RESUMEN
INTRODUCTION: Prevalence estimates of electronic cigarette (e-cigarette) use may underestimate actual use in youth. Confusion resulting from the fact that a multitude of devices (eg, vape pens, JUULs) fall under the umbrella term "e-cigarettes," the use of different names to refer to e-cigarettes (eg, vapes, electronic vaping devices), and the use of different terminology to refer to e-cigarette use (eg, "vaping," "JUULing"), may lead some young e-cigarette users to incorrectly indicate nonuse. Therefore, we compared rates of endorsing lifetime e-cigarette use when adolescents were asked about lifetime e-cigarette use in two different ways. METHODS: In May to June 2018, a total of 1960 students from two high schools in Connecticut completed a computerized, school-based survey. Participants first reported on lifetime "e-cigarette" use and, subsequently, on lifetime use of five different e-cigarette devices: disposables, cig-a-likes, or E-hookahs; vape pens or Egos; JUULs; pod systems other than JUULs such as PHIX or Suorin; and advanced personal vaporizers or mods. RESULTS: In total, 35.8% of students endorsed lifetime "e-cigarette" use, whereas 51.3% endorsed lifetime use of at least one e-cigarette device. The kappa statistic indicated only 66.6% agreement between the methods of assessing e-cigarette use. Overall, 31.5% of adolescents who endorsed lifetime device use did not endorse lifetime "e-cigarette" use, although rates of discordant responding varied across subgroups of interest (eg, sex, race). CONCLUSIONS: Assessing adolescents' use of specific e-cigarette devices likely yields more accurate results than assessing the use of "e-cigarettes." If these findings are replicated in a nationally representative sample, regulatory efforts requiring all e-cigarette devices to be clearly labeled as "e-cigarettes" may help to reduce confusion. IMPLICATIONS: Different prevalence estimates of lifetime e-cigarette use were obtained depending on the way that prevalence was assessed. Specifically, fewer adolescents (35.8%) endorsed lifetime e-cigarette use when they were asked "Have you ever tried an e-cigarette, even one or two puffs?" than when they were queried about lifetime use of five different e-cigarette devices (51.3%). Among those who endorsed lifetime use of at least one specific e-cigarette device, 31.5% did not endorse lifetime "e-cigarette" use. These findings suggest that when assessing adolescents' lifetime e-cigarette use, using of terms referring to specific devices likely produces more accurate prevalence estimates than using the term "e-cigarettes."
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos , Estudiantes/psicología , Productos de Tabaco/estadística & datos numéricos , Vapeo/epidemiología , Adolescente , Connecticut/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Fumadores/psicología , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Vapeo/psicologíaRESUMEN
Rates of e-cigarette use are high among youth, and there is little known about the long-term health effects of e-cigarettes. Since peer influence is a powerful determinant of tobacco use, we aimed to identify message themes about e-cigarettes that youth would use to encourage or discourage peers from using e-cigarettes. We conducted 10 focus groups (N = 69) with non-smokers and smokers from one middle school, high school and college in Connecticut. Participants engaged in a discussion about e-cigarettes, and each participant created one written message to encourage e-cigarette use and one to discourage use among peers. We content-analyzed the messages and identified three main themes and 12 encouraging and discouraging sub-themes. Encouraging themes included health benefits of e-cigarettes relative to cigarettes, attractive product characteristics (e.g. flavors) and social advantages (e.g. positive social image) of using e-cigarettes. Discouraging messages included health risks of e-cigarettes relative to cigarettes, unattractive product characteristics (e.g. cost) and social disadvantages (e.g. negative social image of using an e-cigarette). Overall, there were no differences by sex, age group or smoking status in generation of encouraging and discouraging message themes. This study identified youth-generated themes that may aid in e-cigarette prevention among youth.
