Alcohol Use Disorder Symptoms Rather than Alcohol Exposure Predict Experiences of Cannabis Use Disorder Symptoms among Adolescents and Young Adults.

Background: Alcohol and cannabis use are highly comorbid. Objective: We evaluate if alcohol use and/or alcohol use disorder symptoms predict experiences of cannabis use disorder symptoms among adolescents and young adults and whether the relationships differ based on frequency of cannabis use, recency of cannabis initiation and age. Method: Data were drawn from five annual surveys of the National Survey on Drug Use and Health (2014-2018) to include adolescents and young adults (age 12 to 21 years) who reported using cannabis and alcohol at least once in the past 30 days. Results: Number of alcohol use disorder symptoms, over and above alcohol quantity or frequency, was positively associated with each of the cannabis use disorder symptoms as well as the total number of cannabis use disorder symptoms endorsed. The association between alcohol and cannabis use disorder symptoms was stronger among those who were younger and those who initiated cannabis use within the past 2 years. Conclusions: Treatment should consider these and other cross-over effects of substance disorder symptoms when addressing risk for chronic and dependent use.

Behavioral symptoms of eating disorders among adopted adolescents and young adults in the United States: Findings from the Add Health survey.

OBJECTIVE: More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating-disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals. METHOD: We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self-induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis. RESULTS: Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (ps < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (ps < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms. DISCUSSION: This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.

The Interpretation of Statistical Power after the Data have been Gathered.

Post-hoc power estimates (power calculated for hypothesis tests after performing them) are sometimes requested by reviewers in an attempt to promote more rigorous designs. However, they should never be requested or reported because they have been shown to be logically invalid and practically misleading. We review the problems associated with post-hoc power, particularly the fact that the resulting calculated power is a monotone function of the p-value and therefore contains no additional helpful information. We then discuss some situations that seem at first to call for post-hoc power analysis, such as attempts to decide on the practical implications of a null finding, or attempts to determine whether the sample size of a secondary data analysis is adequate for a proposed analysis, and consider possible approaches to achieving these goals. We make recommendations for practice in situations in which clear recommendations can be made, and point out other situations where further methodological research and discussion are required.

Integrative Data Analysis of Gender and Ethnic Measurement Invariance in Nicotine Dependence Symptoms.

Little research has evaluated whether conflicting evidence for gender and racial/ethnic differences in nicotine dependence (ND) may be attributed to differences in psychometric properties of ND symptoms, particularly for young Hispanic smokers. Inadequate racial/ethnic diversity and limited smoking exposure variability has hampered research in young smokers. We used integrative data analysis (IDA) to pool DSM-IV ND symptom data for current smokers aged 12-25 (N = 20,328) from three nationally representative surveys (1999, 2000 National Surveys on Drug Use and Health (NSDUH) and Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Moderated nonlinear factor analysis (MNLFA) tested symptom measurement invariance in the pooled sample containing greater ethnic and smoking exposure variability. There was study noninvariance for most symptoms. NESARC participants were more likely to report tolerance, using larger amounts or for longer periods, inability to cut down/quit, and more time spent smoking at higher levels of ND severity, but reported emotional/physical health problems at lower ND severity. Four symptoms showed gender or race/ethnicity noninvariance, but observed differences were small. An ND severity factor score adjusting for symptom noninvariance related to study membership, gender, and race/ethnicity did not differ substantively from traditional DSM-IV diagnosis and number of endorsed symptoms in estimated gender and race/ethnicity differences in ND. Results were consistent with studies finding minimal gender and racial/ethnic differences in ND, and suggest that symptom noninvariance is not a major contributor to observed differences. Results support IDA as a potentially promising approach for testing novel ND hypotheses not possible in independent studies.

Exploring alternate processes contributing to the association between maternal smoking and the smoking behavior among young adult offspring.

INTRODUCTION: Maternal smoking during pregnancy (MSP) is a known risk factor for regular smoking in young adulthood and may pose a risk independently of mother's lifetime smoking. The processes through which MSP exerts this influence are unknown but may occur through greater smoking quantity and frequency following initiation early in adolescence or increased sensitivity to nicotine dependence (ND) at low levels of smoking. METHODS: This study used path analysis to investigate adolescent smoking quantity, smoking frequency, and ND as potential simultaneous mediating pathways through which MSP and mother's lifetime smoking (whether she has ever smoked) increase the risk of smoking in young adulthood among experimenters (at baseline, <100 cigarettes/lifetime) and current smokers (>100 cigarettes/lifetime). RESULTS: For experimenters, MSP was directly associated with more frequent young adult smoking and was not mediated by adolescent smoking behavior or ND. Independently of MSP, the effect of mother's lifetime smoking was fully mediated through frequent smoking and was heightened ND during adolescence. Controlling for MSP eliminated a previously observed direct association between mother's lifetime smoking and future smoking among experimenters. For current smokers, only prior smoking behavior was associated with future smoking frequency. CONCLUSIONS: These results seem to rule out sensitivity to ND and increased smoking behavior as contributing pathways of MSP. Further, the impact of MSP on young adult smoking extends beyond that of having an ever-smoking mother. Future work should test other possible mediators; for example, MSP-related epigenetic changes or gene variants influencing the brain's nicotine response.

