Sexual Identity Differences in Tobacco (Re)Uptake: Testing Mediation by Internalizing and Externalizing Symptoms.

INTRODUCTION: Tobacco use among gay, lesbian, and bisexual individuals is disproportionately higher than among heterosexual individuals. Identifying the mechanisms behind these differences can inform prevention and cessation efforts aimed at advancing health equity. Internalizing and externalizing symptoms as mediators of tobacco (re)uptake among sexual minority individuals was examined. METHODS: Waves 4 and 5 of the Population Assessment of Tobacco and Health (2016-2019) study were analyzed in 2022. Adolescents aged ≥14 and adults years not using tobacco at Wave 4 (n=21,676) were included. Wave 4 sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or something else. Associations of sexual identity with (re)uptake of cigarette use, E-cigarette use, and polytobacco use at Wave 5 were assessed, along with possible mediation of these associations by Wave 4‒internalizing and ‒externalizing symptoms. RESULTS: Internalizing and externalizing symptoms predicted tobacco (re)uptake regardless of sexual identity, particularly for female individuals. Gay/lesbian females (AOR=2.26; 95% CI=1.14, 4.48) and bisexual females (AOR=1.36; 95% CI=1.06, 1.74) had greater odds of E-cigarette (re)uptake than heterosexual females. High internalizing and externalizing symptoms accounted for over one third of the difference in E-cigarette (re)uptake among bisexual compared with that among heterosexual females. Males who reported sexual identity as something-else had lower odds of cigarette (re)uptake than heterosexual males (AOR=0.19; 95% CI=0.06, 0.66); this association was not mediated by internalizing and externalizing symptoms. CONCLUSIONS: Internalizing and externalizing symptoms uniquely contribute to E-cigarette (re)uptake among bisexual females. Strategies that reduce sexual minority stressors and resulting psychological distress may help to reduce tobacco use disparities.

Trajectories of Prescription Drug Misuse Among US Adults From Ages 18 to 50 Years.

Importance: US adults born from 1965 to 1996 had high exposure to controlled medications, yet little is known about how this exposure has affected them over time. Prescription drug misuse (PDM) has increased among adults in the past 2 decades, with related increases in emergency department visits, overdoses, and deaths. Objectives: To identify 32-year PDM trajectories involving opioids, stimulants, and sedatives or tranquilizers and to examine associations between these PDM trajectories and substance use disorder (SUD) symptoms in adulthood as well as between baseline characteristics and PDM trajectories. Design, Setting, and Participants: This cohort study included 11 cohorts of adolescents who were followed up longitudinally from age 18 years (study start, 1976-1986) to age 50 years (2008-2018) in the Monitoring the Future (MTF) study, which included a national multistage random sample of US 12th grade students. Baseline surveys (modal age 18) were self-administered in classrooms. Ten follow-ups were conducted by mail. Data analysis was conducted from December 2020 to October 2021. Main Outcomes and Measures: Sociodemographic variables were measured at baseline. PDM and SUD symptoms were measured at baseline and every follow-up. Latent profile analysis (LPA) was used to create PDM trajectory profiles. Associations between these PDM trajectories, SUD symptoms, and baseline sociodemographic characteristics were examined. Results: The sample of 26 575 individuals was 50.8% (95% CI, 50.2%-51.4%) female and 79.3% (95% CI, 78.8%-79.8%) White. The baseline response rate ranged from 77% to 84%, and the 32-year retention rate was 53%. In adjusting for attrition, 45.7% (95% CI, 44.9%-46.4%) of the respondents reported past-year PDM at least once during the 32-year reporting period. Among those who reported PDM, the prevalence of poly-PDM was 40.3% (95% CI, 39.3%-41.3%). Based on LPA, the number of class-specific PDM trajectories ranged from 4 (prescription opioids) to 6 (prescription stimulants). For the class-combined analyses, we identified 8 PDM trajectories consisting of early peak trajectories (eg, age 18 years), later peak trajectories (eg, age 40 years), and a high-risk trajectory (eg, high frequency PDM at multiple ages). All PDM trajectories were associated with increased odds of developing SUD symptoms in middle adulthood, especially the later peak and high-risk trajectories compared with early peak trajectories (eg, peak at age 40 years: adjusted odds ratio [aOR], 5.17; 95% CI, 3.97-6.73; high-risk: aOR, 12.41; 95% CI, 8.47-18.24). Baseline characteristics associated with a high-risk trajectory were binge drinking (aOR, 1.69; 95% CI, 1.13-2.54), cigarette smoking (aOR, 2.30; 95% CI, 1.60-3.29), and marijuana use (aOR, 3.78; 95% CI, 2.38-6.01). More recent cohorts (eg, 1985-1986) had a higher risk of belonging to later peak PDM trajectories (ages 40 and 45 years) than the 1976-1978 cohort (age 40 years peak: aOR, 2.49; 95% CI, 1.69-3.68). Conclusions and Relevance: In this cohort study, adults with later peak PDM trajectories were at increased risk of SUD symptoms in middle adulthood. These findings suggest the need to screen for PDM and SUD from adolescence through middle adulthood.