Asunto(s)
Comunicación en Salud/métodos , Vapeo/prevención & control , Adolescente , Fumar Cigarrillos/prevención & control , Connecticut , Femenino , Aromatizantes , Grupos Focales , Humanos , Masculino , Grupo Paritario , Medio Social , Adulto JovenRESUMEN
Among adolescents, low socioeconomic status (SES) is associated with greater exposure to tobacco cigarette advertising and cigarette use. However, associations among SES, e-cigarette advertising and e-cigarette use are not well understood. This study examined exposure to e-cigarette advertisements as a mediator of the relationship between SES and adolescent e-cigarette use. Adolescents (Nâ¯=â¯3473; 51% Female) from 8 high schools in Connecticut completed an anonymous survey in Spring 2015. Mediation analysis was used to examine whether the total number of sources of recent e-cigarette advertising exposure (e.g., TV, radio, billboards, magazines, local stores [gas stations, convenience stores], vape shops, mall kiosks, tobacco shops, social media) mediated the association between SES (measured by the Family Affluence Scale) and past-month frequency of e-cigarette use. We clustered for school and controlled for other tobacco product use, age, sex, race/ethnicity and perceived social norms for e-cigarette use in the model. Our sample recently had seen advertisements via 2.1 (SDâ¯=â¯2.8) advertising channels. Mediation was supported (indirect effect: ßâ¯=â¯0.01, SEâ¯=â¯0.00, 95% CI [0.001, 0.010], pâ¯=â¯0.02), such that higher SES was associated with greater recent advertising exposure, which, in turn, was associated with greater frequency of e-cigarette use. Our study suggests that regulations to reduce youth exposure to e-cigarette advertisement may be especially relevant to higher SES youth. Future research should examine these associations longitudinally and evaluate which types of advertisements target different SES groups.
Asunto(s)
Publicidad , Sistemas Electrónicos de Liberación de Nicotina , Factores Socioeconómicos , Vapeo , Adolescente , Connecticut , Femenino , Humanos , Masculino , Instituciones Académicas , Encuestas y Cuestionarios , Uso de TabacoRESUMEN
BACKGROUND: This exploratory study examines the prevalence and predictors of current and former smokers' use of electronic (e-) cigarettes for smoking cessation among a sample of adolescent and young adult established smokers. METHODS: We conducted school-wide surveys in two middle (n = 1166) and four high schools (n = 3614) in fall 2013 and one public college (n = 625) in spring 2014. We analyzed data from 189 established smokers (reported smoking 100 cigarettes in their lifetime) who also reported ever-use of e-cigarettes (50.7% female, 89.4% White race, Mage 18.3 [SD = 2.8]). We further classified participants as current smokers (reported past-month cigarette smoking) and former smokers (no past-month smoking). Adjusted logistic regression assessed associations of using e-cigarettes to quit smoking with demographic, cigarette and e-cigarette use patterns, e-cigarette flavor preference, and risk perception variables. RESULTS: Overall, 41.8% of the sample reported that they "have used an e-cigarette to quit smoking." In adjusted models, older age, White race, higher e-cigarette frequency, and preference for using a combination of e-cigarette flavors predicted increased odds of having used e-cigarettes to quit smoking (p < .05). Using e-cigarettes to quit smoking was not associated with current or former cigarette smoking status or perceptions that "e-cigarettes help people quit smoking" or "e-cigarettes are safer than quit smoking medications." CONCLUSIONS: Adolescents and young adults who report more frequent e-cigarette use and preference for using flavor combinations are more likely to use e-cigarettes for smoking cessation. Future studies are needed to determine whether e-cigarette use leads to tobacco abstinence in youth smokers. IMPLICATIONS: Among young established smokers, more frequent e-cigarette use and preference for using flavors mixed together, but not perceptions of harmfulness of e-cigarettes or comparative safety of e-cigarettes compared with cigarettes or other smoking cessation medications or helpfulness of e-cigarettes in quitting smoking, are associated with using e-cigarettes for smoking cessation.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/métodos , Fumadores , Cese del Hábito de Fumar/métodos , Adolescente , Adulto , Fumar Cigarrillos/epidemiología , Fumar Cigarrillos/terapia , Estudios Transversales , Femenino , Humanos , Masculino , Fumadores/psicología , Fumar/epidemiología , Fumar/psicología , Fumar/terapia , Cese del Hábito de Fumar/psicología , Prevención del Hábito de Fumar/métodos , Encuestas y Cuestionarios , Fumar Tabaco/terapia , Adulto JovenRESUMEN