The natural course of nicotine dependence symptoms among adolescent smokers.

INTRODUCTION: Few studies have investigated the natural course of nicotine dependence prospectively from the earliest experiences with smoking. METHODS: Drawing on a cohort of 9th- and 10th-grade adolescents followed over 48 months, survival analyses were conducted to evaluate the cumulative probability, following smoking initiation, for the development of nicotine dependence symptoms. RESULTS: Although each nicotine dependence symptom was significantly more prevalent among adolescents who had smoked more than 100 cigarettes by the end of the follow-up assessment, 20% of adolescents smoking fewer than 100 cigarettes reported experiencing "smoking to relieve restlessness and irritability" and "smoking a lot more now to be satisfied compared to when first smoked." Nicotine dependence symptoms were also reported before reaching 100 cigarettes for a substantial number of adolescents (between 9.4% and 58.8% for individual symptoms). Endorsement of nicotine dependence symptoms prospectively predicted past-week smoking (odds ratios [ORs] between 3.18 and 14.62 for significant symptoms) and past-month daily smoking (significant symptoms' ORs between 3.52 and 10.68) at the 48-month assessment even when controlling for amount of previous smoking. CONCLUSIONS: The present study adds to the growing body of literature on the natural course of nicotine dependence from earliest experiences with smoking by showing that symptoms of nicotine dependence may develop soon after initiation and/or at low levels of smoking. Our findings suggest that novice adolescent smokers should not be neglected in smoking cessation intervention and that screening and effective intervention for early emerging symptoms among adolescent smokers may be an important target in preventing chronic smoking.

Trends in U.S. Depression Prevalence From 2015 to 2020: The Widening Treatment Gap.

INTRODUCTION: Major depression is a common and potentially lethal condition. Early data suggest that the population-level burden of depression has been exacerbated by the COVID-19 pandemic. Prepandemic estimates of depression prevalence are required to quantify and comprehensively address the pandemic's impact on mental health in the U.S. METHODS: Data were drawn from the 2015-2020 National Survey on Drug Use and Health, a nationally representative study of U.S. individuals aged ≥12 years. The prevalence of past-year depression and help seeking for depression were estimated from 2015 to 2019, and time trends were tested with Poisson regression with robust SEs. Point estimates were calculated for 2020 and not included in statistical trend analyses because of differences in data collection procedures. RESULTS: In 2020, 9.2% (SE=0.31) of Americans aged ≥12 years experienced a past-year major depressive episode. Depression was more common among young adults aged 18-25 years (17.2%, SE=0.78), followed closely by adolescents aged 12-17 years (16.9%, SE=0.84). Depression increased most rapidly among adolescents and young adults and increased among nearly all sex, racial/ethnic, income, and education groups. Depression prevalence did not change among adults aged ≥35 years, and the prevalence of help seeking remained consistently low across the study period. CONCLUSIONS: From 2015 to 2019, there were widespread increases in depression without commensurate increases in treatment, and in 2020, past 12‒month depression was prevalent among nearly 1 in 10 Americans and almost 1 in 5 adolescents and young adults. Decisive action involving a multipronged public health campaign that includes evidence-based prevention and intervention to address this ongoing mental health crisis is urgently needed.

DSM-IV nicotine dependence symptom characteristics for recent-onset smokers.

INTRODUCTION: This study evaluated how well DSM-IV nicotine dependence symptoms measure an underlying dependence construct for recent-onset daily and nondaily smokers. METHODS: Based on a nationally representative sample of 2,758 recent-onset adolescent smokers from the National Surveys on Drug Use and Health, we used multiple group item response theory analysis to assess 7 symptoms representing DSM-IV diagnostic features of nicotine dependence. RESULTS: After controlling for age, gender, current smoking quantity, and length of smoking exposure, all 7 DSM-IV symptoms were invariant across nondaily and daily smokers and discriminated well among levels of the nicotine dependence construct. Symptoms most likely to be endorsed at lower levels of the dependence construct included spending more time getting, using, or getting over the effects of smoking and wanting or trying to stop or cut down. Symptoms most likely to be endorsed only at higher levels of the construct included giving up important activities and emotional/psychological and health problems related to smoking. DSM-IV symptoms were most precise for moderately high levels of the dependence construct and less precise for lower levels for both nondaily and daily smokers. DISCUSSION: DSM-IV nicotine dependence symptoms appear to have desirable psychometric properties for measuring a nicotine dependence construct among recent-onset adolescent smokers at both daily and nondaily levels, providing justification for the use of these symptoms in a measure that aims to evaluate the full continuum of nicotine dependence severity in this population.

