Perspectives regarding cannabis use: Results from a qualitative study of individuals engaged in substance use treatment in Georgia and Connecticut.

Objective: Cannabis use is increasingly pervasive throughout the U.S. People in treatment for substance use disorders (SUD) may be especially at-risk of harm due to this changing context of cannabis in the U.S. This study's objective was to qualitatively describe experiences and beliefs around cannabis among people who had entered treatment for any SUD in the past 12-months. Methods: From May to November of 2022, we conducted 27 semi-structured interviews (n=16 in Georgia, n=11 in Connecticut) with individuals in treatment for SUD in Georgia and Connecticut. Interviews were recorded, transcribed, and thematically analyzed using an emergent approach. Results: All participants had used cannabis in the past. Four themes emerged from the interviews. Participants: (1) perceived cannabis as an important contributor to non-cannabis substance use initiation in adolescence; (2) viewed cannabis as a substance with the potential to improve health with fewer side effects than prescription medications; (3) expressed conflicting opinions regarding cannabis as a trigger or tool to manage cravings for other non-cannabis substances currently; and 4) described concerns related to negative legal, social service, and treatment-related consequences as well as negative peer perception relating to the use of cannabis. Conclusion: Although participants described cannabis's important role as an initiatory drug in adolescence and young adulthood, many felt that cannabis was a medicinal substance for a range of health challenges. These findings suggest SUD treatment clinicians should address medicinal beliefs related to cannabis among their clients and emphasizes the need for research on cannabis use and SUD treatment outcomes.

A Mixed Media Campaign to Promote Bystander Intervention and Reduce Alcohol Use Among College Students: A Pilot Study.

This study examined the limited efficacy of a mixed media campaign that promoted bystander intervention as a sexual violence (SV) prevention strategy and aimed to decrease alcohol use. A quasi-experimental design was used to assess the limited efficacy of the Be a Watch Dawg mixed media campaign implemented at a large Southeastern public university in 2017. Social marketing along with social cognitive theory, social norms theory, and theory of planned behavior were utilized as the framework for the campaign. Be a Watch Dawg promoted bystander intervention in SV risk situations and targeted bystanders' alcohol use via social media (e.g., Facebook, Instagram, and Twitter) and printed materials (e.g., posters, stickers, and handbills). Participants included 244 undergraduate students 18 to 24 years of age. Study outcomes included bystander intervention, intentions to intervene, and alcohol use. Adjusted linear regression and logistic regression models were used to examine differences in outcomes between pre and postcampaign samples as well as associations with campaign exposure. Significant increases in bystander intervention were observed between the pre and postcampaign samples. Campaign exposure was marginally related to intentions to intervene but was not significantly associated with bystander intervention. Social media analytics revealed that the campaign reached 39,466 social media users and received 50,854 impressions and 19,523 views. A mixed media campaign may be a promising and low-resource approach to increase bystander intervention as a strategy to combat campus SV.

A biomonitoring assessment of secondhand exposures to electronic cigarette emissions.

BACKGROUND: Electronic cigarette (e-cigarette) conventions regularly bring together thousands of users around the world. In these environments, secondhand exposures to high concentrations of e-cigarette emissions are prevalent. Some biomarkers for tobacco smoke exposure may be used to characterize secondhand e-cigarette exposures in such an environment. METHODS: Participants who did not use any tobacco product attended four separate e-cigarette events for approximately six hours. Urine and saliva samples were collected from participants prior to the event, immediately after the event, 4-h after the event, and the next morning (first void). Urine samples from 34 participants were analyzed for cotinine, trans-3'-hydroxycotinine, S-(3-hydroxypropyl)-N-acetylcysteine (3-HPMA), S-carboxyethyl-N-acetylcysteine (CEMA), select tobacco-specific nitrosamines (TSNAs), and 8-isoprostane. Saliva samples were analyzed for cotinine and trans-3'-hydroxycotinine. RESULTS: Data from 28 of 34 participants were used in the data analysis. Creatinine-adjusted urinary cotinine concentrations increased up to 13-fold and peaked 4-h after completed exposure (range of adjusted geometric means [AGMs] = 0.352-2.31 µg/g creatinine). Salivary cotinine concentrations were also the highest 4-h after completed exposure (range of AGMs = 0.0373-0.167 ng/mL). Salivary cotinine and creatinine-corrected concentrations of urinary cotinine, trans-3'-hydroxycotinine, CEMA, and 3-HPMA varied significantly across sampling times. Urinary and salivary cotinine, urinary trans-3'-hydroxycotinine, and urinary 3-HPMA concentrations also varied significantly across events. CONCLUSION: Secondhand e-cigarette exposures lasting six hours resulted in significant changes in exposure biomarker concentrations of both nicotine and acrolein but did not change exposure to tobacco-specific nitrosamines. Additional research is needed to understand the relationship between biomarker concentrations and environmental concentrations of toxicants in e-cigarette emissions.

