Media/Marketing Influences on Adolescent and Young Adult Substance Abuse

Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019

BACKGROUND

It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level.

AIMS

We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group.

METHOD

Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index.

RESULTS

Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years.

CONCLUSIONS

Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.

Association Between Social Media Use and Substance Use Among Middle and High School-Aged Youth

Purpose: The purpose of our study was to identify whether different aspects of social media use were associated with substance use among middle- and high school-aged youth. Methods: Participants were recruited from four Northeast U.S. middle schools and invited to complete an online survey in Fall 2019 and Fall 2020. We conducted separate adjusted logistic mixed effects models the substance use outcomes: ever use of alcohol, cannabis, e-cigarettes, tobacco cigarettes, prescription drugs, and multiple substances. Our sample included N = 586 participants (52.7% female, 58% White). Results: Seeing a social media post about drugs/alcohol in the past-12-months was significantly associated with higher odds of ever using alcohol, cannabis, e-cigarettes, and multiple substance use. Total number of social media sites ever used was significantly associated with higher odds of ever using cannabis, cigarettes, e-cigarettes, and multiple substances. Checking social media every hour or more was significantly associated with higher odds of ever using alcohol. Higher problematic internet use score was significantly associated with higher odds of ever using cannabis, e-cigarettes, and multiple substances. Online social support seeking score was not associated substance use. Conclusions: Our findings support the need for substance use prevention and social media literacy education and screening to begin early, ideally in elementary school before youth are using social media and substances.

Evaluation of the awareness of Western Australian SunSmart campaigns between 2008 and 2022

ISSUE ADDRESSED

It is unknown whether SunSmart health promotion campaigns in Western Australia are still effectively reaching their target audience of young people (under 45 years). This study examined trends over time in awareness, relevancy and believability of SunSmart advertisements and identified socio-demographic characteristics and risk factors associated with campaign awareness.

METHOD

Linear regression and log-binomial modelling were undertaken using data from the annual SunSmart post-campaign evaluation surveys between 2008/2009 and 2021/2022. SunSmart campaigns were analysed and categorised into the following themes: (1) personal real-life stories; (2) daily activities/sun exposure leads to skin cancer; or (3) cartoon/animated.

RESULTS

Between 2008 and 2022, there were declines in total awareness (74.2% to 20.4%), unprompted awareness (33.7% to 4.9%) and relevancy (89.5% to 54.8%) of SunSmart advertisements (representing annual percent decreases of 3.6%, 3.1% and 1.8%, respectively). However, believability remained high over time (>94% in each annual survey). Trends were inconsistent between the awareness of campaign themes and socio-demographic characteristics and risk factors. Several campaigns had greater awareness in their subsequent years, compared with the first campaign year.

CONCLUSION

In more recent years, SunSmart advertisements and campaigns may not have reached their target audience. In addition to socio-demographic characteristics, particularly age, advertisement factors may also affect the awareness of specific campaigns. SO WHAT?: Given the changing advertising landscape and its rising costs, ongoing funding is pertinent to increase the reach of future SunSmart campaigns. Increasing advertisements on alternative platforms and designing campaigns which separately target adolescents and adults need to be considered.

Advertising Exposure From Online and Offline Sources and Youth Tobacco Use: Findings From the Adolescents, Place, and Behavior Study

INTRODUCTION

Tobacco use among adolescents is an ongoing public health concern. Youth tobacco use has been associated with advertising, from both online sources and retail environments.

AIMS AND METHODS

This study examined associations between exposure to tobacco advertisements from tobacco retail outlets (TROs), internet, and social media sources and ever tobacco use among adolescents. Data were obtained from youth, aged 11-17 years (N = 401) from Richmond, VA. Bayesian index and group index models were fitted to estimate indices of exposure to (1) social media use, (2) tobacco ads on social media, and (3) TRO store visits and their association with ever tobacco use. The most important components of the exposure indices were also determined based on the index component weights from the Bayesian index models.

RESULTS

In Bayesian index models of single exposures, each exposure index was significantly associated with tobacco use. In the best-fitting model, social media tobacco ads (odds ratio [OR] = 2.2; 95% credible interval [CI]: 1.2, 4.5) and TRO store visits (OR = 1.6; 95% CI: 1.1, 2.3) were significantly associated with ever tobacco use, as was older age (OR = 1.4; 95% CI: 1.2, 1.8). Index component weights revealed Snapchat ad frequency as the most important platform in the social media index and convenience stores as the most important type of store in the TRO index.

CONCLUSIONS

Exposure to pro-tobacco advertisements on social media and visits to TROs are associated with adolescent ever tobacco use. Results provide support for policies that would restrict the promotion of tobacco products at TROs and on social media. Tobacco regulations and interventions targeting convenience stores and Snapchat may be warranted to reduce youth tobacco use.

IMPLICATIONS

Current evidence provide support for policies that would restrict the promotion of tobacco products at TROs and on social media. Findings suggest that regulations and interventions that specifically target advertisements in convenience stores and on Snapchat may be currently warranted to reduce youth tobacco use.

The Marketing and Perceptions of Non-Tobacco Blunt Wraps on Twitter

OBJECTIVE

Non-tobacco blunt wraps (N-TBWs), which entered the marketplace in 2017, are being promoted as an alternative to traditional TBWs (e.g., cigarillos) for blunt smoking. The lack of studies on these novel products warrants an investigation. This study was the first to explore blunt smokers' perceptions about N-TBWs and the extent of product marketing on Twitter.

METHODS

A corpus of tweets from Twitter, posted between January 2017 and November 2021, were identified by a Boolean search string (N = 149,343), where 48,695 tweets were classified as relevant by a machine learning algorithm. These relevant tweets were further screened and labeled as promotional or organic based on product URLs, usernames, keywords, or hashtags. Topic modeling using Dirichlet Allocation was then employed for identifying latent patterns of words among relevant tweets. The Social Networking Potential (SNP) score was employed for identifying influential accounts.

RESULTS

Most relevant tweets (89%) were organic, non-promotional expressions about N-TBWs. Account users who only posted non-promotional tweets had a significantly higher SNP than those who only posted promotional tweets. Yet, neither of the two groups of account users consisted of known celebrities. Topic modeling revealed three broad groups of topics (7 in total) denoting the attributes of hemp N-TBWs, interest in non-hemp N-TBWs, and product marketing.

CONCLUSIONS

The large proportion of organic tweets is indicative of the nascency of N-TBWs, which will need to be marketed more extensively if they are to replace cigar products used by blunt smokers.