Trajectories of smoking from adolescence to early adulthood and their psychosocial risk factors.

OBJECTIVE: To explore patterns of persistence and change in smoking behavior as well as risk factors associated with the developmental course of smoking from age 13 to 25. DESIGN: Data from the public use sample of the National Longitudinal Study of Adolescent Health (N = 5,789) were analyzed using semiparametric group-based modeling. MAIN OUTCOME MEASURES: Smoking quantity-frequency in the past 30 days. RESULTS: Six distinct smoking trajectories were identified: nonsmokers, experimenters, stable light smokers, quitters, late escalators, and stable high smokers. Baseline risk factors that were associated with greater likelihood of membership in all of the smoking trajectory groups compared with nonsmokers included alcohol use, deviance, peer smoking, and (with the exception of the late escalators) drug use. Deviance, peer smoking, and alcohol and drug use also distinguished the likelihood of membership among several of the 5 smoking trajectory groups. CONCLUSION: The results add to basic etiologic research on developmental pathways of smoking in adolescence and young adulthood by providing evidence of heterogeneity in smoking behavior and prospectively linking different patterns of risk factors with the probability of trajectory group membership.

Risk and protective factors associated with trajectories of depressed mood from adolescence to early adulthood.

This study used semi-parametric group-based modeling to explore unconditional and conditional trajectories of self-reported depressed mood from ages 12 to 25 years. Drawing on data from the National Longitudinal Study of Adolescent Health (N = 11,559), 4 distinct trajectories were identified: no depressed mood, stable low depressed mood, early high declining depressed mood, and late escalating depressed mood. Baseline risk factors associated with greater likelihood of membership in depressed mood trajectory groups compared with the no depressed mood group included being female, Black or African American, Hispanic or Latino American, or Pacific Islander or Asian American; having lower socioeconomic status; using alcohol, tobacco, or other drugs on a weekly basis; and engaging in delinquent behavior. Baseline protective factors associated with greater likelihood of membership in the no depressed mood group compared with the depressed mood trajectory groups included 2-parent family structure; feeling connected to parents, peers, or school; and self-esteem. With the exception of delinquent behavior, risk and protective factors also distinguished the likelihood of membership among several of the 3 depressed mood groups. The results add to basic etiologic research regarding developmental pathways of depressed mood in adolescence and young adulthood.

Disordered eating and substance use in high-school students: results from the Youth Risk Behavior Surveillance System.

OBJECTIVE: To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample. METHOD: Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System. RESULTS: Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed. CONCLUSION: Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Ethnic differences in weight control practices among U.S. adolescents from 1995 to 2005.

OBJECTIVE: To examine trends in weight control practices from 1995 to 2005. METHOD: The Youth Risk Behavior Surveillance System biennially assesses five weight control behaviors among nationally representative samples of United States high school students. RESULTS: Across time, more females than males dieted (53.8% vs. 23.8%), used diet products (10% vs. 4.3%), purged (7.5% vs. 2.7%), exercised (66.5% vs. 46.9%), or vigorously exercised (42.8% vs. 36.8%). All weight control behaviors among males increased during the decade. Black females were less likely than Hispanic females, who were less likely than White females, to practice weight control. White males were less likely than Black males, who were less likely than Hispanic males, to practice weight control. The ethnic difference in weight control practices is consistent across time. CONCLUSION: All male adolescents are at increasing risk for developing eating disorder symptomatology, and Black females appear to continue to resist pressure to pursue thinness.

Socioeconomic Disparities in Smoking Among U.S. Adults With Depression, 2005-2014.