Air monitoring at large public electronic cigarette events.

BACKGROUND: Electronic cigarette (e-cigarette) conventions bring hundreds to thousands of e-cigarette users together socially regularly across the world. E-cigarette secondhand exposures to chemicals in this environment, likely the public setting with the highest concentration of e-cigarette secondhand aerosol, have not been characterized. METHODS: Air sampling for formaldehyde, acetaldehyde, acrolein, nicotine, and propylene glycol was conducted at three e-cigarette conventions and one smaller event from April 2016 to March 2017 in three states in the Southeastern United States. Volunteers attended the events as members of the public and wore backpacks containing air sampling pumps. Control sampling was conducted when venues were crowded for non-e-cigarette events. Additional control sampling was conducted in two venues when they were empty. RESULTS: Formaldehyde and acetaldehyde concentrations during e-cigarette events were comparable to background concentrations. The median formaldehyde concentrations during events, crowded control events, and empty control events were 12.0, 10.5, and 12.5 µg/m3, respectively. The median acetaldehyde concentrations during events, crowded control events, and empty control events were 9.7, 15.5, and 3.5 µg/m3, respectively. Propylene glycol and nicotine were not detected during control sampling. The median nicotine concentration during events was 1.1 µg/m3. The median propylene glycol concentration during events was 305.5 µg/m3. CONCLUSION: Results indicate e-cigarette secondhand exposures are sources of elevated nicotine and propylene glycol exposures. Secondhand exposures to e-cigarettes did not contain consistently elevated concentrations of formaldehyde or acetaldehyde. Additional research is needed to characterize exposures via inhalation to propylene glycol at concentrations measured in this study.

Elevated Nicotine Dependence Scores among Electronic Cigarette Users at an Electronic Cigarette Convention.

Electronic cigarette (e-cigarette) conventions are trade shows held across the globe to promote e-cigarette products and provide a venue for users to socialize. E-cigarette users that attend these events likely represent the most intensive e-cigarette user group. No study has characterized addiction and behavior characteristics in this population. We surveyed 131 e-cigarette users attending a large Southeastern e-cigarette convention in Fall 2015. All questions from the Fagerstrom Test for Nicotine Dependence (FTND), select questions from the Penn State Electronic Cigarette Dependence Index, and novel user behavior questions were included. In total, 25 questions were included in the survey. FTND scores were calculated for each respondent who answered all six FTND questions (n = 117). Fisher's Exact Chi square test was used to assess the relationship between addiction and behavior characteristics and FTND scores. Most respondents were classified as moderately dependent (score 5-7, 45.3% of respondents). Length of use, waking at night to use an e-cigarette, strength of cravings, strength of urges over the past week, and frequency of visiting e-cigarette blogs were significantly associated with FTND scores. E-cigarettes users have average FTND scores higher than tobacco smokers. Scores were not significantly associated with prior tobacco cigarette use. Characteristics associated with tobacco smokers' nicotine addiction, such as waking at night to smoke and strength of cravings experienced, are relevant to e-cigarette users. E-cigarettes do not contain the magnitude of toxicants in tobacco cigarettes, but e-cigarettes may produce new chemical exposures evidenced by the adverse health effects reported by some respondents.

Prevalence of and Factors Related to Tobacco Ban Implementation in Substance Use Disorder Treatment Programs.

This study examined the prevalence of and factors (psychological climate for change and staff attributes) related to indoor and outdoor tobacco bans for patients, employees, and visitors in U.S. substance use disorder treatment programs. Data were collected from a random sample of 1,026 program administrators. Almost all programs banned tobacco use indoors and around one third banned tobacco use outdoors. When there was no tobacco ban, the majority of programs restricted smoking to designated indoor and/or outdoor areas. Further, all psychological climate for change factors (perceived program support, perceived tobacco culture, and tobacco ban beliefs) but none of the staff attributes (percentage licensed/certified clinicians, percentage clinicians with master's degrees, total staff with education in health-related field) were significantly related to the implementation of comprehensive tobacco bans (both indoors and outdoors).