Adolescents' perceptions of substance use messaging in the age of social media: resolving cognitive dissonance

This study interviewed adolescents about their exposure to and perceptions of substance-related social media content and substance use prevention messages. Participants (analytic sample N = 30, age 14-18 years, in CA, USA, 40% male) were recruited from Instagram and Facebook for online semi-structured interviews. An interview transcript coding guide was developed based on the interview questions and emerging themes. Most (27/30) participants reported exposure to peers using substances on social media through posts made on personal accounts. All peer posts portrayed substance use in a positive light. Most participants reported exposure to formal prevention messages on social media (i.e. public service announcements) (19/30) and in schools (i.e. drug education) (21/30; 70.0%) teaching the negative consequences of substance use. Responses to the differences between peer posts and prevention messages included dismissing prevention messages (7/30), believing that their peers were more credible (4/30), desiring comprehensive substance information (3/30) and believing that the no-use message was ineffective for at-risk youth (4/30). Messages shared by peers online significantly contrasted with prevention messages (i.e. public service announcements and drug education). This difference appeared to undermine prevention message credibility. Balanced prevention messages acknowledging the spectrum of risk and reward when using different substances may reduce dissonance and increase engagement.

Exposure to media with alcohol-related content across young adulthood: Associations with risky drinking and consequences among high-risk 2- and 4-year college students

INTRODUCTION

Exposure to media with alcohol-related content is a known risk for alcohol use and related harms among young people. The present study used longitudinal self-report data on exposure to media with alcohol-related content to examine age trajectories across young adulthood and to estimate associations with heavy episodic drinking (HED) and negative consequences.

METHOD

Participants were 201 high-risk young adults enrolled in 2- and 4-year colleges (ages 18-25 at screening; 63.7% female). Repeated assessments occurred at four timepoints across a 12-month period.

RESULTS

Self-reported exposure to both positively and negatively portrayed alcohol-related media content decreased with age. Between-persons, controlling for alcohol use frequency, exposure to positive alcohol-related media content was positively associated with HED, and exposure to negative alcohol-related media content was inversely associated with HED; no within-person effects on HED were significant. For negative consequences, controlling for alcohol quantity, exposure to positive media content was associated with more negative consequences both between- and within-persons. Unexpectedly, exposure to negatively portrayed media content was positively associated with negative consequences at the within-person level.

DISCUSSION AND CONCLUSIONS

Trajectories in exposure to media with alcohol-related content showed that relatively younger participants reported greater exposure, highlighting the need for policy and prevention efforts to protect this vulnerable demographic. Findings generally indicated that positive portrayals of alcohol use increase alcohol-related risks. Moreover, increased exposure to negative portrayals in a given assessment was associated with more negative consequences-potentially by normalising or glorifying high-risk drinking and consequences, though mechanistic/causal research is needed.

Social media influencers and adolescents' health: A scoping review of the research field

Social media influencers (SMIs) have become an important source of health information for adolescents. However, the lack of expertise and commercial interests of SMIs pose challenges for adolescent health. To gain a better understanding of these challenges, this scoping review aimed to synthesize existing research on the role of SMIs in adolescent health. Using the PRISMA-ScR approach, we conducted a comprehensive search of eight databases and screened articles based on predefined criteria. The final sample included 51 articles published between 2012 and 2022. Results revealed inconsistent definitions and classifications of SMIs. The most common topics included appearance, nutrition, and substance use, while mental and sexual health topics were underrepresented. The ability of SMIs to establish trustworthy relationships with their followers was highlighted in the reviewed studies, shedding light on potential benefits and challenges for adolescent health. However, most studies focused on the negative roles of SMIs, such as the promotion of unrealistic body images, unhealthy diets, substance use, and inaccurate diagnosis and treatment advice. In addition, inappropriate advertising of unhealthy products (e.g., junk food, tobacco products and alcohol) was identified as a major challenge. The reviewed studies identified stricter regulation and improved social media and health literacy as important avenues for policy action. Less attention was given to the potential positive impact of SMIs and how to effectively include them in health promotion campaigns. In addition, the majority of studies were conducted in the Global North and relied on quantitative approaches, resulting in a lack of representation of minority populations and male adolescents.

Examining indirect effects of advertising exposure on young adults' cannabis and nicotine vaping

OBJECTIVE

To examine longitudinal associations between exposure to two types of advertisements (medical/recreational cannabis and e-cigarette retailers [vape shops]) and young adults' cannabis and nicotine vaping behavior. Positive and negative expectancies for cannabis and vaping nicotine were examined as mediators of these associations.

METHOD

Secondary analysis of observational data from a longitudinal cohort of young adults recruited from Southern California (Wave 13: N = 2,411, 56% female, Mage = 23.6). Participants completed web-based surveys annually, reporting on advertising exposure in 2018, expectancies in 2019, and cannabis and nicotine vaping in 2020. Two path models were specified: (a) of past-month cannabis vaping only, nicotine vaping only, and co-use (vs. no vaping) and (b) of single product vaping (vs. co-use). Path analyses modeled direct and indirect associations between variables.

RESULTS

Controlling for past-month cannabis and nicotine use and other covariates, there were no significant direct associations of advertising exposure with cannabis and/or nicotine vaping. However, the association between cannabis advertising exposure and vaping (cannabis only) was significantly mediated by positive cannabis expectancies (β = 0.02, SE = 0.01, p = .03). Among those who vaped cannabis and/or nicotine in the past month at Wave 13, expectancies did not significantly mediate associations between advertising exposure and single product use (vs. co-use).

CONCLUSIONS

Although exposure to cannabis advertisements may not be directly associated with young adults' cannabis vaping 2 years later, the effects of advertising exposure may be exerted indirectly by increasing positive beliefs about cannabis. Implications for public health policy are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social media use and health risk behaviours in young people: systematic review and meta-analysis

OBJECTIVES

To examine the association between social media use and health risk behaviours in adolescents (defined as those 10-19 years).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXic, PsyArXiv, medRxiv, and Google Scholar (1 January 1997 to 6 June 2022).

METHODS

Health risk behaviours were defined as use of alcohol, drugs, tobacco, electronic nicotine delivery systems, unhealthy dietary behaviour, inadequate physical activity, gambling, and anti-social, sexual risk, and multiple risk behaviours. Included studies reported a social media variable (ie, time spent, frequency of use, exposure to health risk behaviour content, or other social media activities) and one or more relevant outcomes. Screening and risk of bias assessments were completed independently by two reviewers. Synthesis without meta-analysis based on effect direction and random-effects meta-analyses was used. Effect modification was explored using meta-regression and stratification. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).