INTRODUCTION: Identifying youth at risk for future e-cigarette use is critical for informing prevention efforts. Prior research established measures of susceptibility to conventional cigarettes, and this study aimed to examine whether items adapted for e-cigarette susceptibility predicted subsequent e-cigarette use among never e-cigarette users. METHODS: Longitudinal school-wide survey data were collected from middle and high school students in Fall 2013 (wave 1) and Spring 2014 (wave 2). Among never e-cigarette users at wave 1 (n = 1720), e-cigarette susceptibility was measured by two items assessing anticipation of experimenting with e-cigarettes in the future and willingness to use an e-cigarette if offered by a best friend. Logistic regression models examined susceptibility as a predictor of e-cigarette initiation and past 30-day use 6 months later at wave 2. Models were clustered by school and controlled for sex, age, race, SES, and other substance use (alcohol, marijuana, and other tobacco). RESULTS: In total, 8.9% (n = 153) of youth initiated e-cigarettes and 3.7% (n = 63) reported past 30-day use at wave 2. E-cigarette susceptibility was a significant independent predictor of subsequent initiation (OR = 4.27, 95% CI = 3.12-5.85) and past 30-day e-cigarette use (OR = 5.10, 95%CI = 3.38-7.68) 6 months later. Susceptible youth were more likely to be male, older, and have used alcohol, marijuana, or other tobacco products. CONCLUSIONS: These findings provide initial support for adapting two susceptibility items to identify adolescents at risk for future e-cigarette use. Identifying strategies that are effective for targeting susceptible youth and preventing future e-cigarette use will be critical areas for future research. IMPLICATIONS: More than a quarter of the sample who reported both a willingness to try e-cigarettes if offered by a best friend and anticipation of experimenting with e-cigarettes in the future went on to try e-cigarettes within the academic year, suggesting that targeting this group will be critical for preventing youth e-cigarette initiation. There were notable demographic differences between susceptible and non-susceptible youth, suggesting targeting e-cigarette prevention efforts to male students who have used other substances may be especially important for preventing future e-cigarette use. Research is needed to determine the most effective prevention strategies to reach susceptible youth.
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Sistemas Electrónicos de Liberación de Nicotina/métodos , Fumar/psicología , Estudiantes/psicología , Productos de Tabaco/estadística & datos numéricos , Adolescente , Susceptibilidad a Enfermedades , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Instituciones Académicas , Fumar/epidemiología , Estudiantes/estadística & datos numéricosRESUMEN
BACKGROUND: The objective of this study was to determine the effects of the N-methyl-d-aspartate (NMDA) receptor antagonist, memantine (0, 20, 40 mg/d), upon alcohol drinking and craving in heavy drinkers with or without a family history (FH) of alcoholism, and to explore the modulatory influence of the presence of impulsivity on these outcomes. METHODS: Ninety-two, nontreatment-seeking, heavy drinkers received memantine or placebo for 8 days. On the eighth day, they received a priming dose of alcohol followed by a 3-hour period of alcohol access. RESULTS: Memantine at a dose of 20 mg reduced alcohol craving but did not influence alcohol drinking. No effects of FH were observed. In participants with higher baseline levels of impulsivity, 40 mg of memantine reduced alcohol craving but increased alcohol drinking and alcohol-induced stimulation. CONCLUSIONS: NMDA receptor signaling may play divergent roles in mediating alcohol cue-induced craving and alcohol drinking in heavy drinkers. The potential efficacy of memantine as monotherapy for alcohol use disorders may be limited by its tendency to disinhibit drinking in some individuals.