Prescription Opioid Misuse in Older Adult Surgical Patients: Epidemiology, Prevention, and Clinical Implications.

ABSTRACT: The United States and many other developed nations are in the midst of an opioid crisis, with consequent pressure on prescribers to limit opioid prescribing and reduce prescription opioid misuse. This review addresses prescription opioid misuse for older adult surgical populations. We outline the epidemiology and risk factors for persistent opioid use and misuse in older adults undergoing surgery. We also address screening tools and prescription opioid misuse prevention among vulnerable older adult surgical patients (e.g., older adults with a history of an opioid use disorder), followed by clinical management and patient education recommendations. A significant plurality of older adults engaged in prescription opioid misuse obtain opioid medication for misuse from health providers. Thus, nurses can play a critical role in identifying those older adults at a higher risk for misuse and deliver quality care while balancing the need for adequate pain management against the risk for prescription opioid misuse.

Sexual orientation differences in childhood sexual abuse, suicide attempts, and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in the US.

BACKGROUND: Childhood sexual abuse (CSA) contributes to increased risk of substance use and mental health disorders in the general population. OBJECTIVE: To assess the prevalence and associations of CSA and suicide attempts, substance use, and mental health disorders as a function of sex (female, male) and sexual orientation (lesbian, gay, bisexual, heterosexual-identified with same-sex attraction and/or behavior, heterosexual-identified without same-sex attraction and/or behavior, and unsure). PARTICIPANTS AND SETTING: Data were collected using structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 US adults. METHODS: We used descriptive statistics and logistic regression modeling to analyze data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). RESULTS: Childhood sexual abuse was most prevalent among sexual minorities, especially bisexual females. Nearly one-third of bisexual females (30.6%) reported experiencing two or more types of CSA, p < .001. Among all participants, exposure to one or more types of CSA was associated with greater odds of lifetime suicide attempts, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol, tobacco or other drug use disorder, and mental health disorders, after adjusting for other childhood adversity/maltreatment and general life stressors. CONCLUSIONS: Sexual minority females and males in the US are more likely than their heterosexual counterparts to report CSA. Higher risk of suicide attempts and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in adulthood was directly associated with CSA, particularly among bisexual females. Health professionals working with individuals who have experienced CSA should assess these risks and intervene as needed.

School-Level Prevalence and Predictors of e-Cigarette Use in 8th, 10th, and 12th Grade U.S. Youth: Results From a National Survey (2015-2016).