RESULTS

Of 17 077 studies screened, 126 were included (73 included in meta-analyses). The final sample included 1 431 534 adolescents (mean age 15.0 years). Synthesis without meta-analysis indicated harmful associations between social media and all health risk behaviours in most included studies, except inadequate physical activity where beneficial associations were reported in 63.6% of studies. Frequent (v infrequent) social media use was associated with increased alcohol consumption (odds ratio 1.48 (95% confidence interval 1.35 to 1.62); n=383 068), drug use (1.28 (1.05 to 1.56); n=117 646), tobacco use (1.85, 1.49 to 2.30; n=424 326), sexual risk behaviours (1.77 (1.48 to 2.12); n=47 280), anti-social behaviour (1.73 (1.44 to 2.06); n=54 993), multiple risk behaviours (1.75 (1.30 to 2.35); n=43 571), and gambling (2.84 (2.04 to 3.97); n=26 537). Exposure to content showcasing health risk behaviours on social media (v no exposure) was associated with increased odds of use of electronic nicotine delivery systems (1.73 (1.34 to 2.23); n=721 322), unhealthy dietary behaviours (2.48 (2.08 to 2.97); n=9892), and alcohol consumption (2.43 (1.25 to 4.71); n=14 731). For alcohol consumption, stronger associations were identified for exposure to user generated content (3.21 (2.37 to 4.33)) versus marketer generated content (2.12 (1.06 to 4.24)). For time spent on social media, use for at least 2 h per day (v <2 h) increased odds of alcohol consumption (2.12 (1.53 to 2.95); n=12 390). GRADE certainty was moderate for unhealthy dietary behaviour, low for alcohol use, and very low for other investigated outcomes.

CONCLUSIONS

Social media use is associated with adverse health risk behaviours in young people, but further high quality research is needed to establish causality, understand effects on health inequalities, and determine which aspects of social media are most harmful.

STUDY REGISTRATION

PROSPERO, CRD42020179766.

Assessment of Online Marketing and Sales Practices Among Recreational Cannabis Retailers in Five U.S. Cities

Background: With more states legalizing recreational cannabis, examining cannabis retail and marketing is crucial, as it may influence consumers' perceptions and behaviors. Particularly understudied is online cannabis retail. Methods: In Spring 2022, coders collected and analyzed data regarding retailer characteristics, age verification, and marketing strategies (e.g., product availability, health-related content, promotions, website imagery) among 195 cannabis retail websites in five U.S. cities (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive analyses characterized the websites overall and across cities. Results: Overall, 80.5% verified age for website entry, and 92.8% offered online purchases (92.3% of retailers in Seattle, where prohibited). Of these, 82.9% required age verification for purchases, and 30.9% offered delivery. Almost all (>92%) offered flower/bud, concentrates, edibles, vaping devices, topicals, and tinctures. Health warnings were displayed on 38.3% of websites. Although all five states required health warnings regarding use during pregnancy, only 10.3% had these warnings. In addition, 59.0% posted some unsubstantiated health claims, most often indicating physical and mental health benefits (44.6%). Although Colorado, Washington, and Oregon prohibit health claims, 51.2-53.8% of these retailers posted them. Discounts, samples, or promotions were present on 90.8% of websites; 63.6% had subscription/membership programs. Subpopulations represented in website content included the following: 27.2% teens/young adults, 26.2% veterans, 7.2% sexual/gender minorities, and 5.6% racial/ethnic minorities. Imagery also targeted young people (e.g., 29.7% party/cool/popularity, 18.5% celebrity/influencer endorsement). Conclusions: Regulatory efforts are needed to better monitor promotional strategies and regulatory compliance (e.g., health claims, youth-oriented content, underage access) among online cannabis retailers.

Adolescents' perceptions of alcohol portrayals in the media and their impact on cognitions and behaviors

OBJECTIVE

Exposure to alcohol in the media is pervasive and may influence adolescents' perceptions and use of alcohol. The purpose of this study was to better understand how adolescents perceive alcohol-related content in both entertainment and social media, with a focus on the valence of portrayals (i.e., positive, negative) and impacts on cognitions and behaviors.

METHOD

Participants were 40 high school students (60% female). Nine focus groups were conducted via videoconferencing, stratified by grade (9th/10th, 11th/12th) and gender. Transcripts were analyzed via template-style thematic analyses to identify themes.

RESULTS

Six themes were developed, including (a) some portrayals of alcohol may increase likelihood of using alcohol, (b) some portrayals of alcohol in the media can discourage drinking, (c) sometimes truly negative consequences of alcohol are portrayed positively or downplayed, (d) media portrayals of alcohol are perceived to be based in reality but are at times exaggerated, (e) adolescent and adult alcohol use is portrayed differently in entertainment media, and (f) the extent to which adolescents are influenced by the media may depend on their preexisting attitudes, beliefs, and education.

CONCLUSIONS

Adolescents have awareness of media portrayals of alcohol, both positive and negative, and their associated impacts. Findings highlight the need for much more work to understand the conditions under which, and for whom, exposure to different types of positive portrayals of alcohol in the media translate into positive expectancies about alcohol or drinking motives. Such work may ultimately inform intervention targets to reduce early initiation and/or risky drinking among adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities

As cannabis retail expands in the US, its surveillance is crucial to inform regulations and protect consumers. This study addresses this need by conducting point-of-sale audits examining regulatory compliance (e.g., age verification, signage), advertising/promotional strategies, products, and pricing among 150 randomly-selected cannabis retailers in 5 US cities (30/city: Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California) in Summer 2022. Descriptive and bivariate analyses characterized the retailers overall and across cities. Age verification rates were high (>90%). The majority of retailers had signage indicating restricted access (e.g., no minors; 87.3%), onsite consumption (73.3%), and distribution to minors (53.3%). Retailers were likely to post warnings regarding use during pregnancy/breastfeeding (72.0%), followed by health risks (38.0%), impacts on children/youth (18.7%), and DUI (14.0%). Overall, 28.7% posted health claims, 20.7% posted youth-oriented signage, and 18.0% had youth-oriented packaging. Price promotions were prevalent, particularly price specials (75.3%), daily/weekly/monthly specials (66.7%), and membership programs (39.3%). One-fourth had signs/promotions indicating curbside delivery/pick-up (28.0%) and/or online ordering (25.3%); 64.7% promoted their website or social media page. The most potent cannabis products were most often e-liquids (38.0%) or oils (24.7%); the least potent were often edibles (53.0%). The most expensive product was often bud/flower (58.0%); the least was joints (54.0%). The vast majority (≥81%) sold vaporizers, wrapping papers, and hookah/waterpipes/bongs, and 22.6% sold CBD products. Marketing strategies differed across cities, reflecting differences in state-specific regulations and/or gaps in compliance/enforcement. Findings underscore the need for ongoing cannabis retail surveillance to inform future regulatory and enforcement efforts.

Exposure to alcohol advertising and alcohol consumption among children and early teenagers in South Africa

BACKGROUND

There is a paucity of information on alcohol adverts on alcohol consumption among early teenagers. The study aimed to examine the association between exposure to alcohol adverts and alcohol consumption.

