiliation(s)
- Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA.
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA
| | - Dana A Cavallo
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA
| | - Asti Jackson
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA
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Alghamdi AA, Gartner C, Najman J, Smirnov A. Co-administering cannabis with tobacco and persistent tobacco smoking after 4½ years in young adults who use stimulants: A prospective population-based study. J Psychoactive Drugs 2022; 54:119-128. [PMID: 34254884 DOI: 10.1080/02791072.2021.1947546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/22/2021] [Accepted: 05/13/2021] [Indexed: 10/20/2022]
Abstract
Tobacco smoking remains highly prevalent in high-risk groups, including young adults who use cannabis and a variety of other drugs. We examine whether co-administering cannabis with tobacco is associated with heavier and more persistent tobacco smoking compared to separate use of these substances among young adults who use drugs recreationally. Data are from a prospective population-based study of young adults residing in Queensland, Australia, who recurrently used ecstasy or methamphetamine. The mean age was 20.8 years at baseline, and 47% were female. An ordinal regression model was developed (n = 277) with levels of tobacco smoking at 4½ years as the outcome. At baseline, just under half the sample (44.6%) had not co-administered cannabis with tobacco in the last month, 9.5% rarely co-administered, 7.7% sometimes co-administered, and 38.2% always co-administered. Always co-administering cannabis with tobacco was associated with more frequent and persistent tobacco smoking at 4½ years (Odds Ratio (OR): 1.98, 95% Confidence Interval (CI): 1.02, 3.83), independently of factors including baseline frequency of cannabis and tobacco use. Young adults who use cannabis should be advised not to co-administrate cannabis with tobacco, and comprise an important target group for tobacco smoking cessation interventions.
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Affiliation(s)
- Abdullah Ahmed Alghamdi
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jake Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andrew Smirnov
- Senior Lecturer and Director of Research Training, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Skelton KR, Donahue E, Benjamin-Neelon SE. Measuring cannabis-related knowledge, attitudes, perceptions, motivations, and influences among women of reproductive age: a scoping review. BMC Womens Health 2022; 22:95. [PMID: 35346156 PMCID: PMC8961997 DOI: 10.1186/s12905-022-01673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cannabis use among women of reproductive age has increased substantially in recent decades. Understanding reasons for cannabis use in this population is critical for cannabis use prevention efforts. Thus, this scoping review aimed to identify and synthesize current measures on reasons for cannabis use in women of reproductive age. Methods We searched PubMed, PyschINFO, CINAHL, and Google Scholar for relevant studies published in English between January 2010 and April 2021. Peer-reviewed, quantitative studies reporting on measures of cannabis-related knowledge, attitudes, perceptions, motivations, and influences among women of reproductive age were eligible for inclusion. We excluded studies not focused on women of reproductive age and studies reporting cannabis use prevalence data only. Results We included 11 studies (10 primary studies and 1 review) with varying subpopulation samples of women, including non-pregnant women (n = 2), women experiencing infertility (n = 1), pregnant women (n = 4), postpartum women (n = 3), and women in the perinatal period (n = 1). Measurement topic areas included information received from health care professionals, attitudes, perceptions and experiences about cannabis use, knowledge of potential harms, and motivations for cannabis use. Most studies including measures of risk perceptions were conducted among pregnant or postpartum women (n = 4). A single study measured influences of cannabis use; no studies measured social or peer influences of use. Most studies (n = 7) created their own measures, with 2 studies using secondary data via measures from population-based surveillance systems in the United States, and one using a previously validated instrument. Recommendations for future research were centered around addressing knowledge gaps of health effects of cannabis use across different time periods, and etiology of cannabis use. Conclusions We found vast measurement gaps in current measures of antecedents of cannabis use among women of reproductive age, providing clear direction for future research in this area. Findings necessitate psychometric evaluation of existing measures to ascertain validity and reliability, as well as development of additional measures of women’s cannabis-related attitudes, perceptions, motivations, and influences. This work is critical to guide not only epidemiologic studies, but cannabis-related prevention work as well. Supplementary information The online version contains supplementary material available at 10.1186/s12905-022-01673-6.
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Affiliation(s)
- Kara R Skelton
- Department of Health Sciences, College of Health Professions, 251 Towson Way, Towson, MD, 21204, USA.
| | - Erin Donahue
- Department of Occupational Therapy and Occupational Science, College of Health Professions, 251 Towson Way, Towson, MD, 21204, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
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Sumbe A, Wilkinson AV, Clendennen SL, Bataineh BS, Sterling KL, Chen B, Harrell MB. Association of tobacco and marijuana use with symptoms of depression and anxiety among adolescents and young adults in Texas. Tob Prev Cessat 2022; 8:03. [PMID: 35128214 PMCID: PMC8792993 DOI: 10.18332/tpc/144500] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Young people with depression and/or anxiety may self-medicate with tobacco or tobacco with marijuana to reduce their symptoms. This study sought to differentiate between the use of tobacco products as intended and tobacco products modified to accommodate marijuana, and to explore their relationships with symptoms of depression and anxiety among youth and young adults. METHODS The study is a secondary analysis of Wave 9 (Spring 2019) data from the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) (n=2439, N=274030). Anxiety and major depressive symptoms were measured by GAD-7 and PHQ-9, respectively. RESULTS The odds of reporting current use of e-cigarettes without marijuana (adjusted prevalence odds ratio, APOR=2.34; 95% CI: 1.30-4.21, p=0.005) and current use of combustible tobacco without marijuana (APOR=2.99; 95% CI: 1.26-7.09, p=0.014) were significantly higher among those who reported depression/anxiety comorbidity compared to those who reported no symptoms of major depressive symptoms (MDS), anxiety or comorbidity. The odds of reporting ever use of e-cigarettes with marijuana (APOR=3.68; 95% CI: 1.69- 8.00, p=0.001), current use of e-cigarettes with marijuana (APOR=2.76; 95% CI: 1.28-5.97, p=0.01) and ever use of combustible tobacco with marijuana (APOR=3.99; 95% CI: 1.66-9.58, p=0.002) were significantly higher among those reporting only MDS compared to those who reported no symptoms of MDS, anxiety or comorbidity. CONCLUSIONS The study findings can have implications for intervention planning, as interventions need to address marijuana and nicotine use in tobacco products and address anxiety and depression.
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Affiliation(s)
- Aslesha Sumbe
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Austin, United States
| | - Anna V. Wilkinson
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Austin, United States
| | - Stephanie L. Clendennen
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Austin, United States
| | - Bara S. Bataineh
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Dallas, United States
| | - Kymberle L. Sterling
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center, Dallas, United States
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Austin, United States
| | - Melissa B. Harrell
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Austin, United States
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22
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Smith DM, Hyland A, Kozlowski L, O'Connor RJ, Collins RL. Use of Inhaled Nicotine and Cannabis Products among Adults Who Vape Both Substances. Subst Use Misuse 2022; 57:432-441. [PMID: 34986066 DOI: 10.1080/10826084.2021.2019773] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Co-occurring use (co-use) of nicotine and cannabis is common, and represents a broad range of use behaviors, including concurrent use, sequential use, and co-administration. Co-use has primarily been examined through the lens of smoked tobacco and cannabis. Little is known about those who co-use vaped nicotine and cannabis, and the degree to which specific co-use behaviors are associated, based on mode of use and/or substance. METHODS We conducted an online pilot survey on use behaviors related to inhaled modes of nicotine and cannabis. The survey was administered to 112 concurrent vapers of these substances. Descriptive analyses examined sample characteristics and co-administered vaping and smoking behaviors. Logistic regressions examined associations in use behaviors by mode and substance. RESULTS Participants who vaped nicotine and cannabis monthly also reported monthly smoking of cannabis (100%), and cigarettes (58%). Most exhibited moderate-to-high degrees of mental health and substance use problems requiring clinical intervention. Monthly concurrent use exhibited more differences by mode, and more similarities by substance. Specific sequential use practices showed mode-specific associations; with greater frequency of cigarette smoking and nicotine vaping. Co-administration was associated with more frequent tobacco and cannabis smoking. CONCLUSIONS Those who regularly vape nicotine and cannabis tend to engage in some form of smoking. Different subsets of nicotine and cannabis co-use behaviors showed different associations with patterns of use and modes of drug delivery. Findings underscore the diversity of nicotine and cannabis use behaviors among co-users, and the importance of considering associations by both substance and mode of use.