Substance Use Disorder Counselors' Reports of Tobacco Cessation Services Availability, Implementation, and Tobacco-related Knowledge.

PURPOSE: Adolescence is a prime developmental stage for early tobacco cessation (TC) intervention. This study examined substance use disorder counselors' reports of the availability and implementation of TC services (behavioral treatments and pharmacotherapies) in their treatment programs and the relationship between their tobacco-related knowledge and implementation of TC services. METHODS: Survey data were collected in 2012 from 63 counselors working in 22 adolescent-only treatment programs. Measures included 15 TC behavioral treatments, nine TC pharmacotherapies, and three tobacco-related knowledge scales (morbidity/mortality, modalities and effectiveness, pharmacology). RESULTS: First, nine of the 15 behavioral treatments are reported as being available by more than half of counselors; four of the 15 behavioral treatments are used by counselors with more than half of adolescents. Of the nine pharmacotherapies, availability of the nicotine patch is reported by almost 40%, buproprion by nearly 30%, and clonidine by about 21% of counselors. Pharmacotherapies are used by counselors with very few adolescents. Second, counselors' tobacco-related knowledge varies based on the knowledge scale examined. Third, we only find a significant positive relationship between counselors' implementation of TC behavioral treatments and TC modalities and effectiveness knowledge. DISCUSSION: Findings suggest that more behavioral treatments should be made available in substance use disorder treatment programs considering that they are the main treatment recommendation for adolescents. Counselors should be encouraged to routinely use a wide range of available behavioral treatments. Finally, counselors should be encouraged to expand their knowledge of TC modalities and effectiveness because of the relationship with behavioral treatments implementation.

Factors Linked to Substance Use Disorder Counselors' (Non)Implementation Likelihood of Tobacco Cessation 5 A's, Counseling, and Pharmacotherapy.

STUDY BACKGROUND: Despite efforts to promote the use of tobacco cessation services (TCS), implementation extensiveness remains limited. This study investigated three factors (cognitive, behavioral, environmental) identified by social cognitive theory as predictors of substance use disorder counselors' likelihood of use versus non-use of tobacco cessation (TC) 5 A's (ask patients about tobacco use, advise to quit, assess willingness to quit, assist in quitting, arrange for follow-up contact), counseling, and pharmacotherapy with their patients who smoke cigarettes. METHODS: Data were collected in 2010 from 942 counselors working in 257 treatment programs that offered TCS. Cognitive factors included perceived job competence and TC attitudes. Behavioral factors encompassed TC-related skills and general training. External factors consisted of TC financial resource availability and coworker TC attitudes. Data were analyzed using logistic regression models with nested data. RESULTS: Approximately 86% of counselors used the 5 A's, 76% used counseling, and 53% used pharmacotherapy. When counselors had greater TC-related skills and greater general training they were more likely to implement the 5 A's. Implementation of counseling was more likely when counselors had more positive attitudes toward TC treatment, greater general training, greater financial resource availability, and when coworkers had more positive attitudes toward TC treatment. Implementation of pharmacotherapy was more likely when counselors had more positive attitudes toward TC treatment, greater general training, and greater financial resource availability. CONCLUSION: Findings indicate that interventions to promote TCS implementation should consider all three factors simultaneously as suggested by social cognitive theory.

Sustained, new, never, and discontinued tobacco cessation services adopters.

This study examined longitudinal adoption patterns of tobacco cessation (TC) counseling and TC pharmacotherapy in substance use disorder treatment programs and baseline predictors (program characteristics and program culture) of these patterns 12-months later. Telephone survey data were collected in 2010 from 685 randomly sampled program administrators working in geographically representative treatment programs across the U.S. Regarding TC counseling, about 41% of programs never adopt, 33% sustain, and 27% change adoption patterns. Concerning TC pharmacotherapy, about 62% of programs never adopt, 19% sustain, and 18% change adoption patterns. The three most consistent predictors of counseling adoption patterns are TC reimbursement, TC financial resource availability, and smoking culture. For TC pharmacotherapy adoption patterns, the most consistent predictors include profit status, TC reimbursement, level of care, TC financial resource availability, and smoking culture. Findings provide insights into program characteristics and program culture as both potential barriers and facilitators of longitudinal TCS adoption.

Relationship between Low-Income Patient Census and Substance Use Disorder Treatment Programs' Availability of Tobacco Cessation Services.