INTRODUCTION: The purpose of this study is to estimate changes in the cigarette smoking prevalence among U.S. adults with and without depression from 2005 to 2014 by income and education level and overall. METHODS: This study examined data from adult respondents (aged ≥18 years) in the National Survey on Drug Use and Health, an annual cross-sectional study of U.S. individuals. Data from the years 2005 to 2014 were analyzed for a total analytic sample of n=378,733. The prevalence of past-month cigarette smoking was examined annually from 2005 to 2014 among adults with and without past-year major depression, overall and by income/education, using linear trend analyses. Data analysis occurred in 2017. RESULTS: The prevalence of smoking declined significantly from 2005 to 2014 among those with depression (37.62% to 34.01%; p<0.001) and without depression (23.99% to 19.87%; p<0.001). Yet, smoking remained nearly twice as common among those with depression during this period. Among adults with depression in the lowest income and education groups, the prevalence of smoking was more than double the prevalence of smoking among adults with depression in the highest income and education groups. CONCLUSIONS: Disparities in smoking prevalence are pronounced when depression and SES are considered simultaneously. Targeted public health and clinical efforts to reduce smoking among adult smokers of lower SES with depression are needed.

The absence of DSM-IV nicotine dependence in moderate-to-heavy daily smokers.

BACKGROUND: Current theoretical models of nicotine dependence assume a close relationship between use and dependence; however, previous data suggest that many daily smokers fail to develop nicotine dependence. OBJECTIVES: To determine what percentage of daily smokers fail to meet DSM-IV criteria for nicotine dependence within their lifetime, how non-dependence relates to duration and quantity of cigarette use, and whether other tobacco use and/or specific dependence criteria differentiate never-dependent and dependent smokers. METHODS: Cross-sectional data collected via personal interview from a nationally representative sample of 8213 past year daily smokers were analyzed. RESULTS: Approximately 39.4% of daily smokers never reached nicotine dependence. While the probability of remaining non-dependent decreased with smoking quantity and duration since the onset of daily smoking, a substantial portion of individuals (37.7%) who reported smoking >or=10 cigarettes per day and began smoking daily >or=10 years prior, remained never nicotine dependent. CONCLUSIONS: The absence of nicotine dependence in heavy daily smokers may result from limitations in the measurement of dependence and/or nicotine exposure. Alternatively, some individuals may be relatively resistant to becoming nicotine dependent despite extensive use. The latter explanation would have important implications for understanding the nature of nicotine dependence.

Testing the dual pathway hypothesis to substance use in adolescence and young adulthood.

BACKGROUND: We tested the dual pathway hypothesis to substance use which posits that substance use can develop via internalizing symptoms or deviant behaviors. METHOD: Using data from the Add Health study, we used latent class analysis to define subgroups based on patterns of substance use, and logistic regression procedures to evaluate the prospective association between symptoms of depression, deviance, and the individual substance use patterns. RESULTS: Groups representing similar patterns of substance use were identified in both adolescence and young adulthood. Some support for the dual pathway hypothesis was demonstrated. Deviance was prospectively associated with substance group assignment in both adolescence and young adulthood, while depression uniquely predicted assignment to the smoking group in young adulthood among females. CONCLUSIONS: Further testing of the dual pathway hypothesis should be built on diverse pattern-centered approaches able to explore the presence of population subgroups.

The association between cigarette smoking and DSM-IV nicotine dependence among first year college students.

AIMS: This study was undertaken to evaluate the association between cigarette smoking behavior and DSM-IV nicotine dependence. DESIGN: Drawing on a sample of first year college students selected for representation across a continuum of smoking behavior, current DSM-IV nicotine dependence criteria were assessed among participants reporting any smoking in the preceding week on a web-based survey protocol. Logistic regression and receiver operator characteristic analyses were used to estimate the overall concordance between smoking and DSM-IV nicotine dependence. FINDINGS: Relationships were supported between both quantity and frequency of smoking in the past week and DSM-IV nicotine dependence showing higher prevalence of dependence at higher levels of use (p<0.05). While the highest prevalence of nicotine dependence was seen among those reporting the most frequent and heavy smoking, a substantial number of participants reporting daily and/or heavy smoking did not meet criteria for nicotine dependence. Conversely, nicotine dependence was seen among a subgroup of participants reporting relatively low levels of non-daily smoking. Diagnostic concordance was found to be moderate for both quantity and frequency and was not improved by combining information from these two indices. CONCLUSIONS: Aside from confirming DSM-IV nicotine dependence at relatively low levels of smoking, these results may be used to inform research aimed at identifying samples of nicotine dependent youth across the range of smoking levels.

Predictive validity of four nicotine dependence measures in a college sample.