Asunto(s)
Consumo de Bebidas Alcohólicas/tratamiento farmacológico , Trastornos Relacionados con Alcohol/tratamiento farmacológico , Ansia/efectos de los fármacos , Antagonistas de Aminoácidos Excitadores/administración & dosificación , Conducta Impulsiva , Memantina/administración & dosificación , Adulto , Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Alcohol/psicología , Señales (Psicología) , Relación Dosis-Respuesta a Droga , Antagonistas de Aminoácidos Excitadores/farmacología , Femenino , Humanos , Masculino , Memantina/farmacologíaRESUMEN
INTRODUCTION: There is limited evidence on electronic cigarette (e-cigarette) use among U.S. adolescents. METHODS: Cross-sectional, anonymous surveys conducted in 4 high schools (HS; n = 3,614) and 2 middle schools (MS; n = 1,166) in Connecticut in November 2013 examined e-cigarette awareness, use patterns, susceptibility to future use, preferences, product components used (battery type, nicotine content, flavors), and sources of marketing and access. RESULTS: High rates of awareness (MS: 84.3%; HS: 92.0%) and of lifetime (3.5% MS, 25.2 % HS) and current (1.5% MS, 12% HS) use of e-cigarettes was observed. Among those who had not tried e-cigarettes, 26.4% of MS and 31.7% of HS students reported being susceptible to future use. Males (OR = 1.70, p < .01), older students (OR = 1.39, p < .05), Caucasians (OR = 2.01, p < .001), ever cigarette smokers (OR = 13.04, p < .001), and current cigarette smokers (OR = 65.11, p < .001) were more likely to be lifetime e-cigarette users and to report greater future susceptibility (males: OR = 1.30; Caucasians: OR = 1.14; ever cigarette smokers; OR = 3.85; current cigarette smokers; OR = 9.81; ps < .01-.001). Among MS students who were lifetime e-cigarette users, 51.2% reported that e-cigarette was the first tobacco product they had tried. E-cigarettes that were rechargeable and had sweet flavors were most popular. Smokers preferred e-cigarettes to cigarettes. Current cigarette smokers were more likely to initiate with nicotine-containing e-cigarettes, and ever and never cigarette smokers to initiate with e-cigarettes without nicotine. Primary sources for e-cigarette advertisements were televisions and gas stations and, for acquiring e-cigarettes, were peers. CONCLUSIONS: Longitudinal monitoring of e-cigarette use among adolescents and establishment of policies to limit access are imperatively needed.
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Sistemas Electrónicos de Liberación de Nicotina/psicología , Aromatizantes , Instituciones Académicas , Cese del Hábito de Fumar/psicología , Fumar/psicología , Estudiantes/psicología , Adolescente , Connecticut/epidemiología , Estudios Transversales , Sistemas Electrónicos de Liberación de Nicotina/métodos , Femenino , Aromatizantes/administración & dosificación , Humanos , Masculino , Mercadotecnía/métodos , Fumar/epidemiología , Cese del Hábito de Fumar/métodos , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Understanding why young people try and stop electronic cigarette (e-cigarette) use is critical to inform e-cigarette regulatory efforts. METHODS: We conducted 18 focus groups (N = 127) in 1 middle school (MS), 2 high schools (HSs), and 2 colleges in Connecticut to assess themes related to e-cigarette experimentation and discontinuation. We then conducted surveys to evaluate these identified themes in 2 MSs, 4 HSs, and 1 college (N = 1,175) to explore whether reasons for e-cigarette experimentation and/or discontinuation differed by school level or cigarette smoking status. RESULTS: From the focus groups, we identified experimentation themes (i.e., curiosity, flavors, family/peer influence, easy access, and perceptions of e-cigarettes as "cool" and as a healthier/better alternative to cigarettes) and discontinuation themes (i.e., health concerns, loss of interest, high cost, bad taste, and view of e-cigarettes as less satisfying than cigarettes). The survey data showed that the top reasons for experimentation were curiosity (54.4%), appealing flavors (43.8%), and peer influences (31.6%), and the top reasons for discontinuation were responses related to losing interest (23.6%), perceiving e-cigarettes as "uncool" (16.3%), and health concerns (12.1%). Cigarette smokers tried e-cigarettes because of the perceptions that they can be used anywhere and to quit smoking and discontinued because they were not as satisfying as cigarettes. School level differences were detected. CONCLUSIONS: E-cigarette prevention efforts toward youth should include limiting e-cigarette flavors, communicating messages emphasizing the health risks of use, and changing social norms surrounding the use of e-cigarettes. The results should be interpreted in light of the limitations of this study.