PURPOSE: The aim of this study was to examine the school-level prevalence and predictors of e-cigarette use among U.S. adolescents. METHODS: The Monitoring the Future study is an annual national cross-sectional study of secondary (middle and high) school students. This study uses 2015 and 2016 survey data from 8th, 10th, and 12th grade students (n = 38,926) attending 580 U.S. public and private secondary schools. E-cigarette use, binge drinking, cigarette smoking, marijuana use, and nonmedical prescription drug use were measured at the individual level. School-level characteristics were measured with both aggregated student-level measures (e.g., school-level e-cigarette use, school-level racial composition) and school characteristics (e.g., public vs. private, urban vs. rural). RESULTS: The prevalence of past-month e-cigarette use varied considerably across 580 U.S. middle and high schools, ranging from 0% to 60% at individual schools (mean = 10.2%, standard deviation = 8.9%). Multivariable regression analyses indicated that past-month e-cigarette use was significantly higher at schools with a higher proportion of White students, schools that were located in the U.S. Southern and Western regions, and schools with higher prevalence of past-month cigarette smoking, after controlling for relevant individual- and school-level covariates. CONCLUSIONS: E-cigarette use varies considerably across schools, and this study suggests that school context plays an important role in e-cigarette use. Cigarette smoking and e-cigarette use at the school level are closely linked and are important risk factors for individual-level e-cigarette use. The wide variation in prevalence of e-cigarette use highlights the need for schools to work with professionals to obtain school-level assessment rather than relying solely on state or national results to guide prevention efforts.

Trends in E-Cigarette, Cigarette, Cigar, and Smokeless Tobacco Use Among US Adolescent Cohorts, 2014-2018.

Objectives. To examine changes in age of initiation of e-cigarette, cigarette, cigar, and smokeless tobacco use among adolescents in the United States.Methods. We used data from 5 cohorts of the National Youth Tobacco Survey (2014-2018; n = 26 662).Results. In 2014, 8.8% of lifetime e-cigarette users initiated use at 14 years or younger, as compared with 28.6% of lifetime e-cigarette users in 2018. There was no such change in initiation ages for cigarettes, cigars, and smokeless tobacco among lifetime users of each of these products.Conclusions. US adolescents are initiating e-cigarette use at younger ages in recent years. This is concerning given the association of e-cigarette use with subsequent cigarette use. Continued surveillance of these trends and additional prospective research are needed. Tobacco prevention programs, policies, and regulations that make it more difficult for youths to obtain e-cigarettes are warranted.

E-Cigarette Use, Polytobacco Use, and Longitudinal Changes in Tobacco and Substance Use Disorder Symptoms Among U.S. Adolescents.

PURPOSE: The objective of this study was to examine the combinations of e-cigarette use, cigarette use, and other tobacco use over time and the relationship these longitudinal use patterns have with symptoms of tobacco use disorder (TUD) and substance use disorders (SUDs) among a sample of adolescents. METHODS: Data from U.S. adolescents (aged 12-17 years) who were surveyed for the Population Assessment of Tobacco and Health Study at baseline, first follow-up, and second follow-up (2013-2014, 2014-2015, and 2015-2016; n = 7,595) was used to analyze symptoms of TUD and SUDs based on longitudinal combinations of tobacco/nicotine use. RESULTS: The most common combination of tobacco/nicotine use across the three waves was "no use of any tobacco/nicotine products" at baseline and first follow-up to "e-cigarette use only" at the second follow-up. Multivariable analyses found that past 30-day cigarette use and other tobacco use at the most recent follow-up was associated with an increase in both current TUD and SUD symptoms, whereas past 30-day e-cigarette use at the most recent follow-up was modestly associated with an increase in current SUD symptoms. CONCLUSIONS: Individuals who transitioned to e-cigarette use were at relatively low risk for increased TUD and SUD symptoms. However, individuals who transitioned or continually used cigarettes were typically at greater risk for indicating more TUD and SUD symptoms. Given the low risk of e-cigarette only users to indicate TUD and SUD symptoms, prevention efforts need to be made to target these youth before they transition to cigarettes and other types of tobacco use.

The epidemiology of prescription fentanyl misuse in the United States.