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Affiliation(s)
- Danielle M Smith
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Lynn Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - R Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
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23
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González-Roz A, Aonso-Diego G, Martínez-Loredo V, Cuesta M, Secades-Villa R. Effects of Risk Perception and Accessibility on Cannabis Use among Young Population in Spain: Findings from the 2016 National Survey (ESTUDES). Subst Use Misuse 2022; 57:36-46. [PMID: 34678115 DOI: 10.1080/10826084.2021.1981387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BackgroundCannabis use in the young population has undergone a significant increase in Europe. Empirical assessments of individual and contextual mediating variables in relation to cannabis use are informative for prevention actions and have yet to be conducted in Spain. Objectives: This study used the 2016 National Survey on Drug Use in Secondary Education in Spain (ESTUDES) to inform on potentially relevant cannabis prevention targets. We examined individual variables (sex, age, and cannabis risk perception), past 30-day legal and illicit substance use, substance-free activities, and contextual factors (perceived accessibility to cannabis) associated to past 30-day cannabis use. Methods: Data were drawn from 35,369 adolescents (% females: 50.1). Structural equation modeling (SEM) was implemented to identify predictors of cannabis use, and indirect paths were tested via bootstrapping to examine the mediating effects of cannabis risk perception and accessibility. Results: Demographics (male sex, higher age), and past 30-day tobacco, alcohol, and illicit substance use were associated with past 30-day cannabis use. Frequency of past-year engagement in hobbies and reading did also predict past 30-day cannabis use. The mediators worked on most of the relationships examined, except for hobbies and illegal substance use in the case of accessibility and reading and hobbies in the case of risk perception. Conclusions/importance: Cannabis use is more likely to emerge in the event of low risk perception and high accessibility. Lower frequency of past year reading and higher engagement in some hobbies that are often carried out alone represent risk factors, which could potentially influence prevention programs.
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Affiliation(s)
- Alba González-Roz
- Department of Psychology, University of Oviedo, Oviedo, Spain.,Department of Psychology, Research Institute of Health Sciences (IUNICS) - University of the Balearic Islands, Palma de Mallorca, Spain
| | | | - Víctor Martínez-Loredo
- Department of Psychology, University of Oviedo, Oviedo, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
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24
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Reboussin BA, Wagoner KG, Ross JC, Suerken CK, Sutfin EL. Tobacco and marijuana co-use in a cohort of young adults: Patterns, correlates and reasons for co-use. Drug Alcohol Depend 2021; 227:109000. [PMID: 34507062 PMCID: PMC8516030 DOI: 10.1016/j.drugalcdep.2021.109000] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND As marijuana is legalized in more states, modes of administration that facilitate co-use with tobacco are growing in popularity among young adults. This study examines the prevalence, patterns, correlates, and reasons for co-use so that targeted interventions can be developed to prevent negative consequences associated with tobacco use and co-use. METHODS In Fall 2019, 1887 young adults, originally recruited in 2010 from 11 colleges in North Carolina and Virginia to participate in a cohort study, completed an online survey. Co-use was defined as self-reported use of marijuana and tobacco in the past month. Tobacco-only, marijuana-only and co-users were compared using regression modeling. RESULTS Overall, 9.3% of the sample were co-users, 7.1% tobacco-only, and 15.8% marijuana-only users. Tobacco use was associated with an increased likelihood of marijuana use and vice-versa. Co-users were more likely to use e-cigarettes and blunts to administer marijuana and less likely to use smokeless tobacco products. They were more likely to use cocaine, have less anxiety, and be heavier marijuana users than marijuana-only users. Co-users of e-cigarettes and marijuana were less likely to be daily e-cigarette users and make quit attempts than e-cigarette users that did not use marijuana. Experimentation was the primary reason for co-use of tobacco and marijuana. CONCLUSIONS Co-users were more likely to use modes of administration that facilitate use of both substances and have patterns of use that may impact cessation efforts. These findings highlight the importance of surveillance of co-use and the development of interventions targeting experimentation with these substances by young adults.
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Affiliation(s)
- Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States.
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
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25
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Smith DM, Kozlowski L, O'Connor RJ, Hyland A, Collins RL. Reasons for individual and concurrent use of vaped nicotine and cannabis: their similarities, differences, and association with product use. J Cannabis Res 2021; 3:39. [PMID: 34452640 PMCID: PMC8401016 DOI: 10.1186/s42238-021-00097-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding similarities, differences, and associations between reasons people vape nicotine and cannabis may be important for identifying underlying contributors to their co-use. METHODS A cross-sectional survey of 112 co-users of vaped nicotine and cannabis was conducted in 2020. A convenience sample of participants was recruited for the survey using Amazon Mechanical Turk. Participants responded to questions about their reasons for individual nicotine and cannabis product use and co-use and rated their level of agreement using numerical scales. Mean ratings for each reason for use subscale were examined across all participants and compared using paired samples t tests. Associations between reasons for use ratings and product consumption behaviors were examined using linear and logistic regression analyses. RESULTS Cannabis vaping and smoking exhibited similar mean ratings for user experience and product/substance-related reasons for use. Mean ratings for reasons related to product utility were similar for cannabis vaping and nicotine vaping. Mean ratings for utility-related reasons for use were higher for cannabis vaping than cannabis smoking (mean (SD), 3.6 (± 1.0) vs. 2.6 (± 1.2), p < 0.0001). On average, harm reduction-related reasons for use were rated higher for nicotine vaping than cannabis vaping (2.4 (± 1.6) vs. 1.8 (± 1.4), p < 0.0001). Regression models showed higher average ratings for utility-related (b = 0.32; 95% CI, 0.03-0.60) and harm reduction-related (b = 0.21; 95% CI, 0.04-0.37) reasons for nicotine vaping were associated with more frequent nicotine vaping (both p < 0.05). Higher average ratings for instrumentality-related reasons for co-use corresponded with more frequent monthly nicotine vaping (b = 0.26; 95% CI, 0.08-0.44) and higher odds of ever chasing cannabis with nicotine (aOR, 3.06; 95% CI, 1.29-7.30). CONCLUSIONS Vaping serves purposes that differ by substance; nicotine vaping was more closely related to reducing tobacco smoking-related harms, and cannabis vaping was more closely related to circumventing social problems posed by cannabis smoking. Lifetime sequential co-use practices and more frequent nicotine vaping were associated with enhancing the intoxicating effects of cannabis. While replication of these findings using non convenience-based sampling approaches is warranted, results underscore the need to consider shared and unique aspects of nicotine and cannabis vaping, as well as cross-substance interactions between nicotine and cannabis.