BACKGROUND: The present study compared the predictive and incremental validity of four commonly used dependence measures (Diagnostic and Statistical Manual-IV [DSM-IV] nicotine dependence criteria, Fagerstrom Test for Nicotine Dependence [FTND], Hooked On Nicotine Checklist [HONC], Nicotine Dependence Syndrome Scale [NDSS]) in a first year college sample reporting light smoking patterns. METHODS: Nicotine dependence measures were administered at the end of the first semester and follow-up smoking behavior (i.e. continued smoking, quantity, frequency, and length of abstinence) was assessed at the end of the first and second academic years. RESULTS: Higher levels of dependence as measured by the HONC and DSM-IV predicted smoking behavior at both follow-up assessments. While higher scores on some of the NDSS factors predicted heavier smoking behavior during follow-up assessments, higher scores on other NDSS factors predicted lighter smoking behavior. The DSM-IV, NDSS-priority, and HONC measures provided some evidence for incremental validity. Higher dependence scores on all four measures were related to shorter lengths of smoking abstinence. CONCLUSIONS: The four dependence measures were differentially related to smoking behavior outcomes in a light smoking sample. These findings suggest that nicotine dependence can predict a variety of smoking behaviors in light smokers.

Association between parental and individual psychiatric/substance use disorders and smoking stages among Puerto Rican adolescents.

OBJECTIVE: To examine the associations between parental and individual psychiatric disorders and smoking stages among Puerto Rican youth from migrant and non-migrant families. METHOD: Analyses were conducted drawing on data collected as part of a migrant family study examining youth at high and low risk for substance use disorders based on the presence or absence of a parental history of substance abuse or dependence. Parents and their offspring were recruited in San Juan, Puerto Rico (n=450) and New Haven, CT, USA (n=350). RESULTS: Experimental smoking among adolescent offspring was associated with parent proband disorders. In contrast, regular smoking behavior, defined as at least weekly smoking for a month or more, and DSM-IV nicotine dependence were more strongly associated with the adolescents' own psychiatric disorders. With the exception of anxiety disorders, significant bivariate associations were shown between each psychiatric/substance use disorder and nicotine dependence. Once comorbidity was statistically controlled, only attention deficit hyperactivity disorder (ADHD), and alcohol and drug use disorders were significantly associated with nicotine dependence. After controlling for adolescents' psychiatric comorbidity, there was an association between parental disorders and both experimental and regular smoking in their adolescent offspring. CONCLUSIONS: By combining family and migrant research strategies within a single study, the present investigation was able to simultaneously examine familial, individual and sociocultural factors that may play a role in development and/or persistence of smoking behavior among Puerto Rican adolescents.

Progression of nicotine dependence, mood level, and mood variability in adolescent smokers.

Mood processes are theorized to play a role in the initiation and progression of smoking behavior. Available work using real-time assessments in samples of young smokers, including several reports from the Social and Emotional Contexts of Adolescent Smoking Patterns (SECASP) study, has indicated that smoking events acutely improve mood and that escalating smoking frequency may stabilize mood. However, prior analyses have not specifically evaluated within-person change in nicotine dependence, which is conceptually distinguishable from frequent smoking and may be associated with unique mood consequences. The current investigation addressed this question using data from 329 adolescent SECASP participants (9th or 10th grade at recruitment) who contributed mood reports via ecological momentary assessment in up to four 1-week bursts over the course of 24 months. Mixed-effects location scale analyses revealed that within-person increases in scores on the Nicotine Dependence Syndrome Scale were associated with elevations in negative mood level and increased variability of both positive and negative moods. These effects remained when within-person changes in smoking frequency were covaried and were not fully attributable to a subgroup of youth who rapidly escalated their smoking frequency over time. The findings indicate that adolescents tend to show increasing levels of positive mood states, decreasing levels of negative mood, and diminishing mood variability between ages 16 to 18, but progression of nicotine dependence may counteract some of these developmental gains. Emergence of withdrawal symptoms is a likely explanation for the adverse mood effects associated with dependence progression. (PsycINFO Database Record

Association between psychiatric disorders and smoking stages among Latino adolescents.

OBJECTIVE: We examined the prevalence of smoking behaviors and their association with psychiatric disorders within a representative sample of youth from Puerto Rico. METHOD: A complex sampling design was used and analyses were conducted to account for the unequal selection probability, stratification and clustering. All analyses were weighted back to the population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0 (DISC-IV). RESULTS: After controlling for other comorbidity, major depression and oppositional defiant disorder were significantly associated with nicotine dependence, rather than with lower levels of use. In contrast, conduct disorder was generally associated with lower levels of use rather than with nicotine dependence. As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. CONCLUSIONS: By examining psychiatric correlates of smoking stages within an island-wide sample of adolescents, the present study highlights those disorders that may play a role in the development and/or persistence of smoking behavior in Puerto Rico and further clarifies the appropriate targets for smoking intervention conducted in community settings.