Young Adult Alcohol and Cannabis Impaired Driving After the Opening of Cannabis Retail Stores in Washington State.

Motor vehicle crashes are a leading cause of death for young adults (YA) in the USA, and driving under the influence of alcohol (DUIA), cannabis (DUIC), and simultaneous use of both substances (DUIAC) are prominent risk factors. Trends in YA impaired driving behaviors after opening of cannabis retail stores have been understudied. We examined YA trends in DUIA, DUIC, and DUIAC from immediately prior through 5 years following the opening of cannabis retail outlets in Washington State (2014-2019). Differences in trends were assessed across age, sex, and urbanicity. Weighted logistic regressions assessed yearly change in prevalence of DUIA, DUIC, and DUIAC from 2014 to 2019, using annual statewide data from the Washington Young Adult Health Survey (n = 12,963; ages 18-25). Moderation of trends by age, sex, and urbanicity was assessed. Prevalence of DUIA decreased overall (AOR = 0.93, 95% CI 0.90, 0.97) and among drinkers (AOR = 0.95, 95% CI 0.91, 0.99) but remained at concerning levels in 2019 (10% overall; 16% among drinkers). Overall DUIC did not change significantly (AOR = 0.99, 95% CI 0.96, 1.03; 11% by 2019) but decreased among those who used cannabis (AOR = 0.91, 95% CI 0.86, 0.96; 33% by 2019). DUIAC decreased but not significantly (overall: AOR = 0.89, 95% CI 0.78, 1.01; those who used alcohol and cannabis: AOR = 0.84, 95% CI 0.74, 1.04). Prevalence of YA DUI remained concerning. Trends may reflect some success in reducing DUI, but additional detection and prevention are needed.

Using Alcohol and Cannabis as Sleep Aids: Associations with Descriptive Norms Among College Students.

PURPOSE: Young adults may use alcohol and cannabis as sleep aids, a risky behavior that can worsen sleep health over time and lead to substance dependence. Perceived norms for such risky behaviors are often overestimated and related to one's own use. This cross-sectional study examined: (a) the extent to which college students overestimated the prevalence of alcohol and cannabis use as sleep aids (i.e., perceived descriptive norms), and (b) the extent to which perceived descriptive norms were associated with students' own use of alcohol and cannabis as sleep aids. METHODS: 2,642 undergraduate college students (Mage = 18.84 years) reported past 30-day use of alcohol and cannabis as sleep aids. Participants also estimated the percent of college students who use alcohol and cannabis as sleep aids (i.e., perceived descriptive norms). RESULTS: One-sample t-tests revealed participants, on average, overestimated the norms for using alcohol and cannabis as sleep aids. Participants who endorsed past 30-day use of these substances as sleep aids overestimated these norms to an even greater extent. Count regression models showed perceived descriptive norms were associated with students' use of alcohol and of cannabis as sleeps aids, in respective models, even when controlling for sleep difficulties. CONCLUSIONS: College students may overestimate the prevalence of using alcohol and cannabis as sleep aids, and students who believe these behaviors are more normative report more frequent use of these substances as sleep aids. Taken together, findings may highlight the potential for norm-correcting strategies as a prudent approach to reducing/preventing the use of alcohol and cannabis as sleep aids.

Cannabis Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis.

Objectives. To examine changes in prevalence of cannabis use and of cannabis use disorder symptomatology among young adults from 2014 to 2019 in Washington State, where nonmedical (or "recreational") cannabis was legalized in 2012 and retail stores opened in July 2014. Methods. We used 6 years of cross-sectional data collected annually from 2014 (premarket opening) to 2019 from 12 963 (∼2000 per year) young adults aged 18 to 25 years residing in Washington. Logistic regression models estimated yearly change in prevalence of cannabis use at different margins and related outcomes. Results. Prevalence of past-year, at least monthly, at least weekly, and daily use of cannabis increased for young adults, although increases were driven by changes among those aged 21 to 25 years. There was also a statistically significant increase in prevalence of endorsing at least 2 of 5 possible symptoms associated with cannabis use disorder. Conclusions. Among young adults in Washington, particularly those of legal age, prevalences of cannabis use and cannabis use disorder symptomatology have increased since legalization. This trend may require continued monitoring as the nonmedical cannabis market continues to evolve. (Am J Public Health. 2022;112(4):638-645. https://doi.org/10.2105/AJPH.2021.306641).