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Affiliation(s)
- Danielle M Smith
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA. .,Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
| | - Lynn Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
| | - Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - R Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
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26
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Fitzke RE, Davis JP, Pedersen ER. Co-use of Tobacco Products and Cannabis among Veterans: A Preliminary Investigation of Prevalence and Associations with Mental Health Outcomes. J Psychoactive Drugs 2021; 54:250-257. [PMID: 34334112 DOI: 10.1080/02791072.2021.1956026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While tobacco product (such as combustible cigarettes and nicotine vaping products) and cannabis use rates remain high in the general United States (U.S.) population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at high risk of high rates of cannabis and tobacco use. Co-use of tobacco and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the U.S. However, little is understood about the prevalence rates of tobacco and cannabis co-use among U.S. veterans and its associations with mental health symptomatology. The current study conducted a preliminary analysis of co-use patterns of tobacco and cannabis and associated mental health outcomes among a sample of OEF/OIF veterans (N = 1,230). Results indicated high rates of lifetime and past 30-day use of both substances. Past 30-day co-users endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Results suggest that the addition of cannabis use in conjunction with tobacco use may be associated with greater mental health symptoms among veterans. Findings indicate veteran tobacco and cannabis co-users may benefit from mental health care to help mitigate poor mental health symptoms.
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Affiliation(s)
- Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, University of Southern California, Los Angeles, CA, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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27
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Berg CJ, Krishnan N, Graham AL, Abroms LC. A synthesis of the literature to inform vaping cessation interventions for young adults. Addict Behav 2021; 119:106898. [PMID: 33894483 PMCID: PMC8113079 DOI: 10.1016/j.addbeh.2021.106898] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/13/2021] [Accepted: 02/24/2021] [Indexed: 12/01/2022]
Abstract
There is an urgent need to address young adult (YA) vaping. However, there is limited vaping cessation intervention research, particularly studies tested via experimental designs. This manuscript focuses on YA vaping and critical needs for research to advance vaping cessation interventions for YAs. The smoking cessation literature, especially regarding YA smoking, provides evidence and theory from which to draw. However, the extent to which this literature has utility for vaping cessation warrants investigation. Research to inform the development and optimization of effective vaping cessation interventions for YAs requires attention to both potential targets for behavioral intervention (e.g., conceptual framework) and how to best reach YAs (i.e., delivery modality). Regarding the former, such interventions must consider the complexity of YA vaping (e.g., complex social influences, limited negative outcome expectancies, quit intentions). One particularly challenging aspect of YA cessation is co-use of other tobacco products and marijuana and ensuring that those who quit vaping do not continue or increase other product use. With regard to intervention modality, technology-based interventions (e.g., text messaging, apps) may prove promising, and individualized intervention (e.g., one-on-one counseling) may be needed to carefully intervene on the complexity of substance use, particularly cigarette and marijuana use, within this population.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; George Washington University Cancer Center, George Washington University, Washington, DC, United States.
| | - Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States; Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; George Washington University Cancer Center, George Washington University, Washington, DC, United States
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28
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Manu E, Douglas M, Ntsaba MJ. Theoretical understanding of contextual motivations for sustained adolescent marijuana use in South Africa. S Afr J Psychiatr 2021; 27:1615. [PMID: 34394975 PMCID: PMC8335752 DOI: 10.4102/sajpsychiatry.v27i0.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 05/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Although various reasons for adolescent marijuana use have extensively been explored, contextual factors that sustain the practice in settings where the plant is illegally cultivated, especially in South Africa, remain a grey area. Aim We aimed to explore the contextual factors of sustained adolescent marijuana use in two illicit marijuana-growing settings of the Ingquza Hill Local Municipality of South Africa, based on the differential opportunity theory (DOT) and subcultural theory (SCT). Setting The study was conducted in two illicit marijuana-growing communities in the Ingquza Hill Local Municipality of the Eastern Cape Province of South Africa. Methods Exploratory qualitative research, using focus group discussions approach, was conducted amongst 37 participants, four focus groups and in two communities in the Ingquza Hill Municipality of the Eastern Cape Province of South Africa. Purposive and snowball sampling techniques were used to select the communities and participants, respectively. The data were analysed using a thematic content analysis approach and presented under various themes. Results Nine themes, grouped under two broad factors, DOT influences (availability and affordability of marijuana, idleness and means of dealing with personal problems) and SCT influences (peer conformity, the pleasure derived from marijuana smoking, manipulation of appetite, health reasons, for higher cognitive function and addiction), emerged from the analysis. Conclusion As marijuana has been identified to be a gateway drug for the use of other illicit drugs, its sustained usage amongst adolescents poses a health challenge to the user, community and the country’s healthcare system at large. Hence, there is the need to intensify adolescent marijuana use prevention campaigns in illicit marijuana-growing contexts of South Africa, focussing on the differential opportunities and subcultural inclinations that promote the behaviour in those contexts.
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Affiliation(s)
- Emmanuel Manu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Mbuyiselo Douglas
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mohlomi J Ntsaba
- Department of Nursing, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
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29
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D'Amico EJ, Rodriguez A, Tucker JS, Dunbar MS, Pedersen ER, Shih RA, Davis JP, Seelam R. Early and Late Adolescent Factors that Predict Co-use of Cannabis with Alcohol and Tobacco in Young Adulthood. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:530-544. [PMID: 31960260 DOI: 10.1007/s11121-020-01086-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The changing legal landscape of cannabis in the USA has coincided with changes in how cannabis is used, including its co-use with other substances. This study analyzed 10 years of data from a diverse cohort of youth (N = 2429; 54% Hispanic, 16% Asian, 16% white, 3% black, 10% multiracial) to examine predictors in early and late adolescence of co-use of alcohol with cannabis (AC) and tobacco with cannabis (TC) at age 21. Two forms of co-use were examined: concurrent (use of both substances in past month) and sequential (use of one substance right after the other). Analyses focused on four predictor domains: individual (e.g., resistance self-efficacy), peer (e.g., time spent around peers who use), family (e.g., sibling use), and neighborhood (i.e., perceived alcohol and drug problems in neighborhood). For each co-use combination (AC or TC), we estimated parallel process piecewise latent growth models in a structural equation modeling framework using Mplus v8. The final AC and TC co-use models included all predictor variables from the four domains. Increases in positive expectancies and time spent around peers who use AC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of AC co-use in young adulthood. Increases in sibling TC use and time spent around peers who use TC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of TC co-use in young adulthood. Overall, findings highlight the importance of addressing peer influence in prevention programming during both early and late adolescence.
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Affiliation(s)
| | | | - Joan S Tucker
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Michael S Dunbar
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | - Eric R Pedersen
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Regina A Shih
- RAND Corporation, 1200 S Hayes St, Arlington, VA, 22202, USA
| | - Jordan P Davis
- University of Southern California, Los Angeles, CA, 90089, USA
| | - Rachana Seelam
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
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30
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Rogers SM, Harrell MB, Chen B, Springer A, Loukas A, Perry CL. Multi-directional pathways of tobacco and marijuana use, including comorbid use, among a population-based cohort of adolescents in Texas: A six-wave cross-lagged model. Addict Behav 2021; 115:106771. [PMID: 33387975 PMCID: PMC8686621 DOI: 10.1016/j.addbeh.2020.106771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Past 30-day tobacco and marijuana use commonly occur among adolescents. It is unclear whether use of one product precedes the other, especially given the new climate surrounding marijuana legalization and the increasing popularity of e-cigarettes. METHODS Six-panel cross-lagged regression models, with six months between each panel/Wave (2014-17), were used to model stability paths, bi-directional paths, and comorbid paths (i.e., correlations) between past 30-day use of marijuana and tobacco products. Data were derived from three cohorts of adolescents (n = 3907; weighted N = 461,069) in 6th, 8th, and 10th grades at baseline. RESULTS Few bidirectional relationships between past 30-day tobacco and marijuana use were observed in early adolescence (6th grade). During the middle adolescence developmental period (8th grade), past 30-day marijuana use was prospectively associated with greater risk of past 30-day tobacco use. In late adolescence (10th grade), increased odds of past 30-day marijuana use given prior past 30-day e-cigarette use, and vice versa, were observed. For all cohorts, stability paths were common, especially for past 30-day marijuana use. Comorbid use was common in middle adolescence (8th grade) but small in magnitude. CONCLUSIONS This is the first study to longitudinally situate comorbid, past 30-day use of tobacco and marijuana and simultaneously examine bi-directional past 30-day use of these products for adolescents. Marijuana use more often and more strongly predicted subsequent tobacco use than the reverse, especially during middle adolescence (13-15 years old). Marijuana use should be considered when creating interventions that address adolescent e-cigarette use in the U.S.