METHODS

A sample of 3833 early teenagers aged 12-14 years were extracted from the South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey (SABSSM) 2017. Participants answered questions related to their exposure to alcohol adverts across television, Poster/billboard, events, and social media. Alcohol consumption was assessed on ever consumed alcohol and in the previous 12 months. Information on demographic characteristics was collected. Descriptive and inferential statistics were used to process the data.

RESULT

Exposure to alcohol adverts increases from 5.2% for Events to 77.0% on television. All alcohol media of adverts were associated with alcohol consumption by age. The results mirror studies that demonstrated that exposure to alcohol advertisements was associated with alcohol consumption.

CONCLUSION

The association between alcohol consumption, exposure to alcohol adverts, and demographic characteristics need the urgent attention of policymakers and interventionists. The focus of action should be on protecting these early teenagers from exposure to media of adverts and risk background factors.

Characteristics Associated with Young Adults' Intentions to Engage with Anti-Vaping Instagram Posts

The purpose of this study was to identify behavioral and sociodemographic factors associated with intentions to engage with anti-vaping Instagram posts among a young adult population. This study proposes the following research questions: (1) Does e-cigarette use status influence intentions to engage with anti-vaping Instagram posts?, and (2) How are e-cigarette use and social media use associated? We recruited a convenience sample of young adults (N = 459; aged 18-30 years) in July of 2022 into an online experimental study from Prolific. Participants saw five image-based Instagram posts about the health harms of using e-cigarettes. Participants were then asked about their intentions to engage ("Comment on", "Reshare", "DM/Send this to a friend", "Like", and/or "Take a screenshot of") with the posts. We used logistic regression to run adjusted models for each engagement outcome, which included fixed effects for sociodemographics, tobacco use, and social media/internet use. For the sum of the engagement outcome, we used Poisson regression. Total number of social media sites used was associated with intentions to "Like" the posts (p = 0.025) and the overall engagement score (p = 0.019), respectively. Daily internet use was associated with intentions to "Comment on" (p = 0.016) and "Like" (p = 0.019) the posts. Young adults who reported past 30-day e-cigarette use had higher odds of using Twitter (p = 0.013) and TikTok (p < 0.001), and a higher total number of social media sites used (p = 0.046), compared to young adults who reported never use e-cigarettes. The initial evidence from our exploratory research using a convenience sample suggests that social media campaigns about the harms of e-cigarette use may be an effective way to engage younger audiences, a generation that frequents social media. Efforts to disseminate social media campaigns should consider launching on multiple platforms, such as Twitter and TikTok, and consider e-cigarette use status when posting.

Psychedelic discourses: A qualitative study of discussions in a Danish online forum

BACKGROUND

This study focuses on user-perspectives related to norms, beliefs and practices concerning psychedelic substances as they are articulated in a Danish online forum. The study combines an interest in online drug research with a focus on discourse analysis to account for the dialectical relationship between individual and shared knowledge regarding the use and meaning of psychedelics.

METHODS

A total of 1,865 posts from 154 threads of online discussion were coded and analyzed thematically, inspired by a socio-cognitive approach to the study of discourse. All topics were arranged into 54 categories which were further analyzed to map recurring patterns in the construction of meaning resulting in a limited number of dominant discourses.

RESULTS

Five dominant discourses were identified: the recreational, the therapeutic, the spiritual, the scientific and the performance discourse. We suggest that these discourses can be seen as the available frameworks which forum users draw upon and reproduce when they describe, discuss, and negotiate their understandings and uses of psychedelics.

CONCLUSION

This study demonstrates the importance of having a nuanced approach to user perceptions. Future drug policy and practice development should take these nuances into account and expect significant variation in the motives and modalities of the use of psychedelics.

Perceived Substance Use Risks Among Never Users: Sexual Identity Differences in a Sample of U.S. Young Adults

INTRODUCTION

Lower perceived risk is a well-established risk factor for initiating substance use behaviors and an integral component of many health behavior theories. Established literature has shown that many substance use behaviors are more prevalent among individuals who identify as lesbian, gay, or bisexual than among those who identify as heterosexual. However, potential differences in perceived risk by sexual identity among individuals with no lifetime use have not been well characterized to date.

METHODS

Data on 111,785 adults aged 18-34 years (including 11,377 lesbian, gay, and bisexual adults) were from the 2015-2019 National Survey on Drug Use and Health. Perceived risks (classified as great risk versus less than great risk) were assessed with 11 National Survey on Drug Use and Health survey items regarding 6 different substances (alcohol, cigarettes, marijuana, cocaine, lysergic acid diethylamide, and heroin). Survey-weighted and sex-stratified logistic regression models were used to estimate sexual identity differences regarding perceived great risk among those reporting no lifetime use. Analyses were conducted in 2021-2022.

RESULTS

Gay men, bisexual men, lesbian/gay women, and bisexual women were all significantly less likely than heterosexual peers to perceive great risk associated with specific marijuana, cocaine, lysergic acid diethylamide, and heroin use behaviors. Bisexual men and women were also significantly less likely than heterosexual peers to perceive great risk associated with binge drinking behaviors and smoking ≥1 packs of cigarettes daily.

CONCLUSIONS

This novel investigation among never users provides evidence that lesbian, gay, and bisexual adults perceive significantly lower risks associated with multiple substance use behaviors than heterosexual adults, which may indicate important sexual identity differences in susceptibility to substance use initiation.

Testing if attitudes mediate the association between advertising exposure and adolescent tobacco use

INTRODUCTION

A growing body of evidence indicates that exposure to tobacco advertising among adolescents increases the likelihood of subsequent tobacco use. It is important to understand the process by which this occurs, in order to appropriately target factors for intervention. The objective of this study was to test whether attitudes towards tobacco advertising mediates the impact of advertising exposure on tobacco use.

METHODS

From an ongoing prospective cohort study of male adolescents (aged 11-16 at baseline), we recruited a subset of tobacco users and non-users to participate in an additional ecological momentary assessment (EMA) project (N = 164). Adolescents completed smartphone-based surveys 2-3 times/day over a 10-day period with items assessing their exposures and attitudes towards tobacco-related advertising. If participants reported exposure to tobacco advertising, they were asked about their attitudes toward it (how much they enjoyed it, liked it, and found it appealing).

RESULTS

Adolescents who reported a greater amount of advertising exposure during the EMA period were more likely to report past-30-day tobacco use at their next cohort follow-up (6-12 months later). Moreover, the impact of advertising exposure on subsequent use was mediated by attitudes toward the tobacco advertisements, as reported during the EMA. This effect remained after controlling for baseline tobacco use.

CONCLUSIONS

By pairing EMA with long-term follow-up, we identified attitudes as a mediator between adolescent advertising exposure and subsequent tobacco use. Interventions to lessen adolescents' positive attitudes toward tobacco advertisements may help disrupt this impact.