Low income adults with substance use disorders (SUDs) have a high prevalence of tobacco use and often limited access to tobacco cessation treatment. This study examines the relationship between low-income SUD patient census (i.e., percentage of patients whose treatment costs are covered by Medicaid and Federal block grants) and SUD programs' availability of three evidence-based tobacco cessation services: behavioral treatments, system-level support, and pharmacotherapy. Data were collected from a random sample of 1,006 program administrators in 2010. Mixed-effects models results show that the percentage of low-income patients is significantly positively associated with the availability of behavioral treatments and system-level support but not pharmacotherapy. Thus, low-income patients may have similar access to tobacco cessation pharmacotherapy but greater access to behavioral treatments and system-level support. However, the availability of tobacco cessation services is not widespread overall, which may hamper access to extensive services to address low-income SUD patients' high smoking rates.

Understanding counselors' implementation of tobacco cessation services with patients.

This study aimed to understand substance use disorder counselors' implementation of evidence-based tobacco cessation services (TCS) with their patients who smoke. Drawing from an established adoption of innovations framework, we investigated the association between counselors' perceptions of the availability of TCS (both pharmacotherapies and behavioral treatments) in their treatment program and the implementation of TCS (both pharmacotherapies and behavioral treatments) with their patients who smoke and whether this association is moderated by the strength of an organization's climate for implementation and the fit of the innovation with users' values. Data were collected in 2010 from 682 counselors working in 239 treatment programs across the U.S. that offer evidence-based TCS. Mixed-effect models showed that perceived availability of TCS was related with greater TCS implementation. This relationship was moderated by several indicators of climate for implementation but not by the fit of the innovation with users' values.

Organizational factors as predictors of tobacco cessation pharmacotherapy adoption in addiction treatment programs.

OBJECTIVES: This study investigated 3 organizational factors (ie, counseling staff clinical skills, absence of treatment program obstacles, and policy-related incentives) as predictors of tobacco cessation pharmacotherapy (TCP) adoption (comprised of the 9 available TCPs) in addiction treatment programs using the innovation implementation effectiveness framework. METHODS: Data were obtained in 2010 from a random sample of 1006 addiction treatment program administrators located across the United States using structured telephone interviews. RESULTS: According to program administrator reports, TCP is adopted in approximately 30% of treatment programs. Negative binomial regression results show that fewer treatment program obstacles and more policy-related incentives are related to greater adoption of TCP. Counter to prediction, clinical skills are unrelated to TCP adoption. CONCLUSIONS: Our findings suggest that organizational factors, on the basis of established theoretical frameworks, merit further examination as facilitators of the adoption of diverse TCP in addiction treatment programs.

Climate for innovation, 12-step orientation, and tobacco cessation treatment.

This study examined the relationship between (1) three indicators of climate for innovation (clinician skills, absence of program obstacles, policy-related incentives) and adoption extensiveness of both behavioral treatments for tobacco cessation (TC) and system-level support for TC in substance use disorder treatment programs, (2) a program's 12-step treatment orientation and adoption extensiveness, and (3) whether 12-step treatment orientation moderates the relationship between climate for innovation and adoption extensiveness. Data were obtained from a random sample of 1006 program administrators. Hierarchical regression results showed that both absence of program obstacles and policy-related incentives are positively related to adoption extensiveness. Twelve-step treatment orientation is neither related to adoption extensiveness nor a moderator of the relationship between climate for innovation and adoption extensiveness. Although the adoption of both behavioral treatments for TC and system-level support for TC is not extensive, we conclude that a 12-step treatment orientation neither hampers nor promotes adoption extensiveness.

Over-the-counter stimulant, depressant, and nootropic use by veterinary students.

US veterinary students are subject to significant stress throughout their veterinary education. In this article, the authors characterize the use of over-the-counter (OTC) medications and relate their use to stress in a veterinary student population. Of the students sampled, 35% were OTC medication users; 33% of these were regular OTC medication users. Forty-three percent of students were energy drink (ED) users; 45% of these were regular ED users. OTC medication users had significantly higher stress scores than non-OTC medication users, and ED users had significantly higher anxiety scores than non-ED users. The most common reasons for use given by OTC medication users were to help with studying and to fall asleep at night. Depression scores were significantly higher for juniors and sophomores than for freshmen. Depression, stress, and anxiety scores were all lower in the Colorado State University students when compared with the University of Georgia students. OTC medication and ED veterinary student users had distinct characteristics that differed from those of nonusers. Users suffered from more stress and anxiety and had more difficulties with sleep, which may have affected their overall health and academic performance. Educating veterinary students about the consequences of using OTC medication and ED and providing counseling support may be of benefit to veterinary students' psychological well-being.