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Affiliation(s)
- Shannon M Rogers
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA.
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
| | - Andrew Springer
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
| | - Alexandra Loukas
- Health Behavior and Health Education in the Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, TX, USA
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31
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Pedersen ER, Tucker JS, Davis JP, Dunbar MS, Seelam R, Rodriguez A, D'Amico EJ. Tobacco/nicotine and marijuana co-use motives in young adults: Associations with substance use behaviors one year later. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:133-147. [PMID: 32551726 PMCID: PMC7746603 DOI: 10.1037/adb0000638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Co-administration of tobacco/nicotine and marijuana (e.g., using both products on the same occasion by mixing them in the same delivery device) is a risky, yet common, form of co-use among young adults. Understanding motivations for co-administration co-use, and how these are associated with subsequent use and related problems, is needed to inform policy, prevention, and intervention efforts. We conducted a latent class analysis on 342 young adults with past-year co-administration of tobacco/nicotine and marijuana to determine how emergent classes of 16 co-use motives were associated with use and co-administration co-use of tobacco/nicotine and marijuana one year later. Four classes emerged: (1) a high all class that reported high endorsement of all motives, (2) a high coping class that reported high endorsement of co-use due to coping with stress and bad moods, (3) a high social/physiological reinforcement class that reported low endorsement of coping but high probability of social and relaxation motives and motives to even out effects of each substance, and (4) a low all class that reported low endorsement of all motives. The high all and high coping classes reported greater frequency and quantity of single substance use and co-administration. The high coping class reported more marijuana consequences than the low all class. The high all and high coping classes reported younger age of initiation of each individual substance and co-administration. Considering co-use motives may be useful in identifying those at highest risk for future use and consequences and tailoring interventions to the distinct needs of co-use subgroups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Jordan P Davis
- Department of Children, Youth, and Families, Suzanne Dworak-Peck School of Social Work, University of Southern California
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Thrul J, Gubner NR, Nguyen N, Nguyen C, Goodell EA, Holmes LM, Vandrey RG, Ling PM. Perceived reward from using cigarettes with alcohol or cannabis and concurrent use: A smartphone-based daily diary study. Addict Behav 2021; 114:106747. [PMID: 33307406 PMCID: PMC7806245 DOI: 10.1016/j.addbeh.2020.106747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Smoking cigarettes under the influence of alcohol or cannabis is associated with perceived pleasure. However, it is unclear whether these changes in perceived reward impact the extent of concurrent use of cigarettes with alcohol or cannabis. The current study investigated if self-reported changes in perceived reward from concurrent use of cigarettes with alcohol or cannabis are related to the extent of concurrent use in real-world contexts using a smartphone-based Ecological Momentary Assessment (EMA) study. METHODS The sample included 126 diverse young adult smokers in the San Francisco Bay Area who reported current alcohol or cannabis use at baseline (M = 22.8 years, 50.8% male, 40.5% sexual minority, 39.7% Non-Hispanic White). Participants completed an online baseline survey and 30 days of smartphone-based daily EMA surveys of cigarette, alcohol, and cannabis use. The baseline assessed self-reported changes in perceived pleasure of smoking cigarettes while using alcohol or cannabis separately. EMA surveys included detailed questions about concurrent use (i.e., the extent of smoking while using another substance) covering the previous day. A total of 2,600 daily assessments were analyzed using mixed models. RESULTS Higher perceived pleasure from smoking cigarettes while drinking alcohol or using cannabis at baseline were both associated with a greater extent of concurrent use of cigarettes with alcohol (b = 0.140; SE = 0.066; t = 2.1; p = .035) and cannabis (b = 0.136; SE = 0.058; t = 2.4; p = .019) on a given day. CONCLUSIONS Results suggest that perceived reward from concurrently using cigarettes with alcohol or cannabis is associated with the extent of concurrent use. Findings can inform tailored smoking cessation interventions.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, United States; Centre for Alcohol Policy Research, La Trobe University, Australia.
| | - Noah R Gubner
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, United States
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, United States
| | - Charlie Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Erin Anderson Goodell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Louisa M Holmes
- Department of Geography, Penn State University, United States
| | - Ryan G Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, United States
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Rogers SM, Loukas A, Harrell MB, Chen B, Springer A, Perry CL. Multidirectional Pathways of Tobacco and Marijuana Use, Including Comorbid Use, Among Young Adults (Aged 18-25 Years) in Texas: A Six-Wave Cross-Lagged Model. J Adolesc Health 2021; 68:116-122. [PMID: 32631731 PMCID: PMC7755747 DOI: 10.1016/j.jadohealth.2020.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/01/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Prevalence of past 30-day tobacco and marijuana use are highest among young adults in the U.S., and comorbid use of these products is common. However, it is unclear whether the use of one product precedes the other-an important consideration, given the new climate surrounding marijuana legalization and the popularity of e-cigarette products. METHODS Six-panel cross-lagged regression models, with 6 months between each panel/wave, were used to model bidirectional paths between past 30-day use and comorbid use of marijuana and tobacco products from 2014 to 2017 among young adults (N = 5,221 college students, aged 18-25 years). RESULTS Combustible tobacco use and e-cigarette use were prospectively associated with greater risk of future marijuana use while controlling for the stability of use over time, age, race/ethnicity, and sex. Marijuana use was prospectively associated with greater risk of future combustible tobacco and e-cigarette use. Comorbid use was common, but while the odds of comorbid use decreased with increasing age, odds of tobacco use increased. CONCLUSIONS More young adults may be consolidating their use than are successfully ceasing their tobacco or marijuana use as they mature through young adulthood. Although we observed decreases in comorbid use of combustible tobacco with marijuana and e-cigarettes with marijuana, we simultaneously observed strong stability in single use of these products over time. Taken together, these results should help structure interventions specific to young adults that target use and comorbid use in early young adulthood to discourage initiation, encourage cessation, and curb subsequent escalation in later young adulthood.
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Affiliation(s)
- Shannon M Rogers
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Alexandra Loukas
- Health Behavior and Health Education, Department of Kinesiology & Health Education, The University of Texas at Austin, Austin, Texas.