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Conducta del Adolescente/psicología , Sistemas Electrónicos de Liberación de Nicotina/psicología , Sistemas Electrónicos de Liberación de Nicotina/tendencias , Fumar/psicología , Fumar/tendencias , Estudiantes/psicología , Adolescente , Adulto , Connecticut/epidemiología , Femenino , Aromatizantes , Grupos Focales/métodos , Humanos , Masculino , Grupo Paritario , Instituciones Académicas/tendencias , Fumar/epidemiología , Cese del Hábito de Fumar/métodos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
INTRODUCTION: Research has shown that adults perceive that electronic cigarettes (e-cigarettes) are effective for smoking cessation, yet little is known about adolescents and young adults' perceptions of e-cigarettes for quitting cigarette smoking. This study describes middle, high school, and college students' beliefs about, and experiences with, e-cigarettes for cigarette smoking cessation. METHODS: We conducted 18 focus groups (n = 127) with male and female cigarette smokers and nonsmokers in 2 public colleges, 2 high schools, and 1 middle school in Connecticut between November 2012 and April 2013. Participants discussed cigarette smoking cessation in relation to e-cigarettes. Verbatim transcripts were analyzed using thematic analysis. RESULTS: All participants, regardless of age and smoking status, were aware that e-cigarettes could be used for smoking cessation. College and high school participants described different methods of how e-cigarettes could be used for smoking cessation: (a) nicotine reduction followed by cessation; (b) cigarette reduction/dual use; and (c) long-term exclusive e-cigarette use. However, overall, participants did not perceive that e-cigarette use led to successful quitting experiences. Participants described positive attributes (maintenance of smoking actions, "healthier" alternative to cigarettes, and parental approval) and negative attributes (persistence of craving, maintenance of addiction) of e-cigarettes for cessation. Some college students expressed distrust of marketing of e-cigarettes for smoking cessation. CONCLUSIONS: Adolescent and young adult smokers and nonsmokers perceive that there are several methods of using e-cigarettes for quitting and are aware of both positive and negative aspects of the product. Future research is needed to determine the role of e-cigarettes for smoking cessation in this population.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/psicología , Conocimientos, Actitudes y Práctica en Salud , Cese del Hábito de Fumar/psicología , Adolescente , Factores de Edad , Connecticut/epidemiología , Femenino , Grupos Focales , Humanos , Estudios Longitudinales , Masculino , Mercadotecnía/métodos , Nicotina/administración & dosificación , Instituciones Académicas , Fumar/epidemiología , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar , Estudiantes/psicología , Tabaquismo/epidemiología , Tabaquismo/rehabilitación , Universidades , Adulto JovenRESUMEN
BACKGROUND: This pilot study conducted a preliminary examination of whether Cognitive Bias Modification (CBM), a computerized task to retrain cognitive-approach biases towards smoking stimuli (a) changed approach bias for cigarettes, and (b) improved smoking cessation outcomes in adolescent smokers. METHODS: Sixty adolescent smokers received four weeks of Cognitive Behavioral Therapy (CBT) for smoking cessation, with CBM (90% avoidance/10% approach for smoking stimuli and 10% avoidance/90% approach for neutral stimuli) or sham (50% avoidance/50% approach for smoking and neutral stimuli) training in the Netherlands (n = 42) and the United States (n = 18). RESULTS: While we did not observe changes in action tendencies related to CBM, adolescents with higher smoking approach biases at baseline had greater decreases in approach biases at follow-up, compared to adolescents with smoking avoidance biases, regardless of treatment condition (p = 0.01). Intent-to-treat (ITT) analyses showed that CBM, when compared with sham trended toward higher end-of-treatment, biochemically-confirmed, seven-day point prevalence abstinence, (17.2% vs. 3.2%, p = 0.071). ITT analysis also showed that regardless of treatment condition, cotinine level (p = 0.045) and average number of cigarette smoked (p ≤ 0.001) significantly decreased over the course of treatment. CONCLUSIONS: The findings from this pilot study suggests that re-training approach biases toward cigarettes shows promise for smoking cessation among adolescent smokers. Future research should utilize larger samples and increased distinction between CBM and sham conditions, and examine mechanisms underlying the CBM approach.
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Conducta del Adolescente/psicología , Terapia Cognitivo-Conductual , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Tabaquismo/prevención & control , Tabaquismo/psicología , Adolescente , Femenino , Humanos , Masculino , Proyectos Piloto , Tabaquismo/rehabilitaciónRESUMEN
BACKGROUND: Adolescent smoking is a major public health concern, and current treatments are only somewhat effective in promoting abstinence. One way to improve treatments is to identify psychosocial characteristics that impede cessation, allowing development of targeted treatments. This study examined the influence of 2 such characteristics, life event stressors and coping, on initiation of cessation treatment and end-of-treatment abstinence status. METHODS: One hundred five adolescent smokers were eligible to participate in a validated contingency management (CM) and cognitive-behavioral (CBT) cessation treatment; of those, 72 completed at least 1 treatment session. Data included sociodemographic characteristics, questionnaires assessing past-year life events and coping behavior use, and abstinence status at the end of the 4-week treatment. Logistic regression was used to predict treatment initiation and abstinence status, with life event stressor number, coping, or their interaction as predictors. RESULTS: Higher levels of cognitive and peer support coping predicted treatment initiation, whereas life events were unrelated. End-of-treatment abstinence was predicted by higher numbers of life events and greater use of avoidant coping. The interaction of helpless coping and life events also predicted abstinence, with greater increases in helpless coping as total life events rose in abstinent but not nonabstinent participants. Finally, greater use of behavioral coping predicted abstinence in participants exposed to only CM treatment, whereas lesser use of behavioral coping predicted abstinence in participants receiving combined CM/CBT treatment. CONCLUSIONS: Exposure to life event stressors may promote cessation by forcing use of self-control resources prior to the quit attempt, which may strengthen such resources. Techniques that improve self-control resources may improve cessation outcome, and prevention programs may want to emphasize behavioral coping to improve rates of treatment initiation.