A model to understand antecedents of nursing attitudes and perceptions influencing outcomes of patients with SUD

INTRODUCTION

Substance use disorder (SUD) is a persistent and long-standing public health issue in the United States. While SUD is medically considered a chronic illness, it is also one that is viewed as self-inflicted, thereby resulting in judgmental attitudes and stigmatization from care providers, specifically from nurses.

DESIGN

In 2020, the authors completed an analytical cross-sectional study that included open-ended questions to examine nurses' knowledge and attitudes toward caring for patients with SUD across practice settings.

METHODS

A conceptual model was constructed by examining original study data and published literature on SUD, re-analyzing themes, determining constructs and variables, then coming to a consensus on critical aspects of the model.

CONCLUSION

The resulting conceptual model highlights antecedents of nursing behaviors that directly affect patient care outcomes, providing a roadmap to improving patient outcomes.

CLINICAL RELEVANCE

Understanding antecedents that affect nurses' attitudes and perceptions of patients with SUD highlights changes that can influence patient outcomes.

Can substance abuse media literacy increase prediction of drug use in students?

Objective

The present study aimed to determine the predictors of drug use among students based on the Extended Prototype willingness model (EPWM).

Methods

This cross-sectional study was performed at Hamadan universities. The participants were selected via multi-stage sampling. Finally, out of 721 students participated. The questionnaire consisted of four sections: (a) socio-demographic characteristics, (b) Questionnaire about the prototype willingness model constructs, (c) Questionnaire about the status of drug use behavior, (d) Substance Abuse Media Literacy (SAML) scale. Data were analyzed using a structural equations partial least squares confirmatory composite approach and SPSS-23.

Results

The mean age of students was of 23.47 ± 4.14 years. Based on results, behavioral willingness (β = 0.420, t-value = 9.010, p < 0.001) and behavioral intention (β = 0.291, t-value = 6.957, p < 0.001) significantly predicted drug use. The presented results of analysis, 66% of the variance of the drug use, 62% of the variable of the behavioral willingness, and 56% of the behavioral intention could be explained by the EPWM.

Conclusion

The present study demonstrated that EPWM could predict drug use in students. Therefore, designing and implementing educational and promotional intervention programs to reduce behavioral willingness and increase students’ skills in substance abuse media literacy is necessary to prevent drug use behavior.

Exposure to Media Messages Portraying Effects of Alcohol Use in a Young Adult Sample

Background: Young adults are prolific media users and tend to use substances, such as alcohol, more than people of other ages. Despite much research on young adults' exposure to alcohol advertisements and portrayals of alcohol use in the media, much is still unknown about the nuances of young adults' exposure to and engagement with alcohol-related media content. The present paper examined how college students' media exposure differed for messages portraying positive and negative alcohol effects, how exposure to alcohol-related content differed across media sources, which themes of alcoholrelated content were seen most, and whether exposure to alcohol-related content was associated with hazardous/harmful drinking. Method: Participants (N=500) were two- and four-year college students (Mage=20.90, SDage=1.70, 63.2% female) recruited for a longitudinal study examining the efficacy of a mobile app intervention for high-risk drinking college students. The data used here comes from the baseline survey. Results: Participants reported the greatest exposure to alcohol-related messages in movies/TV/on-demand streaming shows followed by in social media, and they reported greater exposure to messages portraying positive than negative effects of alcohol. Findings from linear regressions indicated that exposure to messages portraying positive or negative effects of alcohol generally did not predict hazardous/harmful drinking. Conclusion: This sample of high-risk college student drinkers reported seeing alcohol-related content through a variety of media sources, with most content portraying alcohol in a positive light. Future research should assess the effects that messages of different types and from different sources have on use, expectancies, norms, and other outcomes.

Internal developmental assets and substance use among Hispanic adolescents. A cross-sectional study

AIMS

To determine the associations between internal assets (planning and decision-making, interpersonal competence and commitment to learning) and substance use (tobacco, alcohol, binge drinking, marijuana use and other drugs).

DESIGN

A cross-sectional study was conducted in four countries (Chile, Mexico, Spain and Peru).

METHODS

Adolescents aged 12-18 self-completed a multi-purpose questionnaire between 2016 and 2019. Multiple logistic regressions and structural equation models were performed to analyse the association between internal assets (planning and decision-making, interpersonal competence, and commitment to learning) and substance use.

RESULTS

The results indicate that planning and decision-making and commitment to learning are conducive to the prevention of substance use. On the contrary, interpersonal competence was not associated with substance use.

CONCLUSION

The present study shows that planning and decision-making and commitment to learning can be relevant factors in explaining substance use during adolescence. Internal assets can be an important aspect to include in health promotion interventions with children, youth and families to prevent substance use. These findings may be useful for researchers, schools, paediatric nurse practitioners, and health professionals in general to design health programs focused on children and adolescents. Furthermore, the Developmental Assets framework has been proved as a suitable frame of reference for paediatric nurse practitioners to assess and develop child and adolescent positive development and design health promotion interventions to prevent substance use.

Natural Observation of Alcohol Price and Promotions at Bars: Implications for Alcohol Misuse Prevention

Alcohol misuse among young adults remains a primary public health concern given the wide range of short- and long-term physical, social, and societal consequences of the behavior. On-premise drinking establishments, which allow alcohol consumption on site (i.e., bars), are frequent locations for young adult alcohol use. Risks for alcohol misuse within the bar setting are key factors to identify for prevention. Notably, alcohol price and promotions are associated with alcohol consumption among young adults. This study sought to develop and pilot test an observational protocol to assess the alcohol environment at on-premise drinking establishments. Following qualitative exploration of salient risk factors in these settings through focus groups with young adults, an observational tool was adapted and tested in a feasibility study. The refined tool was then pilot tested with two independent data collectors conducting natural observation at 13 establishments in the downtown nightlife district of a small, southeastern city. High interrater reliability was noted. Descriptive summary statistics of bar characteristics demonstrate low alcohol prices with variability across types of alcohol (e.g., beer, wine, and liquor), greater numbers of alcohol promotions inside rather than outside the building, and higher rates of manual versus electronic age verification procedures. Observational assessment of alcohol price and marketing at on-premise drinking establishments as described in this study is needed to inform prevention policy and programs to reduce harms associated with young adult alcohol misuse.

Changes in college student alcohol use during the COVID-19 pandemic: Are perceived drinking norms still relevant?

With widespread concern for increased alcohol use during the COVID-19 pandemic, there is a pressing need to examine changes in young adults' alcohol use and to identify antecedents of increased use. We tested the hypothesis that self-reported changes in alcohol use during the pandemic (frequency, quantity, heavy episodic drinking) would relate to perceptions of peers' changes in alcohol use. In April of 2020, 507 college students self-reported changes in their alcohol use and perceived changes in use for typical students at their university (i.e., norms). Most students in our sample reported decreased alcohol use and perceived decreases in peers' alcohol use. Perceptions of peers' changes in alcohol use behavior strongly related to changes in students' own alcohol use. Findings provide strong support for norms-based strategies that can correct normative misperceptions by highlighting the fact that most college students are not in fact engaging in heavier alcohol use during the COVID-19 pandemic.