"On a night like this": A mixed-methods approach to understanding high-risk drinking events in college students.

BACKGROUND: Previous research indicates college students report heavier drinking on certain events (e.g., 21st birthday). While past research has identified heavier drinking events, students' own reports of which events are associated with elevated drinking remains understudied. The current study utilized mixed methods to explore potential high-risk drinking events (HRDE) for college student drinkers and how these events differed from typical drinking and each other. METHODS: College student drinkers (N = 204) reported the number of drinks they consume on nine predetermined events (e.g., Halloween). Students also responded to open-ended questions listing five events during which they had elevated drinking and indicating the amount consumed on each event. Open-ended responses were coded into similar event categories. Descriptive statistics for drinks consumed were calculated for predetermined and coded open-ended events. Chi-square analyses assessed differences in endorsement of open-ended events by birth sex, age group, and Greek membership. Two multilevel count regressions assessed within-person differences in number of drinks consumed between participants' typical drinking occasions and (1) highly endorsed open-ended events and (2) predetermined events. RESULTS: For all open-ended event categories, average number of drinks consumed exceeded heavy episodic drinking thresholds; however, there was substantial variability. Comparing predetermined events to participants' typical drinking indicated elevated drinking on participants' birthdays, New Year's Eve, Halloween, Finals, and Spring Break; significant differences between events also emerged. Comparison of open-ended categories to participants' typical drinking indicated elevated drinking on birthdays, celebrations, parties, and holidays; however, there were no significant differences between open-ended events. CONCLUSIONS: Students who drink alcohol report heavier drinking on specific calendar-based events (e.g., Spring Break). However, students also report non-calendar-related events (e.g., non-specific parties) as some of their highest drinking events. More research is needed to understand how intervention and prevention programs can be adapted to target both known calendar-based HRDE, and unknown, idiosyncratic HRDE.

College students' virtual and in-person drinking contexts during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in pronounced changes for college students, including shifts in living situations and engagement in virtual environments. Although college drinking decreased at the onset of the pandemic, a nuanced understanding of pandemic-related changes in drinking contexts and the risks conferred by each context on alcohol use and related consequences have yet to be assessed. METHODS: Secondary data analyses were conducted on screening data from a large parent clinical trial assessing a college student drinking intervention (N = 1669). Participants across six cohorts (from Spring 2020 to Summer 2021) reported on the frequency of drinking in each context (i.e., outside the home, home alone, home with others in-person, and home with others virtually), typical amount of drinking, and seven alcohol-related consequence subscales. RESULTS: Descriptive statistics and negative binomial regressions indicated that the proportion and frequency of drinking at home virtually with others decreased, while drinking outside the home increased from Spring 2020 to Summer 2021. Limited differences were observed in the proportion or frequency of individuals drinking at home alone or at home with others in-person. Negative binomial and logistic regressions indicated that the frequency of drinking outside the home was most consistently associated with more alcohol-related consequences (i.e., six of the seven subscales). However, drinking at home was not without risks; drinking home alone was associated with abuse/dependence, personal, social, hangover, and social media consequences; drinking home with others virtually was associated with abuse/dependence and social consequences; drinking home with others in-person was associated with drunk texting/dialing. CONCLUSION: The proportion and frequency of drinking in certain contexts changed during the COVID-19 pandemic, although drinking outside the home represented the highest risk drinking context across the pandemic. Future prevention and intervention efforts may benefit from considering approaches specific to different drinking contexts.

Substance-Specific Risk Factors among Young Adults: Potential Prevention Targets across Cannabis-Permissive Environments.