BACKGROUND: US opioid overdose deaths continue to climb, with a 12.0% increase from 2016 to 2017. Fentanyl, a synthetic opioid, has been a major contributor to opioid-related overdose deaths. While fentanyl-related overdose is driven by illicit fentanyl, little is known about individuals who misuse prescription fentanyl, which is also linked to elevated overdose and mortality risk. This work aimed to fill that gap through analyses of prescription fentanyl misuse correlates. METHODS: Data were from the 2015-16 National Survey on Drug Use and Health (N = 114,043), a nationally representative survey of the non-institutionalized US population. Respondents were (all past-year): those misusing prescription fentanyl (PF); those misusing other (non-fentanyl) prescription opioids (NFPO); and population controls. Respondent groups were compared using multinomial regression on sociodemographics, physical health, mental health and substance use. The PF and NFPO misuse groups were compared on opioid misuse characteristics, using logistic regression. RESULTS: An estimated 4.4% misused NFPO, and 0.1% misused PF (past-year). Past-year heroin use was more common in those who misused PF (44.3%) than those who misused other NFPO (4.4%; relative risk ratio [RRR] = 7.1, 95%CI = 3.7-13.9) or population controls (0.1%, RRR = 35.1, 95%CI = 17.3-71.1). Non-alcohol substance use disorder (SUD) was similarly elevated in those who misused PF (78.7%) versus the other NFPO group (27.5%, RRR = 3.8, 95%CI = 1.8-8.2) or population controls (1.6%, RRR = 20.6, 95%CI = 9.4-45.5). CONCLUSIONS: Respondents who misused prescription fentanyl were both more drug-involved generally and opioid-involved specifically; and likely need a combination of significant interventions and monitoring for their polysubstance use.

Initiation Sequence of E-Cigarette and Cigarette Smoking among US Adolescents: A National Study.

BACKGROUND AND OBJECTIVES: The primary objectives were to: (1) examine the initiation sequence of e-cigarette use and cigarette smoking; (2) assess other substance use as a function of the initiation sequence of e-cigarettes and cigarettes; and (3) investigate the role of early e-cigarette initiation among US secondary school students. METHODS: Data were collected via self-administered questionnaires from independent 2015 and 2016 nationally representative cross-sectional samples of 8th grade, 10th grade, and 12th grade students (N = 36 410). RESULTS: The lifetime initiation sequence included: (1) e-cigarette use before cigarette smoking (1.7%); (2) e-cigarette use and cigarette smoking in same grade (4.2%); (3) cigarette smoking before e-cigarette use (6.1%); (4) e-cigarette use only (12.6%); (5) cigarette smoking only (3.6%); and (6) no e-cigarette use or cigarette smoking (71.8%). The risk of substance use was highest among dual users (regardless of initiation sequence), followed by cigarette smokers, e-cigarette users, and no e-cigarette use or cigarette smoking. The most prevalent initiation sequence of e-cigarette use involved initiating other substances before e-cigarettes, especially among older adolescents. Early initiation of e-cigarette use was associated with increased odds of substance use behaviors for all three age groups. DISCUSSION AND CONCLUSIONS: Adolescents who report a history of both e-cigarette use and cigarette smoking should be considered at high risk for substance-related problems. Early initiation of e-cigarette use is a signal for other substance use. SCIENTIFIC SIGNIFICANCE: Youth substance use prevention programs and prospective studies must take into account polysubstance use when addressing the relationships between e-cigarette use and cigarette smoking. (Am J Addict 2019;28:285-294).

LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities.

OBJECTIVE: To compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities. METHODS: Secondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685). RESULTS: Rates of eligibility for low-dose helical computed tomography (LDCT) were roughly twice as high among sexual minorities than among heterosexuals (21.1% vs. 11.7%). The odds of gay men and lesbian women indicating eligibility for LDCT screening were four to five times higher when compared to their heterosexual peers. No statistically significant differences were found between sexual minorities and heterosexuals with respect to having a CT scan for lung cancer in the past year. CONCLUSIONS: There are potential sexual-identity-related disparities in the utilization of lung cancer screening among eligible smokers. Interventions are needed to increase awareness and uptake of lung cancer screening in order to detect and manage this common form of cancer in the U.S.

Associations Between Early Onset of E-cigarette Use and Cigarette Smoking and Other Substance Use Among US Adolescents: A National Study.