Tobacco and alcohol content in soap operas broadcast on UK television: a content analysis and population exposure

BACKGROUND

Exposure to tobacco and alcohol content in media is a risk factor for smoking and alcohol use in young people. Our previous research suggested that tobacco and alcohol imagery is common in soap operas. We now report an analysis of tobacco and alcohol content in a sample of soap operas broadcast in the UK.

METHODS

We used 1-minute interval coding to quantify tobacco and alcohol content in all episodes (including advertisement breaks) of six soap operas broadcast on UK television during three separate weeks in November and December 2018 and January 2019.

RESULTS

We coded 2222 intervals from 87 episodes and 360 intervals from 77 advertisement breaks. Tobacco content was rare, occurring in 4% of all intervals across 30% of episodes, the only tobacco appearances in adverts appeared in anti-smoking advertising. Alcohol occurred in 24% of intervals across 95% of episodes and in 13% of advertisement intervals. The programmes delivered ~381.28 million tobacco and 2.1 billion alcohol gross impressions to the UK population, including 18.91 million tobacco and 113 million alcohol gross impressions to children.

CONCLUSION

Whilst tobacco was rare, alcohol content was common, resulting in billions of viewer impressions. Soap operas represent a potential driver of alcohol consumption in young people.

Harmful smartphone applications promoting alcohol and illicit substance use: a review and content analysis in the United States

Few studies have conducted analysis of commercially available smartphone applications designed to promote alcohol and illicit substance use. The aim of this review is to determine harmful themes of content in applications promoting alcohol and illicit substance use found using recovery app search terms. A systematic search, via Apple iTunes and Google Play stores, was conducted of applications targeting abstinence or reduced substance use in online app stores (n = 1,074 apps) in March 2018. We conducted a secondary analysis of apps encouraging alcohol and illicit substance use in July 2018. Our initial search yielded 904 apps pertaining to alcohol and illicit substance use. Four reviewers conducted a content analysis of 102 apps meeting inclusion criteria and assessed app design, delivery features, text, and multimedia content pertaining to substance use. The initial coding scheme was refined using a data-driven, iterative method grouping in thematic categories. The number of apps coded to a specific substance include: alcohol (n = 74), methamphetamine (n =13), cocaine (n = 15), heroin (n = 12), and marijuana (n = 15), with nine apps overlapping more than one substance. Key themes identified among apps included: (i) tangibility (alcohol home delivery services); (ii) social networks (builtin social media platforms promoting substance use); (iii) software design (gamification or simulation of substance use); and (iv) aesthetics (sexual or violent imagery). Despite claims of restricting apps promoting substance use, further efforts are needed by online app stores to reduce the availability of harmful content.

Profiles of Parenting in the Digital Age: Associations With Adolescent Alcohol and Marijuana Use

OBJECTIVE

This study assessed parental communication and behavior related to children's Internet and social media usage to delineate profiles of parenting regarding these newer forms of media and associated those profiles with youth alcohol and marijuana use.

METHOD

Using data from 748 adolescents (mean age = 15.8, 52% female, 25% non-White) and their parents, latent class analysis was performed to identify classes based on items concerning device ownership, monitoring, and communication of online activities. The associations between class membership and ever use of alcohol and marijuana were then tested, controlling for screen time, general parenting, substance availability, and deviance.

RESULTS

We identified five classes: high media parenting (23%), low media parenting (20%), moderate media parenting with limited device access (11%), moderate media parenting with high device access (25%), and low monitoring but high communication about online activities (21%). Probability of class membership was differentially associated with contemporaneous and 1-year prospective alcohol and marijuana use. The low-device-access class had the highest percentage of abstainers at both time points. The lowest rate of abstaining was associated with membership in the high-device-access class but moderate levels of monitoring. Membership in the low media parenting class was associated with use of both substances.

CONCLUSIONS

This study provides a novel exploration of media parenting, an important construct in the context of increased access to personalized media devices that allow for streaming of mature media content related to substance use.

Representations of Psychoactive Drugs' Use in Mass Culture and Their Impact on Audiences

Drug use has been increasing worldwide over recent decades. Apart from the determinants of drug initiation established in numerous studies, the authors wish to draw attention to other equally important factors, which may contribute to augmenting this phenomenon. The article aims to draw attention to the content of mass culture, especially representations of drug use in mass media, which may influence the liberalization of attitudes towards drugs and their use. The role of mass culture and its impact on the audience is discussed. It presents an overview of drug representations in the content of mass culture, e.g., in film, music, literature, and the occurrence of drug references in everyday products, e.g., food, clothes, and cosmetics. Attention was drawn to liberal attitudes of celebrities and their admissions to drug use, particularly to the impact of the presented positions on the attitudes of the audience, especially young people for whom musicians, actors, and celebrities are regarded as authorities. Indications for further preventive actions were also presented. Attention was drawn to the need to take appropriate action due to the time of the COVID-19 pandemic when many people staying at home (due to lockdown or quarantine) have the possibility of much more frequent contact with mass culture content, which may distort the image of drugs.

Young Adults Underestimate How Well Peers Adhere to COVID-19 Preventive Behavioral Guidelines

To combat the rampant spread of the SARS-CoV-2 virus that is responsible for the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) has provided Americans with empirically supported preventive behavioral guidelines (e.g., wearing a face mask). However, there is a need to develop behavioral strategies that can effectively increase adherence to these guidelines, especially for young adults, who report particularly poor adherence. Across several domains of prevention science, norms-based interventions have successfully motivated constructive health behavior by correcting normative misperceptions, but these strategies are only relevant when these misperceptions are widespread. We examined the accuracy of young adults’ perceptions of peers’ adherence to CDC-recommended behavioral guidelines (i.e., perceived social norms) to assess the rationale for employing norm-correcting strategies. Young adult college students (N = 539; M_age = 19.5 years) self-reported their level of adherence to a list of preventive behavioral guidelines and estimated the norms regarding the extent to which other young adults adhered to these guidelines. We measured adherence and perceived norms for each guideline in terms of adherence frequency, ranging from 0 to 100% of the time. We found that young adults, on average, underestimated the extent to which other young adults adhere to each of the recommended preventive behaviors. That is, young adults tended to think that other young adults are failing to adhere to CDC guidelines, whereas our self-reported data showed adherence frequency may be quite high. Moreover, we found positive associations between self-reported adherence and perceptions of others’ adherence—that is, those who underestimated others’ adherence also self-reported lower adherence to guidelines. Findings from this study establish proof-of-concept for the development of norms-based strategies designed to improve young adults’ adherence to preventive behavioral guidelines that are both specific to the COVID-19 pandemic and that prepare for future contagious outbreaks.