PURPOSE: This study examined levels of substance-specific risk factors such as perception of harm from substance use among young adults in a range of cannabis-permissive environments. The main objective was to inform future preventive interventions aimed at reducing cannabis use in the context of increasingly permissive environments. METHODS: Data came from the Community Youth Development Study (CYDS) collected in 2016 when participants were about 23 years old (n = 1,722 participants residing in 46 U.S. states). Young adults self-reported their perceptions about the harms related to cannabis, alcohol, and cigarette use; attitudes about and ease of access to cannabis and other substances; and perceived wrongfulness and social acceptability of cannabis, alcohol, and cigarette use and of selling of cannabis and other illegal drugs. RESULTS: Young adults in more permissive cannabis contexts reported higher levels of all cannabis-specific risk factors (e.g., greater access to and more favorable attitudes about cannabis use), except for perception of harm from regular cannabis use. However, permissiveness of the cannabis environment was not associated with heightened levels of risk factors for other substance use (such as alcohol, cigarettes, and opioids). CONCLUSIONS: Future preventive interventions for young adults living in more permissive cannabis contexts may need to focus on cannabis-specific risk factors in particular and go beyond considerations of harm from regular use. Future studies should replicate these findings with other samples.

An Examination of Parental Permissiveness of Alcohol Use and Monitoring, and Their Association with Emerging Adult Drinking Outcomes Across College.

BACKGROUND: Studies have shown that parents have a significant influence on emerging adult college students' drinking during the first year of college. Limited research has been conducted to address the question of whether parenting later in college continues to matter in a similar manner. The current study utilized a prospective design to identify associations between parental permissiveness toward alcohol use and monitoring behaviors and student drinking outcomes during the first and fourth years of college. METHODS: Participants (N = 1,429) at 3 large public universities completed surveys during the fall semesters of their first (T1) and fourth years (T2) (84.3% retention). The study employed a saturated autoregressive cross-lag model to examine associations between parental permissiveness of college student alcohol use, parental monitoring, student drinking, and consequences at T1 and T2, controlling for peer norms, sex, and campus. RESULTS: Examination of the association between parenting and student drinking outcomes revealed: (i) parental permissiveness was positively associated with drinking at T1 and again at T2; (ii) parental permissiveness had indirect effects on consequences via the effects on drinking at both times. Specifically, a 1-unit increase in parental permissiveness at T1 resulted in students experiencing 4 to 5 more consequences as a result of their drinking; (iii) parental permissiveness was not directly associated with monitoring at T1 or T2; and (iv) parental monitoring was significantly associated with drinking at T1 but not T2. CONCLUSIONS: The findings provide evidence for the continued importance of parenting in the fourth year of college and parents expressing low permissiveness toward student drinking may be beneficial to reducing risky drinking even as students turn 21.

An Ecological Momentary Assessment of Affect, Mental Health Symptoms, and Decisions to Drink Among First-Year College Women: A Pilot Study.

College women experience more consequences (e.g., blacking out, unprotected/unwanted sex) on days when they engage in their heaviest drinking. To inform prevention efforts, research is needed to understand decision-making processes that influence women's drinking behaviors at the event level. The present study used ecological momentary assessment (EMA) methods to examine: (1) associations between positive affect (PA) and negative affect (NA) and decision-making processes on days leading up to, during, and following heavy drinking events; and (2) mental health symptoms as moderators of these associations. Female undergraduate drinkers (N = 57) completed a 14-day EMA protocol on their smartphones, which included three daily assessments of PA, NA, and willingness and intentions to drink. Trait anxiety and depressive symptoms were measured before the EMA protocol and assessed as moderators. Time-varying effect models were used to examine covariation among PA, NA, and willingness and intentions to drink on the days leading up to participants' heaviest drinking events, the day of the event itself, and the days following the event. Results revealed PA was positively associated with willingness to drink the 2 days before, the day of, and the day after the heaviest drinking event. Similar effects were observed for PA and intentions to drink. Trait anxiety moderated the association between PA and intentions to drink. Findings underscore that positive affect may influence drinking-related decision-making processes surrounding heavy drinking events, particularly in those college women low in anxiety. Results identify potential entry points for real-time intervention efforts targeting college women during times of elevated PA.

A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice.

BACKGROUND: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. OBJECTIVE: To develop and demonstrate the efficacy of online training. DESIGN: Randomized educational trial. PARTICIPANTS: Primary care providers (PCPs). INTERVENTION: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard. MAIN MEASURES: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention. KEY RESULTS: Among the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists' practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ2 [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p < 0.001; ηp2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp2 = 0.236). Referred melanomas (0.8 ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck. CONCLUSIONS: Mastery learning improved PCPs' ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding. ClinicalTrials.gov NCT02385253.

A Longitudinal Examination of Decisions to Ride and Decline Rides with Drinking Drivers.