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Baojiang Chen
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Andrew Springer
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
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Maier LJ, Ramo DE, Kaur M, Meacham MC, Satre DD. Factors associated with readiness to quit smoking among young adults enrolled in a Facebook-based tobacco and alcohol intervention study. Addict Behav 2020; 111:106524. [PMID: 32791434 PMCID: PMC8262102 DOI: 10.1016/j.addbeh.2020.106524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Young adults who smoke cigarettes often report heavy episodic drinking (HED) and co-use of other psychoactive substances which may complicate efforts to quit cigarette smoking. The current study examined factors associated with readiness to quit cigarette smoking among young adults who smoke and engage in HED. METHODS One hundred seventy-nine young adults aged 18 to 25 who reported regular cigarette smoking and past month HED enrolled in the 90-day Facebook-based Smoking Tobacco and Drinking (STAND) intervention study. Analyses compared baseline differences in patterns of cigarette smoking and alcohol and cannabis use, thoughts about abstinence, use of nicotine replacement therapy (NRT), sociodemographic characteristics, and other health behaviors between participants who were ready to quit cigarette smoking in the next 30 days and those who were not. RESULTS Participants were 40.2% female, 49.7% male, 10.1% non-binary, and 80.4% Non-Hispanic White. They reported on average moderate nicotine dependence (FTCD), moderate risk for alcohol use disorder (AUDIT), and occasional or regular cannabis use. Readiness to quit cigarette smoking in the next 30 days (33.5%) was positively associated with age (p = .021), NRT use in the past 30 days (p = .037) and perceived importance to also reduce alcohol use (p = .033). CONCLUSIONS Findings indicate that readiness to quit cigarette smoking among young adults who drink is positively associated with importance to reduce alcohol use, but not with use patterns or levels of dependence. Interventions addressing polysubstance use may be better suited to help young adults reduce or quit cigarette smoking once they signal readiness for behavior change.
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Affiliation(s)
- Larissa J Maier
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States; Early Postdoc. Mobility Grantee (P2ZHP1_174812), Swiss National Science Foundation, Bern, Switzerland.
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Manpreet Kaur
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Meredith C Meacham
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Derek D Satre
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States; Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States.
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Weinberger AH, Delnevo CD, Wyka K, Gbedemah M, Lee J, Copeland J, Goodwin RD. Cannabis Use Is Associated With Increased Risk of Cigarette Smoking Initiation, Persistence, and Relapse Among Adults in the United States. Nicotine Tob Res 2020; 22:1404-1408. [PMID: 31112595 DOI: 10.1093/ntr/ntz085] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/20/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite increasing use of cannabis, it is unclear how cannabis use is related to cigarette transitions. This study examined cannabis use and smoking initiation, persistence, and relapse over 1 year among a nationally representative sample of US adults. METHODS Data were from US adults (≥18 years) who completed two waves of longitudinal data from the Population Assessment of Tobacco and Health Study (Wave 1, 2013-2014; Wave 2, 2014-2015; n = 26 341). Logistic regression models were used to calculate the risk of Wave 2 incident smoking among Wave 1 never-smokers, smoking cessation among Wave 1 smokers, and smoking relapse among Wave 1 former smokers by Wave 1 cannabis use. Analyses were adjusted for age, gender, race/ethnicity, income, and education. RESULTS Among Wave 1 never-smokers, cannabis use was associated with increased odds of initiation of nondaily (adjusted odds ratio [AOR] = 5.50, 95% confidence limits [CL] = 4.02-7.55) and daily cigarette smoking (AOR = 6.70, 95% CL = 4.75-9.46) 1 year later. Among Wave 1 daily smokers, cannabis use was associated with reduced odds of smoking cessation (AOR = 0.36, 95% CL = 0.20-0.65). Among Wave 1 former smokers, cannabis use was associated with increased odds of relapse to daily and nondaily cigarette smoking (daily AOR = 1.90, 95% CL = 1.11-3.26; nondaily AOR = 2.33, 95% CL = 1.61-3.39). CONCLUSIONS Cannabis use was associated with increased cigarette smoking initiation, decreased smoking cessation, and increased smoking relapse among adults in the United States. Increased public education about the relationship between cannabis use and cigarette smoking transitions may be needed as cannabis use becomes more common among US adults. IMPLICATIONS As cannabis use increases in the United States and other countries, an evaluation of the relationships of cannabis use to other health-related behaviors (eg, cigarette smoking) is needed to understand the population-level impact of legalization. Little is known about associations between cannabis use and cigarette smoking transitions (1) using recent longitudinal data, (2) among adults, and (3) examining transitions other than smoking initiation (eg, smoking relapse). Our results suggest that among US adults, cannabis use was associated with increased cigarette smoking initiation among never-smokers, decreased cigarette smoking cessation among current smokers, and increased cigarette smoking relapse among former smokers.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY.,Institute for Implementation Science in Population Health, City University of New York, New York, NY
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Jan Copeland
- National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, Australia
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY.,Institute for Implementation Science in Population Health, City University of New York, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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West JC, Peasley-Miklus C, Graham AL, Mays D, Mermelstein R, Higgins ST, Villanti AC. Impact of alcohol and drug use on smoking and cessation in socioeconomically disadvantaged young adults. Addict Behav 2020; 110:106486. [PMID: 32688226 PMCID: PMC9063176 DOI: 10.1016/j.addbeh.2020.106486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Population studies highlight that alcohol and marijuana use are correlated with cigarette smoking and other tobacco use. The aim of our study was to describe the ways in which alcohol and drug use may affect cigarette smoking and cessation in socioeconomically-disadvantaged young adult (SDYA) smokers. METHODS Thirty-six SDYA smokers aged 18-29 participated in eight focus groups and two individual interviews in Burlington, Vermont in 2018. Structured focus groups addressed poly-tobacco use, other substance use and co-use with tobacco, and the contexts and facilitators that cue SDYA smoking. Participants were also asked their reasons for smoking, barriers to cessation, and messages or modalities that would make smoking cessation more novel or relevant. Three coders implemented the Framework Method to systematically code focus group transcripts. RESULTS In this sample of SDYA smokers, four key themes emerged around the relationships between alcohol and drug use and smoking: 1) frequent co-use of tobacco and other substances, 2) changes in frequency of smoking when using other substances, including chain smoking when drinking and substituting cigarettes with marijuana, 3) cigarettes as a last remaining addiction for those in recovery from other substance use and, 4) fears that quitting smoking would cause relapse to other substances. DISCUSSION Co-use of other substances emerged as a reason for smoking and a barrier to quitting, including a concern that quitting smoking would trigger drug or alcohol relapse. Findings support demand for interventions that address substance co-use to improve smoking cessation in SDYA smokers.
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Affiliation(s)
- Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Department of Psychological Science, University of Vermont, USA.
| | | | - Amanda L Graham
- Innovations, Truth Initiative, USA; Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, USA
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, USA
| | - Robin Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
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Lanza HI, Barrington-Trimis JL, McConnell R, Cho J, Braymiller JL, Krueger EA, Leventhal AM. Trajectories of Nicotine and Cannabis Vaping and Polyuse From Adolescence to Young Adulthood. JAMA Netw Open 2020; 3:e2019181. [PMID: 33021651 PMCID: PMC7539114 DOI: 10.1001/jamanetworkopen.2020.19181] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Little is known about cannabis vaping trajectories across adolescence and young adulthood or the co-occurrence with nicotine vaping. OBJECTIVE To evaluate nicotine vaping and cannabis vaping trajectories from late adolescence to young adulthood (≥18 years of age) and the extent of polysubstance vaping. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study, 5 surveys (including information on substance vaped) were completed at 10 high schools in the Los Angeles, California, metro area. Students were surveyed at 6-month intervals from fall of 11th grade (October to December 2015; wave 5) through spring of 12th grade (March to June 2017; wave 8) and again approximately 1 to 2 years after high school (October 2018 to October 2019; wave 9). EXPOSURES Past 30-day nicotine and cannabis vaping frequency across 5 waves. MAIN OUTCOMES AND MEASURES Self-reported frequency of nicotine vaping and cannabis vaping within the past 30 days across 5 time points from late adolescence to young adulthood. Trajectories were measured with these past 30-day use frequencies at each wave. Parallel growth mixture modeling estimated conditional probabilities of polysubstance vaping. RESULTS The analytic sample included 3322 participants with at least 1 time point of data (mean [SD] age, 16.50 [0.42] years at baseline; 1777 [53.5%] female; 1573 [47.4%] Hispanic or Latino). Growth mixture modeling identified the 5-trajectory model as optimal for both nicotine vaping and cannabis vaping. Trajectories for nicotine and cannabis vaping were similar (nonusers: 2246 [67.6%] nicotine, 2157 [64.9%] cannabis; infrequent users: 566 [17.0%] nicotine, 608 [18.3%] cannabis; moderate users: 167 [5.0%] nicotine, 233 [7.0%] cannabis; young adult-onset frequent users: 213 [6.4%] nicotine, 190 [5.7%] cannabis; adolescent-onset escalating frequent users: 131 [3.9%] nicotine, 134 [4.0%] cannabis). Males had greater odds of belonging to the adolescent-onset escalating frequent users nicotine (adjusted odds ratio, 2.88; 95% CI, 1.58-5.23; P < .01) and cannabis (adjusted odds ratio, 1.95; 95% CI,1.03-3.66; P < .05) vaping trajectories compared with nonusers. Polysubstance vaping was common, with those in trajectories reflecting more frequent nicotine vaping (adolescent-onset escalating frequent users and young adult-onset frequent users) having a high probability of membership (85% and 93%, respectively) in a cannabis-use trajectory. CONCLUSIONS AND RELEVANCE In this cohort study, the prevalence and type of nicotine vaping and cannabis vaping developmental trajectories from late adolescence to young adulthood were similar. Polysubstance vaping was common from late adolescence to young adulthood, particularly among those reporting more frequent vaping use. The findings suggest that public health policy and clinical interventions should address polysubstance vaping in both adolescence and young adulthood.