Introduction: This study examines the associations between early onset of e-cigarette use and cigarette smoking and other substance use behaviors among US adolescents. Methods: Data were collected via self-administered questionnaires from a nationally representative sample of 2299 US high school seniors attending public and private high schools during the spring of their senior year in 2015 as part of the Monitoring the Future study. Results: A higher percentage of adolescents who began using e-cigarettes in ninth grade or earlier (early onset) were found to report current and lifetime cigarette smoking and other substance use relative to those individuals who never used e-cigarettes or those who began using e-cigarettes later in the 12th grade. Multivariate logistic regression analyses indicated that the adjusted odds of alcohol use, cigarette smoking, marijuana use, nonmedical prescription drug use, and other illicit drug use among early onset e-cigarette users were significantly greater than those for individuals never having used e-cigarettes (adjusted odds ratios [AORs] ranged 9.5-70.6, p < .001). While these associations were significant for both experimental and frequent e-cigarette users, the effects of early onset were stronger among frequent e-cigarette users. Similarly, the odds of these substance use behaviors (except alcohol) among early onset e-cigarette users were also significantly greater than the odds for later onset e-cigarette users (AORs ranged 2.8-4.1, p < .05). Conclusions: Early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. E-cigarette use is often preceded by alcohol use, cigarette smoking, and marijuana use, suggesting that more long-term prospective studies are warranted. Implications: To date, no studies have examined the probability of cigarette smoking and other substance use behaviors as a function of age at onset of e-cigarette use. In the present study, early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. The findings reinforce the importance of addressing a wide range of substances including alcohol, traditional cigarettes, and marijuana when developing early primary prevention efforts to reduce e-cigarette use among youth.

Adolescent Sports Participation, E-cigarette Use, and Cigarette Smoking.

INTRODUCTION: Although sport participation among adolescents has been found to lower the risk of traditional cigarette smoking, no studies to date have assessed if this type of physical activity lowers the risk of e-cigarette use among adolescents. METHODS: National data from the 2014 and 2015 Monitoring the Future study of 12th-grade students were used and analyses were conducted in 2016. Measures for past 30-day e-cigarette use and traditional cigarette smoking were used to assess differences between adolescents who participated in at least one competitive sport during the past year and adolescents who did not. Differences in e-cigarette use and traditional cigarette smoking were assessed between 13 different sports to determine which sports were associated with a greater or lower risk of these behaviors. RESULTS: Adolescents who participated in at least one competitive sport were less likely to engage in past 30-day traditional cigarette smoking (AOR=0.73, 95% CI=0.538, 0.973) and past 30-day dual use of traditional cigarettes and e-cigarettes (AOR=0.66, 95% CI=0.438, 0.982) when compared with their nonparticipating peers. Adolescents who participated in baseball/softball and wrestling were at greatest risk of e-cigarette use. Of the 13 assessed sports, none were found to lower the odds of e-cigarette use. CONCLUSIONS: No significant evidence was found that participation in a sport was a protective factor against e-cigarette use. Certain types of athletes are at an elevated risk of e-cigarette use, and prevention efforts targeted at these specific sports should be considered by school administrators.

Smoking behaviors and intentions among current e-cigarette users, cigarette smokers, and dual users: A national survey of U.S. high school seniors.

E-cigarette use among adolescents has increased significantly in recent years, but it remains unclear whether cigarette smoking behaviors and intentions for future cigarette smoking differ among current (i.e., 30-day) non-users, only e-cigarette users, only cigarette smokers, and dual users. A nationally representative sample of 4385 U.S. high school seniors were surveyed during the spring of their senior year via self-administered questionnaires in 2014. An estimated 9.6% of U.S. high school seniors reported current e-cigarette use only, 6.3% reported current cigarette smoking only, and 7.2% reported current dual use of e-cigarettes and cigarette smoking. There were no significant differences between current only cigarette smokers and dual users in the odds of early onset of cigarette smoking, daily cigarette smoking, intentions for future cigarette smoking, friends' cigarette smoking behaviors, attempts to quit cigarette smoking, or the inability to quit cigarette smoking. Adolescents who only used e-cigarettes had higher odds of intentions for future cigarette smoking in the next 5years (AOR=2.57, 95% CI: 1.21-5.24) than current non-users. Dual users and only cigarette smokers had higher odds of cigarette smoking behaviors and intentions for future cigarette smoking than non-users or only e-cigarette users. Adolescents who engage in current dual use have cigarette smoking behaviors and intentions for future cigarette smoking that more closely resemble cigarette smokers than e-cigarette users. Adolescents who only use e-cigarettes have higher intentions to engage in future cigarette smoking relative to their peers who do not engage in e-cigarette use or cigarette smoking.