BACKGROUND: Riding with a drinking driver (RWDD) is a serious concern that leads to numerous preventable deaths every year. There is a significant gap in research on empirically tested predictors of RWDD that could be implemented in prevention efforts. College students are in need of such prevention efforts, as they have some of the highest rates of alcohol-related crash fatalities and may engage in RWDD more than their noncollege peers. This study utilized behavioral decision-making approach to examine predictors of RWDD and declining a ride from a drinking driver (Decline) in older college students. METHODS: Students (n = 791) in their third year of college were enrolled from 3 large and diverse universities. Psychosocial (e.g., expectancies, norms) and decision-making variables (willingness to RWDD and intentions to use alternatives) were assessed in the fall of their third year. One year later, RWDD and Decline behaviors were assessed. Zero-inflated Poisson analyses were used to assess how decision-making variables predicted RWDD and Decline behavior. Associations between psychosocial and decision-making variables were also assessed. RESULTS: Thirteen percent of students reported RWDD and ~28% reported Decline behavior. Willingness to RWDD and typical weekly drinking were both associated with increases in RWDD (odds ratio [OR] = 1.58 and 1.40, respectively), whereas intentions to use alternatives, sex, and ethnicity were not associated with RWDD. Only weekly drinking was associated with Decline, with an increase in drinking associated with increased Decline (OR = 1.48). All psychosocial variables were significantly associated with the decision-making variables except positive expectancies. CONCLUSIONS: Results provide evidence that willingness to RWDD is a predictor of future RWDD, even if students intend to use safe alternatives. Future research is needed to better understand decision-making factors that influence Decline. Results also suggest prevention and interventions efforts, such as brief motivational intervention, Parent-Based Interventions, and normative feedback interventions could be adapted to reduce RWDD.

Examination of a dual-process model predicting riding with drinking drivers.

BACKGROUND: Nearly 1 in 5 of the fatalities in alcohol-related crashes are passengers. Few studies have utilized theory to examine modifiable psychosocial predictors of individuals' tendencies to be a passenger in a vehicle operated by a driver who has consumed alcohol. This study used a prospective design to test a dual-process model featuring reasoned and reactive psychological influences and psychosocial constructs as predictors of riding with drinking drivers (RWDD) in a sample of individuals aged 18 to 21. METHODS: College students (N = 508) completed web-based questionnaires assessing RWDD, psychosocial constructs (attitudes, expectancies, and norms), and reasoned and reactive influences (intentions and willingness) at baseline (the middle of the spring semester) and again 1 and 6 months later. Regression was used to analyze reasoned and reactive influences as proximal predictors of RWDD at the 6-month follow-up. Subsequent analyses examined the relationship between the psychosocial constructs as distal predictors of RWDD and the mediation effects of reasoned and reactive influences. RESULTS: Both reasoned and reactive influences predicted RWDD, while only the reactive influence had a significant unique effect. Reactive influences significantly mediated the effects of peer norms, attitudes, and drinking influences on RWDD. Nearly all effects were constant across gender except parental norms (significant for females). CONCLUSIONS: Findings highlight that the important precursors of RWDD were reactive influences, attitudes, and peer and parent norms. These findings suggest several intervention methods, specifically normative feedback interventions, parent-based interventions, and brief motivational interviewing, may be particularly beneficial in reducing RWDD.

How estimation of drinking influences alcohol-related consequences across the first year of college.

BACKGROUND: This study examined how well students estimate their overall drinker type and the relation between the accuracy of this estimation with alcohol-related consequences. The study also explored the association between psychosocial alcohol variables and underestimation or overestimation of drinker type. METHODS: College students (n = 1,895) completed questionnaires at baseline (precollege matriculation) assessing self-reported drinker types (SI), protective and risky drinking behaviors, drinking expectancies, attitudes, and norms. Postbaseline assessment occurred during the fall semester sophomore year and included the number and type of alcohol consequences experienced during the previous year. Students' SIs were coded as accurate, overestimated, or underestimated relative to their empirically derived latent class analytic drinker class. The association between drinker type accuracy and consequences and membership in the high-risk Multiple and Repeated Consequence group was assessed, as was the relationship between the psychosocial alcohol variables and accuracy. RESULTS: Eighteen percent of students underestimated and 10% overestimated their drinker type. Students who under- or overestimated their drinker type reported experiencing more consequences, even after controlling for drinking. Increases in positive alcohol expectancies, protective and risky drinking behaviors, and descriptive peer norms were positively associated with underestimation of drinker type. Only protective and risky drinking behaviors were associated with overestimation. CONCLUSIONS: This study underscores the importance of accurate estimation of drinker type and the risk of experiencing alcohol consequences. Future research and intervention strategies are discussed.