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Affiliation(s)
- H. Isabella Lanza
- Department of Human Development, California State University, Long Beach
| | | | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Junhan Cho
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | | | - Evan A. Krueger
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles
- Department of Psychology, University of Southern California, Los Angeles
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles
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Woloshchuk CJ, Carlos Portillo, Lerma M, Villegas D, Fregoso R, Posada E, Torres J, Frietze GA, Cooper TV. Characteristics associated with marijuana use in Latinx college students. J Ethn Subst Abuse 2020; 21:923-938. [PMID: 32857681 DOI: 10.1080/15332640.2020.1808872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While marijuana use rates are significantly high within college students, less is known about use patterns and correlates in Latinx groups. This study assessed the relationships between ever use and frequency of use of marijuana, polysubstance use, expectancies, motives, and mental illness symptoms among Latinx college students (n = 345). Results indicated more frequent marijuana use was positively associated with: enjoyment, celebration, social anxiety, low risk, sleep and availability and was negatively associated with: experimentation, boredom, altered perception, and anxiety. Other dual use with tobacco expectancies were also observed. These constructs should be explored prospectively and inform prevention and intervention efforts.
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Affiliation(s)
- Claudia J Woloshchuk
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Carlos Portillo
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Marcos Lerma
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Diana Villegas
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Roman Fregoso
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Emilio Posada
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Joshua Torres
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Gabriel A Frietze
- School of Pharmacy, The University of Texas at El Paso, El Paso, TX, USA
| | - Theodore V Cooper
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
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Correa JB, Myers MG, Tully LK, Doran N. Co-occurring Use of Cannabis and Tobacco and the Presence of Acute Respiratory Symptoms among Young Adult Light and Intermittent Smokers. Subst Use Misuse 2020; 55:2129-2137. [PMID: 32696699 PMCID: PMC7537795 DOI: 10.1080/10826084.2020.1793366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cannabis use and intermittent smoking are becoming increasingly prevalent among young adults. Thus, identifying health consequences of co-occurring use of these substances represents an emerging research priority. Purpose/Objectives: This study evaluated the relationship between tobacco/cannabis co-use and acute symptoms of respiratory illness among young adult intermittent smokers. We hypothesized that tobacco/cannabis co-use would be more strongly associated with respiratory symptoms relative to use of neither or one product. Methods: A secondary analysis of a three-year observational study was conducted. Non-daily smokers (n = 563) aged 18-24 were recruited via social media and completed electronic surveys at baseline and annually for two years, producing three total assessments. Past-two-week use of tobacco and cannabis was measured at each assessment, as was severity of six acute respiratory symptoms. The respiratory measure was dichotomized to indicate the presence or absence of symptoms. Results: Tobacco/cannabis co-use decreased from 54.8% at baseline to 43.4% at year two (p < .001). Mean respiratory symptoms also declined significantly over time (ps < .05). At each timepoint, co-use was more strongly associated with presence of respiratory symptoms than the use of neither product (aORs = 2.73-4.39, ps ≤ .013). Co-users were also 38%-183% more likely to endorse the presence of respiratory symptoms than single product users at each timepoint (aORs = 1.38-2.83, ps = .023-.212). Conclusions/Importance: Although co-occurring use of tobacco and cannabis by young adults may represent experimental use of multiple substances, it may also promote or exacerbate acute symptoms of respiratory illness. Further exploration with more granular patterns of co-use and across different routes of administration is warranted.
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Affiliation(s)
- John B. Correa
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161
- University of California, 3350 La Jolla Village Drive, San Diego, CA 92161
| | - Mark G. Myers
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161
- University of California, 3350 La Jolla Village Drive, San Diego, CA 92161
| | - Lyric K. Tully
- University of California, 3350 La Jolla Village Drive, San Diego, CA 92161
| | - Neal Doran
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161
- University of California, 3350 La Jolla Village Drive, San Diego, CA 92161
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Nguyen N, Nguyen C, Thrul J. Digital health for assessment and intervention targeting tobacco and cannabis co-use. CURRENT ADDICTION REPORTS 2020; 7:268-279. [PMID: 33643768 DOI: 10.1007/s40429-020-00317-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose of review This article aims to summarize current research on digital health for assessment and intervention targeting tobacco and cannabis co-use and to answer the following questions: Which digital tools have been used? Which populations have been targeted? And what are implications for future research? Recent findings Ecological Momentary Assessment (EMA) via text messages or interactive voice response calls has been used to capture co-use patterns within a time window or co-administration of both substances via blunts among young adults. Feasibility of multicomponent interventions targeting dual cessation of both substances among adult co-users with cannabis use disorder, delivered via smartphone apps, online, and computer modules has been demonstrated. Summary Digital tools, particularly those using EMAs and mobile sensors, should be expanded to assess co-use of emerging tobacco and cannabis products. Digital cessation interventions should be tailored to different groups of co-users and address specific mechanisms underlying different co-use patterns.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Charlie Nguyen
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Wilhelm J, Abudayyeh H, Perreras L, Taylor R, Peters EN, Vandrey R, Hedeker D, Mermelstein R, Cohn A. Measuring the temporal association between cannabis and tobacco use among Co-using young adults using ecological momentary assessment. Addict Behav 2020; 104:106250. [PMID: 31918167 DOI: 10.1016/j.addbeh.2019.106250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Jess Wilhelm
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Haneen Abudayyeh
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Lexie Perreras
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Reddhyia Taylor
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Erica N Peters
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States.
| | - Donald Hedeker
- The University of Chicago, Department of Public Health Sciences, 5841 S. Maryland Ave., Rm. W-254, MC2000, Chicago, IL 60637, United States.
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, Psychology Department, 1747 W. Roosevelt Rd. 544 WROB, MC 275, Chicago, IL 60607, United States.
| | - Amy Cohn
- University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States.