Virtual worlds: taking health promotion to new levels.

Health promotion strategies continue to evolve, with interventions using e-mail, text messaging, and Web sites becoming commonplace. The use of online virtual worlds is a less familiar venue for health promotion but offers numerous possibilities for wired citizens with health issues. The authors discuss three examples of virtual worlds--the River City Project, Whyville, and Second Life--and how health promotion strategies can be implemented in virtual worlds. They also address several challenges associated with implementing health interventions in virtual worlds, including questions of ethics, diffusion of health knowledge and logistics of intervening outside of the real world.

Investigating adolescents' sources of information concerning tobacco and the resulting impact on attitudes toward public policy.

BACKGROUND: In this study, we investigated different sources of information concerning the use of tobacco and the impact that these sources may have on attitudes toward tobacco policies. METHODS: We surveyed 4336 high school students gathered from 5 high schools in the Southeastern United States. RESULTS: The results indicate that just over half of these youth are supportive of public policies targeting bans on smoking in public places and having a minimum age to purchase tobacco products. Race is significant in impacting both age restriction and prohibition of smoking in public places, with African American youth being less supportive of both dependent variables. However, holding this variable constant in an ordinal logistic regression, we found that attitudes toward policy are impacted by the environment related to smoking in which the youth lives; the extent to which the youth believes he/she is well informed; and more important, the amount of correct and accurate information on smoking the youth possess. CONCLUSIONS: Communicating accurate information is vital in increasing youth support for pending or already existing tobacco policies.

African American adolescents and menthol cigarettes: smoking behavior among secondary school students.

PURPOSE: This paper examines the impact of smoking menthol cigarettes among secondary students, primarily African Americans, across five measures of smoking behavior. METHODS: Data were gathered from a 2006 survey of six secondary schools in a large urban area in the southeastern United States. Ordered logit analysis is employed to estimate race and menthol effects on cigarette consumption. RESULTS: African American youth smoke at lower rates than white adolescents; menthol smokers consume cigarettes at higher rates irrespective of race. Most importantly, there is a strong interaction effect with black menthol smokers demonstrating the highest levels of cigarette consumption. CONCLUSIONS: There is a need to provide adolescent and adult African Americans accurate information on the dangers of menthol cigarettes. Any proposed legislation should consider the special problems of menthol and its relationship to high cigarette consumption, especially for African American adolescents.

Prevalence of impaired driving behaviors in a diverse, rural, southern middle school.

Little research has been reported on the risky behaviors of pre-driving adolescents revolving around alcohol use, in particular impaired driving behaviors, which in general have been shown to be higher in rural areas. This study investigated the prevalence of drinking while driving and riding with a drinking driver among 290 middle school students in a Mississippi Delta area middle school. Just under half (45.3%) responded that at least once in the past 30 days they had ridden with a drinking driver and 17% indicated they had driven an automobile after drinking alcohol. The prevalence of underage drinking, driving under the influence of alcohol, and riding with a drinking driver among our sample of middle school students is alarming. This study shows alcohol-related driving behaviors are not solely performed by those who are legally licensed to drive, but simply by those who have access to vehicles. The authors recommend that prevention programs focusing on reducing the incidence of impaired driving should start in early adolescence.

Racial disparities in tobacco use and social influences in a rural southern middle school.

This study investigated racial differences of tobacco use and social exposure to tobacco products in a sample of middle school students. Questionnaires were administered in January 2005 to 290 students in a Mississippi Delta-area middle school. The participants were 51.0% female and 56.6% African American. Unadjusted odds ratios revealed that Caucasian students were statistically more likely than were African American students to (1) have ever tried smoking, (2) have ever been a daily smoker, (3) have smoked in the past 30 days, (4) live with someone who smokes, (5) have seen a parent or guardian smoke, and (6) have friends who smoke. In contrast, African Americans were more likely to report "no one is allowed to smoke" in their home. Caucasian females had the highest rates of smoking, as well as the highest exposure to social smoking behaviors. This study not only showed that Caucasians were indeed smoking more but also that African American adolescents do not have the same exposure to social smoking, particularly African American females. Of particular interest was why the differences eventually dissipate and smoking rates are virtually the same in adulthood. A greater understanding of the impact of exposure to tobacco use on an adolescent's own tobacco use is vital to prevention efforts, especially in regard to racial differences. Future research on youth tobacco prevention and cessation programs should focus on sociocultural and racial differences in the development of tobacco use in adolescents.