Skin self-examination education for early detection of melanoma: a randomized controlled trial of Internet, workbook, and in-person interventions.

BACKGROUND: Early detection of melanoma improves survival. Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma, an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations (SSEs). Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent, detect, or cope with their health issues. The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined. OBJECTIVE: The electronic interactive educational intervention was created to develop a scalable, effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma. The intervention in the office was conducted using one of the following three methods: (1) in-person through a facilitator, (2) with a paper workbook, or (3) with a tablet device used in the clinical office. Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention. METHODS: The three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE, encourage performing SSE, and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance. In creating the electronic interactive SSE educational intervention, the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study. Enrollment totaled 500 pairs (melanoma patient and their SSE partner) with randomization of 165 pairs to the in-person, 165 pairs to the workbook, and 70 pairs to electronic interactive SSE educational intervention. RESULTS: The demographic survey data showed no significant mean differences between groups in age, education, or income. The tablet usability survey given to the first 30 tablet pairs found that, overall, participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist's examination was particularly helpful in understanding what they were asked to do for the study. The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles, and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles. While the in-person intervention performed significantly better on a skill-based quiz, the electronic interactive group performed significantly better than the workbook group. The electronic interactive and in-person interventions were more efficient (30 minutes), while the workbook took longer (45 minutes). CONCLUSIONS: This study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods, and the experience can be accommodated during the customary outpatient office visit with the physician. Further testing of the electronic interactive intervention's role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT01013844; http://clinicaltrials.gov/show/NCT01013844 (Archived by WebCite at http://www.webcitation.org/6LvGGSTKK).

Moderation of a parent-based intervention on transitions in drinking: examining the role of normative perceptions and attitudes among high- and low-risk first-year college students.

BACKGROUND: Parent-based interventions (PBIs) are an effective strategy to reduce problematic drinking among first-year college students. The current study examined the extent to which student-based characteristics, derived from the Theory of Planned Behavior, moderated 3 PBI conditions: (i) prior to college matriculation (PCM); (ii) PCM with a booster during the fall semester; and (iii) after college matriculation. The moderator variables included injunctive and descriptive peer norms about alcohol use and attitudes toward alcohol use. METHODS: Using data from a randomized control trial delivered to 1,900 incoming college students, we examined differential treatment effects within 4 types of baseline student drinkers: (i) nondrinkers; (ii) weekend light drinkers (WLD); (iii) weekend heavy episodic drinkers; and (iv) heavy drinkers. The outcome variable was based on the transitions in drinking that occurred between the summer prior to college enrollment and the end of the first fall semester and distinguished between students who transitioned to 1 of the 2 risky drinking classes. RESULTS: The results indicated that injunctive norms (but not descriptive norms or attitudes) moderated the differential effects of the PBI with strongest effects for students whose parents received the booster. Differential effects also depended on baseline drinking class and were most pronounced among WLDs who were deemed "high-risk" in terms of injunctive peer norms. CONCLUSIONS: Parental influence can remain strong for young adults who are transitioning to college environments, even among students with relatively high peer influence to drink alcohol. Thus, the PBI represents an effective tool to prevent escalation of alcohol use during the first year of college, when risk is highest and patterns of alcohol use are established.

Posttraumatic stress symptoms and substance use among college students: Exploring interactions with sleep quality and assigned sex.

Substance use is widely recognized as a negative outcome following traumatic events and is tied to symptoms of posttraumatic stress (PTS). Sleep quality may influence the PTS and substance use association, particularly among college students who are at risk for poor sleep. The purpose of the present study was to examine the moderating effect of sleep quality on the relationship between PTS and substance use in a cohort of college students, with an exploratory aim of examining potential differences by assigned sex. A screening survey was completed by 2,767 students enrolled in a larger RCT examining various brief college student alcohol reduction strategies. Results found a significant two-way interaction between PTS symptoms and subjective sleep quality on weekly number of drinks and peak drinking occasion, where the significant positive association between PTS symptoms to weekly drinks and peak drinking occasion was only found for those who reported poor sleep quality. A similar pattern emerged for the significant two-way interaction between PTS symptoms and subjective sleep quality on cannabis use frequency. A significant three-way interaction (i.e., PTS Symptoms × Poor Subjective Sleep Quality × Assigned Sex) indicated the two-way interaction between PTS symptoms and sleep quality for both weekly drinks and cannabis use frequency was stronger among male compared to female participants. Study findings suggest sleep quality is an important factor contributing to the relation between PTS symptom severity and substance use among college students. Strategies for assessing and improving sleep quality and PTS symptoms can be incorporated into prevention and intervention efforts targeting substance use related harm for college students.

Injunctive Norms and Driving Under the Influence and Riding With an Impaired Driver Among Young Adults in Washington State.

PURPOSE: Alcohol- and cannabis-impaired driving behaviors remain a public health concern especially among young adults (i.e., ages 18-25). Limited updates to prevention efforts for these behaviors may be due, in part, to limited understanding of malleable psychosocial predictors. The current study assessed associations between perceived injunctive norms (i.e., acceptability) of driving under the influence of alcohol (DUI-A) and cannabis (DUI-C), and riding with a driver under the influence of alcohol (RWI-A) and cannabis (RWI-C) in Washington State young adults. METHODS: Participants included 1,941 young adults from the 2019 cohort of the Washington Young Adult Health Survey. Weighted logistic regressions assessed the associations between peer injunctive norms and impaired driving-related behaviors. RESULTS: A weighted total of 11.5% reported DUI-A, 12.4% DUI-C, 10.9% RWI-A, and 20.9% RWI-C at least once in the past 30 days. Overlap between the outcomes was observed, indicating some young adults had engaged in multiple impaired driving-related behaviors. After controlling for substance use frequency, weighted logistic regressions indicated more positive perceived injunctive norms were associated with nearly 2 ½ times higher odds of DUI-A, 8 times higher odds of DUI-C, 4 times higher odds of RWI-A and six and a half times higher odds of RWI-C. DISCUSSION: Results increase the understanding of how injunctive norms-a potentially malleable psychosocial factor-are associated with four impaired driving-related outcomes. Prevention programs that focus on assessing and addressing the norms of these outcomes individually and collectively, such as normative feedback interventions and media campaigns, may be helpful in reducing these behaviors.

A Comparison of Parents' and Students' Reports of General and Alcohol-Specific Parenting Behaviors Across the Four Years of College.

OBJECTIVE: Whether college students' reports of their parents' behaviors are as reliable a predictor of student drinking as their parents' own reports remains an open question and a point of contention in the literature. To address this, the current study examined concordance between college student and mother/father reports of the same parenting behaviors relevant to parent-based college drinking interventions (relationship quality, monitoring, and permissiveness), and the extent to which student and parental reports differed in their relation to college drinking and consequences. METHOD: The sample consisted of 1,429 students and 1,761 parents recruited from three large public universities in the United States (814 mother-daughter, 563 mother-son, 233 father-daughter, and 151 father-son dyads). Students and their parents were each invited to complete four surveys over the course of the students' first 4 years of college (one survey per year). RESULTS: Paired samples t tests revealed that parental reports of parenting constructs were typically more conservative than student reports. Intraclass correlations revealed moderate associations between parental and student reports on relationship quality, general monitoring, and permissiveness. The associations between parenting constructs and drinking and consequences were also consistent when using parental and student reports of permissiveness. Results were generally consistent for all four types of dyads, and at each of the four time points. CONCLUSIONS: Taken together, these findings provide additional support for the use of student reports of parental behaviors as a valid proxy of parents' actual reports and as a reliable predictor of college student drinking and consequences.

The association between cannabis use and risk of non-medical pain reliever misuse onset among young adults in a legal cannabis context.

BACKGROUND: Little is known about the prospective relationship between cannabis use and pain reliever misuse. This study examined associations of non-medical and medical cannabis use with onset of non-medical pain reliever misuse among young adults in Washington State (WA), where non-medical cannabis is legal. METHODS: Data were from a cohort-sequential study of adults 18-25 residing in WA. Four annual surveys were used from cohorts recruited in 2014, 2015, and 2016. Participants who had not reported non-medical pain reliever misuse at baseline were included in discrete time survival analyses (N = 4,236). Odds ratios (ORs) were estimated for new onset of non-medical pain reliever misuse in any given follow-up year over the course of three years according to baseline non-medical and medical cannabis use. RESULTS: When included separately in models, non-medical and medical cannabis use at baseline were associated with increased risk of non-medical pain reliever misuse adjusting for demographic characteristics as well as past year cigarette use and alcohol use (non-medical OR = 5.27; 95 % CI: 3.28, 8.48; medical OR = 2.21; 95 % CI: 1.39, 3.52). Including both forms of use in the model, associations of non-medical and medical cannabis use with non-medical pain reliever misuse onset remained (non-medical OR = 4.64; 95 % CI: 2.88, 7.49; medical OR = 1.65; 95 % CI: 1.04, 2.62). CONCLUSIONS: Despite claims that cannabis use may reduce opioid use and related harms, findings suggest that cannabis use, including medical use, may not be protective, but instead may increase risk for non-medical pain reliever misuse.

A qualitative study of perceived responsibility and self-blame in type 2 diabetes: reflections of physicians and patients.

BACKGROUND: Despite new treatment therapies and the emphasis on patient activation, nearly 50 % of diabetes patients have hemoglobin A(1c) levels above target. Understanding the impact of unmet treatment goals on the physician-patient relationship is important for maintaining quality care in clinical practice. OBJECTIVE: To explore physicians' and type 2 diabetes patients' views of patients' difficulty achieving diabetes treatment goals. DESIGN: Qualitative study using in-depth interviews with a semi-structured interview guide. PARTICIPANTS: Nineteen endocrinologists and primary care physicians and 34 patients diagnosed with type 2 diabetes at least two years prior. MAIN MEASURES: In-depth interviews with physicians and patients. A multidisciplinary research team performed content and thematic analyses. KEY RESULTS: Qualitative analysis revealed two main findings, organized by physician and patient perspectives. Physician Perspective: Physicians' Perceived Responsibility for Patients' Difficulty Achieving Treatment Goals: Physicians assumed responsibility for their patients not achieving goals and expressed concern that they may not be doing enough to help their patients achieve treatment goals. Physicians' Perceptions of Patients' Reactions: Most speculated that their patients may feel guilt, frustration, or disappointment when not reaching goals. Physicians also felt that many patients did not fully understand the consequences of diabetes. Patient Perspective: Patients' Self-Blame for Difficulty Achieving Treatment Goals: Patients attributed unmet treatment goals to their inability to carry out self-care recommendations. Most patients blamed themselves for their lack of progress and directed their frustration and disappointment inwardly through self-depreciating comments. Patients' Perceptions of Physicians' Reactions: Several patients did not know how their physician felt, while others speculated that their physicians might feel disappointed or frustrated. CONCLUSIONS: Physicians' perceived responsibility and patients' self-blame for difficulty achieving treatment goals may serve as barriers to an effective relationship. Physicians and patients may benefit from a greater understanding of each other's frustrations and challenges in diabetes management.

Meaning in life and stress-related drinking: A multicohort study of college students during the COVID-19 pandemic.

During the COVID-19 pandemic, college students have experienced heightened stressors and reported stress-related drinking. To identify potential protective factors among college students, we investigate the possibility that finding meaning and purpose in one's life may lessen the strength of the association between stress and alcohol consumption in a multicohort sample of college students (N = 694; 64.8% women) recruited between November 2019 and September 2021. Consistent with expectations, negative binomial regressions revealed significant interactions, such that higher stress was only associated with more past-month alcohol use among individuals who reported low levels of meaning in life. The buffering role of meaning in life appeared to be robust; interaction results held when investigating both general perceived stress and COVID-specific stress, and did not vary by cohort. Although longitudinal and experimental research are needed, findings indicate that finding meaning and purpose in one's life may help college students to navigate heightened periods of stress with more adaptive coping strategies that do not result in drinking to cope. Findings highlight the potential utility of meaning-promoting strategies in college alcohol interventions.