Bidirectional associations between e-cigarette use and alcohol use across adolescence

INTRODUCTION

Evidence on prospective bidirectional associations between e-cigarette and alcohol use among adolescents can inform prevention and policy but is largely absent from the literature.

METHODS

Data were drawn from a prospective cohort of students attending 10 Los Angeles high schools (N = 3396; baseline mean age = 14.1, SD = 0.4). Students completed surveys every 6-months from 2013 to 2017; 8 total waves. Analyses were restricted to (a) individuals who were never users of alcohol (N = 2394) or (b) individuals who were never users of e-cigarettes (N = 2704) at baseline. Repeated-measures, generalized linear mixed models were used to estimate the adjusted odds of past 6-month alcohol and e-cigarette initiation, in separate models.

RESULTS

Among alcohol never-users at baseline, 15.7 % (N = 375) initiated alcohol use over the study period. Compared to never-users of e-cigarettes, those who reported use of e-cigarettes had 3.5 times the odds of subsequently initiating alcohol use in the following wave (OR = 3.54; 95 % CI: 2.81, 4.47). Stronger associations were observed for males (OR = 4.94; 95 % CI: 3.78, 6.45) than for females (OR = 3.21; 95 % CI: 2.33, 4.41; p_interaction = 0.04). Among e-cigarette never-users at baseline, 26.3 % (N = 709) initiated e-cigarette use over the study period. Compared to never-users of alcohol, those who reported use of alcohol had 3.2 times the odds of subsequently initiating e-cigarette use in the following wave (OR = 3.23; 95 % CI: 2.68, 3.89). This association did not differ by gender.

CONCLUSIONS

E-cigarette and alcohol use can be markers to identify youth at risk for future alcohol and e-cigarette use, respectively. Research examining mechanisms underlying these associations is needed to infer causality.

Exposure to Television Alcohol Brand Appearances as Predictor of Adolescent Brand Affiliation and Drinking Behaviors

Adolescence and the transition to adulthood is an important developmental stage in the emergence of health risk behaviors, specifically underage alcohol use. Adolescents consume a tremendous amount of screened media (primarily streamed television), and media depictions of behaviors is prospectively linked to youth initiation of behaviors. With the arrival of streamed media technology, alcohol advertising can be nested within television content. This study describes alcohol brand depictions in television and evaluates impact of exposure to such depictions on adolescent drinking outcomes. A national sample of 2012 adolescents (M_age = 17.07; SD = 1.60 years, range 15-20; 50.70% female) reported on television viewership, alcohol brand affiliation, and drinking behavior, with follow-up one year later. Ten series (that remain relevant to youth today) across television ratings from a single television season were content coded for presence/salience of alcohol brand appearances. Adjusting for covariates (e.g., peer/parent drinking, youth sensation seeking, movie alcohol brand exposure), higher exposure to brand appearances in the television shows was associated with youth drinking. Aspirational and usual brand to drink corresponded to television alcohol brand prominence, and television brand exposure was independently associated with drinking initiation and hazardous drinking.

Temporal, Sex-Specific, Social Media-Based Alcohol Influences during the Transition to College

The transition to college is an important developmental phase, usually met with increased social desirability, access to alcohol, and new peer groups. Recently, research has utilized social media as a predictor of events during college, but few have assessed how social media can influence alcohol use during the transition to college. Methods: Participants (N = 320) were recruited prior to entering their first year of college. Participants were 18 years old, 60.7% were women, with 46.3% identifying as White, 16.5% Hispanic, 14.9% Asian, 9.5% Black, and 7.6% other. Each participant was assessed three times: prior to matriculation, first semester, and second semester of their freshman year. We assessed the effect of exposure to alcohol content via social media on long-term trajectories of alcohol use. We also assessed self-reported sex as a moderator. Results: Exposure to alcohol content (over and above one's own posting of alcohol content) was associated with greater frequency of drinking during the transition to college. In the multi-group model, exposure to alcohol content was associated with greater drinking prior to matriculation for men. However, for women, exposure to alcohol content was associated with greater alcohol use in the first semester of college. Conclusion: Our results indicate exposure to alcohol-related media content is a strong predictor, over and above one's own positing, of increased drinking, and this effect varies by sex and point in time. Our results lend support for more tailored and time-specific prevention programming for incoming freshmen that should integrate social media normative feedback.

Country and gender differences in the association between violence and cigarette smoking among youth

BACKGROUND

Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence.

METHODS

Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling.

RESULTS

Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0-1.7; aOR = 2.5, 95%CI = 1.7-3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1-2.4; aOR = 2.0, 95%CI = 1.1-3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1-2.0; aOR = 2.2, 95%CI = 1.6-3.0), but not among Palestinian boys.

CONCLUSION

Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.

Depictions of Alcohol in Australian TV 'Bachelor In Paradise': A Content Analysis

Aims

To quantify the depictions of alcohol in the popular Australian reality TV show—Bachelor in Paradise (season 1: 2018).

Methods

All 16 episodes were coded in 1-min intervals for the presence of alcoholic beverage related content and non-alcoholic beverage content, and the categories of actual use, implied use and other references.

Results

Alcohol was highly prevalent in all episodes. Alcohol content occurred frequently, with 70.7% of intervals having any alcohol content. Actual alcohol use occurred in 31.9% of 1-min intervals, implied alcohol use occurred in 63.4% of intervals and other alcohol references occurred in 14.0% of intervals. Alcohol content was present in the first or second 1-min interval of all 16 episodes. Alcohol content was more than twice as prevalent as non-alcoholic content (34.0%).

Conclusions

The high volume of alcohol content depicted in the show is of concern, due to the important influence it may have on the audience. Vulnerable viewers, especially minors and young adults, are being exposed to ubiquitous alcohol references. This may influence their perceptions of normal alcohol use, their attitudes toward alcohol and their own consumption of alcohol. A stronger regulatory regime is required in Australia to protect young people more effectively from depictions in television programs.

Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization

BACKGROUND

The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents' immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H).

METHODS

639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms.

RESULTS

Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms.

CONCLUSIONS

We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

Covariates of risky health behaviors in pediatric cancer survivors during adolescence

PURPOSE

Adolescent survivors of pediatric cancers may use alcohol and tobacco (73-90% and 10-29%, respectively) at similar rates as their healthy peers despite known adverse health effects of these substances. This is concerning given that these behaviors can increase the risk for adverse late effects among this population. This study explores the beliefs and behaviors associated with alcohol and tobacco use among adolescent survivors of pediatric cancer.

DESIGN

Cross-sectional study using assessment questionnaires by telephone.

PARTICIPANTS

Adolescent cancer survivors who had been seen at Memorial Sloan Kettering Cancer Center (n = 128).