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Gravely S, Driezen P, Smith DM, Borland R, Lindblom EN, Hammond D, McNeill A, Hyland A, Cummings KM, Chan G, Thompson ME, Boudreau C, Martin N, Ouimet J, Loewen R, Quah ACK, Goniewicz ML, Thrasher JF, Fong GT. International differences in patterns of cannabis use among adult cigarette smokers: Findings from the 2018 ITC Four Country Smoking and Vaping Survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102754. [PMID: 32305827 PMCID: PMC7967289 DOI: 10.1016/j.drugpo.2020.102754] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/26/2020] [Accepted: 04/02/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization. METHODS Data are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England. RESULTS Among this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent ( CONCLUSION Patterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia. Further attention as to how varying cannabis regulations may impact co-use patterns is warranted.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada.
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Cancer Council Victoria, Melbourne, VIC, Australia
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC United States
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Ann McNeill
- King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; UK Centre for Tobacco & Alcohol Studies, Nottingham, United Kingdom
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Gary Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Ruth Loewen
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States; Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada; Ontario Institute for Cancer Research, Toronto, Canada
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Zuckermann AM, Williams G, Battista K, de Groh M, Jiang Y, Leatherdale ST. Trends of poly-substance use among Canadian youth. Addict Behav Rep 2019; 10:100189. [PMID: 31193263 PMCID: PMC6525276 DOI: 10.1016/j.abrep.2019.100189] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Poly-substance use, increasingly understood as a behaviour with uniquely adverse consequences, is on the rise among Canadian youth. High levels of e-cigarette vaping and the recent legalization of recreational cannabis use may result in an acceleration of this trend. The aim of this work was to characterise changes in youth poly-substance use over time, generate baseline data for future investigations, and highlight areas of interest for policy action. METHODS Descriptive statistics and regression models explored patterns and trends in concurrent use of multiple substances (alcohol, cigarettes, cannabis, and e-cigarettes) among Canadian high school students taking part in the COMPASS prospective cohort study during Y2 (2013/2014; n = 45,298), Y3 (2014/2015, n = 42,355), Y4 (2015/2016; n = 40,436), Y5 (2016/2017; n = 37,060), and Y6 (2017/2018; n = 34,879). RESULTS Poly-substance use increased significantly over time, with over 50% of students who used substance reporting past-year use of multiple substances by 2017/2018. Male and Indigenous students were significantly more likely to report poly-substance use than female and white students respectively. E-cigarette vaping doubled from Y5 to Y6 and was included in all increasingly prevalent substance use combinations. CONCLUSIONS Youth poly-substance use, rising since 2012/2013, saw a particularly steep increase after 2016/2017. Differential effects were observed for distinct demographic subpopulations, indicating tailored interventions may be required. E-cigarette vaping surged in parallel with the observed increase, suggesting a key role for this behaviour in shaping youth poly-substance use.
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Affiliation(s)
- Alexandra M.E. Zuckermann
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
- Public Health Agency of Canada, Applied Research Division, 785 Carling Ave, Ottawa, ON K1A 0K9, Canada
| | - Gillian Williams
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Katelyn Battista
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Margaret de Groh
- Public Health Agency of Canada, Applied Research Division, 785 Carling Ave, Ottawa, ON K1A 0K9, Canada
| | - Ying Jiang
- Public Health Agency of Canada, Applied Research Division, 785 Carling Ave, Ottawa, ON K1A 0K9, Canada
| | - Scott T. Leatherdale
- University of Waterloo, School of Public Health and Health Systems, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
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Nguyen N, Barrington-Trimis JL, Urman R, Cho J, McConnell R, Leventhal AM, Halpern-Felsher B. Past 30-day co-use of tobacco and marijuana products among adolescents and young adults in California. Addict Behav 2019; 98:106053. [PMID: 31357072 PMCID: PMC6708734 DOI: 10.1016/j.addbeh.2019.106053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/03/2019] [Accepted: 07/14/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Limited research among adolescents and young adults (AYA) has assessed tobacco and marijuana co-use in light of specific products. We examined the patterns of past 30-day co-use of tobacco and marijuana products, and the product-specific associations among past 30-day use of these substances. METHODS Data from three school-based convenience samples of California AYA (aged 15-22) (Sample 1 = 3008; Sample 2 = 1419; Sample 3 = 466) were collected during 2016-2017. Proportions of past 30-day co-use of tobacco (e-cigarettes, cigarettes, hookah, cigars) and marijuana (combustible, vaporized, edible, blunt) were estimated. Multivariable logistic regression analyses examined associations between use of each tobacco and marijuana product for individual samples, then the pooled analysis calculated combined ORs. RESULTS In the three samples, 7.3-11.3% of participants reported past 30-day co-use. Combinations of e-cigarettes or cigarettes and combustible marijuana were the most common co-use patterns. Past 30-day use of e-cigarettes or cigarettes (vs. non-use) increased the odds of past 30-day use of all marijuana products [e-cigarettes: ORs (95%CI) ranging from 2.5 (1.7, 3.2) for edible marijuana to 4.0 (2.8, 5.2) for combustible marijuana; cigarettes: from 3.2 (2.1, 4.2) for vaporized marijuana to 5.5 (3.8, 7.3) for combustible marijuana]. Past 30-day use of hookah or cigars was positively associated with past 30-day use of three of four marijuana products, except for hookah and vaporized marijuana, and for cigars and combustible marijuana. CONCLUSIONS Given various co-use patterns and significant associations among tobacco and marijuana products, interventions targeting AYA should address co-use across the full spectrum of specific products for both substances.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, CA, USA.
| | | | - Robert Urman
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Junhan Cho
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Rob McConnell
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Adam M Leventhal
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
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Roche DJO, Bujarski S, Green R, Hartwell EE, Leventhal AM, Ray LA. Alcohol, tobacco, and marijuana consumption is associated with increased odds of same-day substance co- and tri-use. Drug Alcohol Depend 2019; 200:40-49. [PMID: 31085377 PMCID: PMC6675401 DOI: 10.1016/j.drugalcdep.2019.02.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about event-level patterns of marijuana co- or tri-use with alcohol and tobacco. Thus, the study goal was to examine patterns of same-day alcohol, cigarette, and marijuana co- and tri-use at the individual level in non-treatment-seeking alcohol users. METHODS Participants (N = 551) completed an in-person interview for alcohol, cigarette, and marijuana use over the previous 30 days, and the event-level substance use patterns of n = 179 participants who reported using each of these substances at least once per month were analyzed. RESULTS The use of alcohol, marijuana, or cigarettes independently increased the probability of subsequent, simultaneous co-use of one of the two remaining substances. The co-use of alcohol with cigarettes and marijuana with cigarettes produced generally additive effects on the odds of same day tri-use of marijuana and alcohol, respectively. Conversely, the co-use of alcohol and marijuana produced sub-additive effects on likelihood of cigarette use. Sex moderated several of the observed patterns of co- and tri-use: the relationship between alcohol or cigarette use predicting marijuana co-use was stronger in men, whereas the observed additive relationships between drug co-use leading to tri-use was stronger in women. CONCLUSIONS The presented results may aid in the understanding of how simultaneous co-use of marijuana with alcohol and/or tobacco relates to the etiology, maintenance, and treatment of comorbid and trimorbid substance use disorder. Replication and extension of the results in treatment seeking populations using more fine-grained analysis approaches, e.g. ecological momentary assessment, is needed.
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Affiliation(s)
- D J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - S Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - R Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - E E Hartwell
- Mental Illness Research, Education and Clinical Center, Corporal Michael J Crescenz VA Medical Center, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - A M Leventhal
- Departments of Preventive Medicine and Psychpology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - L A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
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Berg CJ, Haardörfer R, Payne JB, Getachew B, Vu M, Guttentag A, Kirchner TR. Ecological momentary assessment of various tobacco product use among young adults. Addict Behav 2019; 92:38-46. [PMID: 30579116 DOI: 10.1016/j.addbeh.2018.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Young adults are at high risk for using traditional and novel tobacco products. However, little is known about daily/weekly use patterns or psychosocial triggers for using various tobacco products. METHODS This ecological momentary assessment (EMA) study examined timing, tobacco cravings, affect, social context, and other substance use (alcohol, marijuana) in relation to use of cigarettes, electronic nicotine delivery systems (ENDS), and any tobacco product (i.e., cigarettes, ENDS, cigars, hookah), respectively. We also examined interactions between these predictors, sex, and race/ethnicity. From a longitudinal study of 3418 18-25 year-olds from seven Georgia colleges/universities, we recruited 72 reporting current tobacco use to participate in the 21-day EMA study; 43 participated, of which 31 completed ≥66% assessments and were analyzed. Cravings, affect, social context, and substance use were assessed daily across four four-hour windows. RESULTS Of the 31 participants, average age was 21.10 years (SD = 1.95), 45.2% were female, and 71.0% non-Hispanic White; 71.0% used cigarettes, 58.1% ENDS, 38.7% cigars, and 25.8% hookah (25.6% used one product, 46.5% two, 27.9% ≥ three). Predictors of cigarette use included higher anxiety, greater odds of marijuana and alcohol use, and higher boredom levels among women. Predictors of ENDS use included being non-White and greater odds of marijuana use, as well as higher tobacco cravings among women and higher boredom among men. Predictors of any tobacco product use included being non-White, higher boredom levels, and greater odds of marijuana and alcohol use. CONCLUSIONS Distinct interventions may be needed to address use of differing tobacco products among young adults.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322, United States.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Jackelyn B Payne
- Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Alexandra Guttentag
- College of Global Public Health, New York University, 715 Broadway, 12th Floor New York, NY 10003, United States
| | - Thomas R Kirchner
- College of Global Public Health, New York University, 715 Broadway, 12th Floor New York, NY 10003, United States
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Weinberger AH, Pacek LR, Wall MM, Gbedemah M, Lee J, Goodwin RD. Cigarette smoking quit ratios among adults in the USA with cannabis use and cannabis use disorders, 2002-2016. Tob Control 2019; 29:74-80. [PMID: 30952691 DOI: 10.1136/tobaccocontrol-2018-054590] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/02/2018] [Accepted: 11/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking is nearly three times higher among persons who use cannabis and have cannabis use disorders (CUDs), relative to those who do not. The current study examined cigarette quit ratios from 2002 to 2016 among US adults with and without cannabis use and CUDs. METHODS The current study analysed US adults aged 18 years and older from the National Survey on Drug Use and Health, an annual cross-sectional study. Quit ratios (ie, proportion of former smokers among ever-smokers) were calculated annually from 2002 to 2016. Time trends in quit ratios by cannabis use/CUDs were tested using logistic regression. RESULTS In 2016, the quit ratios for people with any cannabis use (23%) and CUDs (15%) were less than half the quit ratios of those without cannabis use and CUDs (51% and 48%, respectively). After controlling for demographics and substance use disorders, the quit ratio did not change from 2002 to 2016 among persons with CUD, though it non-linearly increased among persons with cannabis use, without cannabis use and without CUDs. Quit ratios increased more rapidly among those who reported past-month cannabis use compared with those without past-month cannabis use. CONCLUSIONS Cigarette smoking quit ratios remain dramatically lower among people who use cannabis and have CUDs and quit ratios did not change significantly from 2002 to 2016 among those with CUDs. Public health and clinical attention are needed to increase quit ratios and reduce harmful cigarette smoking consequences for persons with cannabis use and CUDs.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, USA.,Institute for Implementation Science in Population Health, The City University of New York, New York, USA
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Department of Genetics, Albert Einstein College of Medicine, Bronx, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, USA.,Institute for Implementation Science in Population Health, The City University of New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Akbar SA, Tomko RL, Salazar CA, Squeglia LM, McClure EA. Tobacco and cannabis co-use and interrelatedness among adults. Addict Behav 2019; 90:354-361. [PMID: 30522075 DOI: 10.1016/j.addbeh.2018.11.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/05/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
Cannabis and tobacco co-use is prevalent, but consensus regarding the reasons for co-use among adults and the degree of interrelatedness between these substances is lacking. Reasons for co-use have been explored with younger users, but little data exists for more experienced users with entrenched patterns of co-use. The goal of this study was to examine characteristics and patterns of cannabis-tobacco co-use among adults in the Southeastern United States (US), where there is a legal landscape of generally restrictive cannabis legislation coupled with more permissive tobacco control compared to other US regions. Participants (N = 432) were regular cannabis users recruited through Amazon Mechanical Turk. Measures included demographics, patterns of cannabis and tobacco use, and reasons for co-use. Within this sample, 42% were current users of tobacco (n = 182). Cannabis-tobacco co-users were older and had more years of cannabis use than cannabis-only users. Among the co-using sub-sample, there was little consistency in the reasons for co-use, suggesting individual differences in the use of both substances. High levels of cannabis-tobacco interrelatedness (i.e., temporally concurrent use) were associated with smoking more cigarettes (tobacco) per day and greater nicotine dependence scores when compared to users with low levels of interrelatedness. Though these results are limited by a small sample size and generalizability issues, there were individual differences in cannabis-tobacco relatedness, which may be of importance when considering treatment strategies for cannabis, tobacco, or both. With additional research, personalized strategies adapted to cannabis-tobacco relatedness profiles among co-users may be warranted as a treatment strategy.
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Seaman EL, Howard DE, Green KM, Wang MQ, Fryer CS. A Sequential Explanatory Mixed Methods Study of Young Adult Tobacco and Marijuana Co-Use. Subst Use Misuse 2019; 54:2177-2190. [PMID: 31328616 DOI: 10.1080/10826084.2019.1638409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The co-occurring use of tobacco and marijuana among young adults is an important behavioral phenomenon within the field of substance use. Studying tobacco and marijuana use together among young adults can provide important insight into patterns of initiation and continuation. Objectives: The primary goal of this study was to examine characteristics associated with co-use among young adults and to discover the ways experiences of co-users can help contextualize trends in co-use. Methods: This study employed a sequential explanatory mixed methods design. Quantitative analyses used 12 years of nationally representative National Health and Nutrition Examination Survey (NHANES) data (2005-2016) to assess the characteristics and experiences of young adult (21-30) co-users. Results from analyses of NHANES, prior literature, and theoretical constructs were used to develop a guide for 20 in-depth, semi-structured interviews with young adult co-users living in the state of Maryland. Interviews were analyzed using thematic analysis. Quantitative results and qualitative findings were integrated. The original NHANES analysis occurred during October and November 2017, interviews took place during December 2017 and January 2018, and all mixed methods integration was conducted in 2018. Results: Tobacco and marijuana co-users have unique characteristics and experiences compared to single product users; the experiences of co-users can offer unique insights on co-use. Meta-inferences emerged from integration. Conclusions/importance: Co-users conceptualize tobacco and marijuana differently and hold different risk perceptions for each substance. Co-users may be at risk for polytobacco product use. These findings highlight the profound influence these two substances have on young adult co-users' experiences and behaviors.
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Affiliation(s)
- Elizabeth L Seaman
- Department of Behavioral and Community Health, University of Maryland , College Park , Maryland , USA
| | - Donna E Howard
- Department of Behavioral and Community Health, University of Maryland , College Park , Maryland , USA
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland , College Park , Maryland , USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland , College Park , Maryland , USA
| | - Craig S Fryer
- Department of Behavioral and Community Health, University of Maryland , College Park , Maryland , USA
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50
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Adolescent electric cigarette use is associated with subsequent marijuana use. J Pediatr 2018; 200:291-294. [PMID: 30144923 DOI: 10.1016/j.jpeds.2018.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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