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Adaptación Psicológica , Conducta del Adolescente/psicología , Acontecimientos que Cambian la Vida , Cese del Hábito de Fumar/psicología , Fumar/terapia , Adolescente , Terapia Cognitivo-Conductual , Femenino , Humanos , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Quickly progressing from initiating alcohol use to drinking to intoxication recently was identified as a novel risk factor for hazardous drinking in college students (ME Morean et al. [2012] Alcohol Clin Exp Res, 36, 1991-1999). The current study evaluated the risk associated with age of onset (AO) and delay to first intoxication (Delay) in a high school sample. METHODS: Adolescent drinkers (N = 295, age 16.29 [1.14], 55.3% female, 80.3% Caucasian, AO = 13.51 [2.29] years, Delay = 0.80 [1.43] years) completed an anonymous survey about their substance use in February of 2010. Self-report questions assessed AO and age of first intoxication (AI) (i.e., "How old were you the first time you tried alcohol/got drunk?") and past-month alcohol use/binge drinking (i.e., How often did you drink alcohol/drink ≥5 drinks?). RESULTS: Bivariate correlations indicated that AO was positively correlated with AI and inversely correlated with Delay, the frequency of any drinking, and the frequency of binge drinking. When considered alone, Delay was not significantly correlated with either alcohol use outcome. In contrast, hierarchical regression analyses indicated that when considered in concert, an earlier AO and a shorter Delay were each associated with heavier drinking (any drinking adjusted R(2) = 0.08; binge drinking R(2) = 0.06, p-values <0.001) beyond demographic characteristics. Two-way interactions among study variables were nonsignificant, suggesting that AO and Delay conferred risk similarly by racial/ethnic status, gender, and grade in high school. CONCLUSIONS: When considered simultaneously, both an early AO and a quick progression to drinking to intoxication appear to be important determinants of high school student drinking. In addition to continuing efforts to postpone AO, efforts designed to delay intoxication may modulate alcohol-related risk associated with early drinking.
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Edad de Inicio , Consumo de Bebidas Alcohólicas/epidemiología , Intoxicación Alcohólica/epidemiología , Alcoholismo/epidemiología , Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Adolescente , Factores de Edad , Femenino , Humanos , Incidencia , Masculino , Análisis de Regresión , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Shared medical appointments (SMAs) are a novel modality for treating patients with similar conditions, together, by a team of interdisciplinary providers. SMAs benefit patients with substance use disorder (SUD), but no research has focused on the feasibility of implementation of SMAs in a teaching clinic. METHODS: Primary care residents rotated in a half-day ambulatory addiction clinic for 4 weeks where a third-year resident co-facilitated 4 SMAs. Confidence, knowledge, and attitudes about SUD care were assessed using web-based surveys at weeks 0, 4, and 8. Pre- and post-intervention scores were compared using a t test for paired samples. RESULTS: Ten residents were included in the analyses. Using a 10-point Likert scale, confidence in SUD knowledge (7.0-8.3, P = .003), confidence in counseling patients with SUD (7.1-8.2, P = .023), and confidence in facilitating an SMA (5.7-8.3, P = .007) showed statistically significant increases from baseline following exposure to the SMAs. Confidence that counseling and other treatments will make a difference for patients with illicit drug use increased (7.1-8.0, P = .142), but did not differ statistically. Furthermore, on a 4-point Likert scale, understanding of behavioral therapies for treating and preventing the relapse of SUD (2.9-3.2, P = .180) showed a similar increase. Attitudes toward patients with SUD (42.4-42.1, P = .303) and physician empathy (119.3-119.2, P = .963) did not change from pre- to post-intervention. CONCLUSIONS: SMAs are a feasible training tool in the education of primary care residents on an addiction medicine rotation. Residents develop confidence co-facilitating SMAs after 4 weeks. Overall, exposure to SMAs during residency can provide an opportunity to increase confidence in treating patients with SUD, as well as provide a training modality that may shift the way residents interact with patients receiving SUD treatment.
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Internado y Residencia , Citas Médicas Compartidas , Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Sustancias/terapia , Trastornos Relacionados con Sustancias/psicología , Masculino , Femenino , Atención Primaria de Salud , Adulto , Conocimientos, Actitudes y Práctica en SaludRESUMEN
INTRODUCTION: Menthol cigarette and marijuana use among adolescents is high; however, little is known about dual use in this age. Thus, we examined these rates among 2 samples of adolescents in Connecticut. METHODS: Study 1 examined a school-wide survey assessing variables related to cigarettes and marijuana among high school students (N = 837 [13% smokers]), and Study 2 examined these factors using baseline data of high school-aged, treatment-seeking, daily cigarette smokers prior to quitting (N = 132). RESULTS: In Study 1, lifetime marijuana use among all adolescents was 33% and past 30-day marijuana use was 21%. Among cigarette smokers, 55% reported smoking menthol cigarettes, 84% reported lifetime marijuana use, and 66% reported past 30-day marijuana use. Multivariate-adjusted logistic regression models indicated that cigarette smokers, when compared with nonsmokers, had greater rates of lifetime (odds ratio [OR] = 10.91) and past 30-day marijuana use (OR = 10.44). Among smokers, use of menthol cigarettes, when compared with use of nonmenthol cigarettes, was associated with greater lifetime (OR = 5.05) but not past 30-day marijuana use. In Study 2 with daily smokers, 59% of adolescents reported use of menthol cigarettes and 66% reported past 30-day marijuana use. Compared with nonmenthol cigarette smokers, menthol cigarette smokers were more likely to report past 30-day marijuana use (OR = 2.44). CONCLUSIONS: Cigarette smoking is associated with marijuana use, and among smokers, menthol cigarette smoking further increased the odds of marijuana use. More research on the dual use of marijuana and tobacco is needed to inform prevention and treatment of substance use.
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Fumar Marihuana/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Productos de Tabaco/estadística & datos numéricos , Tabaquismo/epidemiología , Adolescente , Cannabis , Connecticut/epidemiología , Demografía , Femenino , Humanos , Modelos Logísticos , Masculino , Mentol , Análisis Multivariante , Oportunidad Relativa , Estudiantes/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Adolescence is a critical developmental period when tobacco use is initiated and progression to regular smoking occurs. Another growing concern is the mounting evidence of ethnic/racial disparities in the smoking rates and adverse health consequences related to smoking. To reduce ethnic/racial disparities in smoking behaviors, understanding the protective influences against smoking behaviors among minority adolescents is important. Therefore, we examined the role of ethnic pride and parental disapproval of smoking on a wide range of smoking behaviors in ethnic/racial minority and White adolescents attending a suburban high school in Connecticut. METHODS: A total of 870 adolescents (ethnic/racial minority: n= 202) completed questions on susceptibility to smoking, ever trying a cigarette, smoking at least one cigarette daily in the past 30 days, as well as parental disapproval of smoking and ethnic pride in a school-wide survey. RESULTS: Logistic regression analyses indicated that perceived parental disapproval of adolescent smoking and ethnic pride were associated with susceptibility to smoking, ever trying a cigarette, and daily smoking differently for minority and White adolescents. For White youth, high parental disapproval of smoking was protective against all three smoking behaviors whereas ethnic pride was not. For minority youth, the combined protective effect of higher ethnic pride and higher parental disapproval of smoking was protective against all smoking behaviors. CONCLUSION: The protective role of parental disapproval of smoking and ethnic pride on smoking behaviors may inform culturally sensitive smoking interventions aimed at diverse, multi-ethnic youth, and future studies are needed to examine this.
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Cultura , Grupos Minoritarios/psicología , Padres/psicología , Fumar/etnología , Adolescente , Connecticut , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Grupos Minoritarios/estadística & datos numéricos , Salud de las Minorías , Análisis de Regresión , Productos de Tabaco/estadística & datos numéricos , Adulto JovenRESUMEN
PURPOSE: E-cigarette use is a problem among youth, yet few vaping cessation programs exist. This study aimed to understand what youth want in a school-based vaping cessation program to inform intervention development. METHODS: We conducted 8 focus groups in Fall 2019 with Connecticut high school youth (N = 4-10 adolescents per group, total N = 62, 50% female). 6 groups were with youth who were current (i.e., past-month) e-cigarette users and 2 groups were with past users (i.e., lifetime users with no past-month use). Discussions focused on desired features and concerns about a vaping cessation program and analyses used an iterative inductive and deductive approach to identify qualitative themes. We also collected brief survey data assessing skills youth wanted to learn from a vaping cessation program. RESULTS: Qualitative themes emerged indicating that youth want a vaping cessation program to include education about health effects of vaping, relatable personal anecdotes from others, and rewards for quitting. Potential concerns include confidentiality (e.g., ensuring teachers/coaches would not know about e-cigarette use), perceptions that youth may not want to participate due to lack of interest/apathy or embarrassment, and needing methods to verify abstinence to limit inaccurate reporting. The most frequently endorsed skills from the survey indicated youth want to learn ways to deal with stress (92%), relax (60%), and deal with poor concentration/attention (55%). CONCLUSIONS: Findings identified key features to include and issues to address when developing school-based vaping cessation programs. Developing effective vaping cessation programs that appeal to youth is important for addressing youth e-cigarette use.
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Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Vapeo , Adolescente , Femenino , Humanos , Masculino , Instituciones Académicas , FumadoresRESUMEN
BACKGROUND: Nicotine vaping and cannabis use are common among youth. Among youth who use e-cigarettes, little is known about how and why they use cannabis and patterns of cannabis and nicotine co-use. Given the popularity of both products among youth, the study aim is to utilize qualitative data to better understand cannabis use among youth who use e-cigarettes. METHOD: Six focus groups of high schoolers who reported past-month e-cigarette use (N = 50; 52% male) were conducted to inform e-cigarette cessation programming. We conducted secondary data analysis examining report of cannabis use during focus groups. Transcripts were examined for report of cannabis use, reasons for use, and nicotine and cannabis co-use. RESULTS: In focus groups, cannabis was commonly discussed. Youth reported vaping cannabis, however other forms of cannabis delivery were common (e.g. blunts, joints). Themes related to reasons for simultaneous use of nicotine and cannabis were to experience stronger psychoactive effects than using either product alone and needing to use less nicotine product overall. Reasons for liking cannabis were positive psychoactive effects and stress relief. Reasons for disliking were related to health concerns. Notably, when youth reported disliking cannabis due to health concerns, a common discussion was strategies to acquire and continue cannabis use in ways that they perceived mitigated health concerns. CONCLUSION: Qualitative evidence identified associations between e-cigarette use and cannabis use among youth. Research and interventions targeting youth using e-cigarettes should consider how to address dual use of these products.
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Cannabis , Sistemas Electrónicos de Liberación de Nicotina , Alucinógenos , Vapeo , Adolescente , Agonistas de Receptores de Cannabinoides , Femenino , Humanos , Masculino , Nicotina , Encuestas y CuestionariosRESUMEN
BACKGROUND: Although shopping behavior among adolescents is normal, for some, the shopping becomes problematic. An assessment of adolescent shopping behavior along a continuum of severity and its relationship to other behaviors and health issues is incompletely understood. METHODS: A large sample of high school students (n = 3999) was examined using a self-report survey with 153 questions concerning demographic characteristics, shopping behaviors, other health behaviors including substance use, and functioning variables such as grades and violent behavior. RESULTS: The overall prevalence of problem shopping was 3.5% (95% CI, 2.93-4.07). Regular smoking, marijuana and other drug use, sadness and hopelessness, and antisocial behaviors (e.g., fighting, carrying weapons) were associated with problem shopping behavior in both boys and girls. Heavy alcohol use was significantly associated with problem shopping only in girls. CONCLUSION: Problem shopping appears fairly common among high school students and is associated with symptoms of depression and a range of potentially addictive and antisocial behaviors. Significant distress and diminished behavioral control suggest that excessive shopping may often have significant associated morbidity. Additional research is needed to develop specific prevention and treatment strategies for adolescents who report problems with shopping.