METHODS

Questionnaires concerned participants' medical history, current health behaviors, attitudes about health behaviors, fear of cancer recurrence, cancer worry, knowledge of risk, and perceived risk of future health problems. Univariate and multiple logistic regression analyses determined the association between psychological covariates with having ever used alcohol and cigarettes.

RESULTS

In multiple logistic regression, higher positive attitude (OR = 3.65; p < 0.001) toward alcohol use and lower knowledge of the risk of binge drinking (OR = 0.38; p < 0.05) were significantly related to alcohol use. Older age (OR = 1.55; p < 0.01), lower knowledge of the risks of smoking (0.41; p < 0.05), and the subjective norm that smoking is desirable to others (OR = 1.90; p < 0.05) were significantly related to cigarette use.

CONCLUSION AND IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Understanding the uptake of risky health behaviors and factors related to tobacco and alcohol use for adolescent survivors is imperative to promoting lifelong healthy behaviors and potentially reducing future adverse health effects. Despite broadly disseminated public service campaigns and anticipatory guidance of our cancer specialists to inform youth about the adverse effects of alcohol and tobacco use, there remains a gap in adolescent cancer survivors' knowledge of these risks. More effective interventions to increase knowledge of the risks of drinking and smoking are needed to bridge this gap.

Digital media use and subsequent cannabis and tobacco product use initiation among adolescents

BACKGROUND

Digital media engagement, such as browsing the internet or social media posting, may be associated with cannabis and tobacco product use initiation among adolescents. Whether certain digital media exposure confers greater - or reduced - risk for specific cannabis or tobacco products is unknown.

METHODS

Adolescents completed surveys on digital media and substance use every 6 months from 2015 to 2017 (4 waves). Self-reported digital media use (14 items) was classified into six subcategories (e.g., "social media posting," "reading news/articles & browsing photos"). Random-effect repeated-measures regression models examined the association of exposure to each digital media subcategory with subsequent cannabis or tobacco product use initiation in the next 6 months, among baseline cannabis and tobacco never-users (n = 1841; n = 1558, respectively).

RESULTS

High frequency digital media use (multiple times/day) of "social media posting" (vs. no high frequency use; OR = 1.95; 95%CI:1.20-3.17) and "checking in" (OR = 1.71; 95%CI:1.23-2.38) was associated with greater odds of any cannabis product use initiation 6 months later. "Reading news/articles & browsing photos" was associated with decreased odds of initiation (OR = 0.52; 95%CI:0.34-0.79). "Checking in" and "reading news/articles & browsing photos" were similarly associated with any tobacco use initiation. "Chatting and shopping" was associated with greater odds (OR = 4.63; 95%CI:1.53-14.06) of e-cigarette initiation, but not of other product use initiation.

CONCLUSIONS

Some subcategories of digital media use conferred increased odds, others conferred reduced odds, and others were not associated with cannabis and tobacco use initiation. Research exploring mechanisms that put users of specific digital media at greater risk for substance use initiation is warranted.

Adolescents' Reactions to Adverts for Fast-Food and Confectionery Brands That are High in Fat, Salt, and/or Sugar (HFSS), and Possible Implications for Future Research and Regulation: Findings from a Cross-Sectional Survey of 11-19 Year Olds in the United Kingdom

The influence that marketing for foods high in fat, salt, and/or sugar (HFSS) has on adolescents extends beyond a dose-response relationship between exposure and consumption. It is also important to explore how marketing shapes or reinforces product/brand attitudes, and whether this varies by demography and Body Mass Index (BMI). To examine this, a cross-sectional survey was conducted with 11-19 year olds in the United Kingdom (n = 3348). Participants watched 30 s video adverts for a fast-food and confectionery brand. For each advert, participants reported reactions on eight measures (e.g., 1 = Makes [product] seem unpopular choice-5 = Makes [product] seem popular choice), which were binary coded based on whether a positive reaction was reported (Yes/No). At least half of adolescents had positive reactions to both adverts for 5/8 measures. Positive reactions had associations with age, gender and, to a lesser extent, BMI. For example, 11-15 year olds were more likely than 16-19 year olds to report appeal to their age group for the fast-food (OR = 1.33, 95% CI: 1.13-1.58) and confectionery advert (OR= 1.79, 95% CI: 1.51-2.11). If these reactions are typical of other HFSS products, future research and regulatory change should examine whether additional controls on the content of HFSS marketing, for example mandated health or nutritional information and revised definitions of youth appeal, offer additional protection to young people.

Constancy (the New Media “C”) and Future Generations

In the past, researchers would consider media’s impact on youth in terms of three “Cs”: consumption, content, and context. This article introduces a new construct—constancy—which supplants the previous terms. Constancy refers to the ubiquitous and continuous state of connected screens in the lives of children and adolescents. Constancy characterizes media content and use, which can be proactive, incidental, or contextual, exerting positive or negative effects on different users. Constancy can influence child development, as persistent access to smartphones and reception of messages will affect future generations’ cognition and education, social interactions, emotions, and health. It will be important to address the developmental needs of the child or adolescent and not the smartphone in his or her pocket. Constancy requires pragmatic and innovative methodologies to understand the new circumstances around children, adolescents, and media. The landscape has changed and so must our approach to research and investigation of media effects.

Long-term Associations Between Substance Use-Related Media Exposure, Descriptive Norms, and Alcohol Use from Adolescence to Young Adulthood

Adolescents and young adults in the United States are constantly exposed to substance-related media and advertising content. The current study seeks to explore, developmentally, how exposure to substance-related media content influences both normative beliefs about peer alcohol use and individual alcohol use. Youth (N = 4'840; 50.6% female) were followed for ten years from age 12 to 22. Auto-regressive latent trajectory with structured residual (ALT-SR) models were used to explore within-person reciprocal associations between substance-related media content, descriptive norms, and alcohol use. Results indicated that' across adolescence and young adulthood, exposure to substance-related media content was associated with increased alcohol use via perceived alcohol norms. The pathway from media exposure to alcohol use was mediated by increased perceived norms for adolescents only. With screen time increasing over the last decade, it is important to invest resources into real-time interventions that address substance-related social media content as it relates to misperceived norms and to begin these interventions in early adolescence.

An E-Learning Adaptation of an Evidence-Based Media Literacy Curriculum to Prevent Youth Substance Use in Community Groups: Development and Feasibility of REAL Media

BACKGROUND

There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking.

OBJECTIVE

Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization.

METHODS

An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders.

RESULTS

Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback.

CONCLUSIONS

The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations.

An E-Learning Adaptation of an Evidence-Based Media Literacy Curriculum to Prevent Youth Substance Use in Community Groups: Development and Feasibility of REAL Media

Background

There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking.

Objective

Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization.

Methods

An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders.

Results

Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback.

Conclusions

The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations.