Oral digoxin effects on exercise performance, K+ regulation and skeletal muscle Na+ ,K+ -ATPase in healthy humans.

We investigated whether digoxin lowered muscle Na+ ,K+ -ATPase (NKA), impaired muscle performance and exacerbated exercise K+ disturbances. Ten healthy adults ingested digoxin (0.25 mg; DIG) or placebo (CON) for 14 days and performed quadriceps strength and fatiguability, finger flexion (FF, 105%peak-workrate , 3 × 1 min, fourth bout to fatigue) and leg cycling (LC, 10 min at 33% V O 2 peak ${\rm{V}}_{{{\rm{O}}}_{\rm{2}}{\rm{peak}}}$ and 67% V O 2 peak ${\rm{V}}_{{{\rm{O}}}_{\rm{2}}{\rm{peak}}}$ , 90% V O 2 peak ${\rm{V}}_{{{\rm{O}}}_{\rm{2}}{\rm{peak}}}$ to fatigue) trials using a double-blind, crossover, randomised, counter-balanced design. Arterial (a) and antecubital venous (v) blood was sampled (FF, LC) and muscle biopsied (LC, rest, 67% V O 2 peak ${\rm{V}}_{{{\rm{O}}}_{\rm{2}}{\rm{peak}}}$ , fatigue, 3 h after exercise). In DIG, in resting muscle, [3 H]-ouabain binding site content (OB-Fab ) was unchanged; however, bound-digoxin removal with Digibind revealed total ouabain binding (OB+Fab ) increased (8.2%, P = 0.047), indicating 7.6% NKA-digoxin occupancy. Quadriceps muscle strength declined in DIG (-4.3%, P = 0.010) but fatiguability was unchanged. During LC, in DIG (main effects), time to fatigue and [K+ ]a were unchanged, whilst [K+ ]v was lower (P = 0.042) and [K+ ]a-v greater (P = 0.004) than in CON; with exercise (main effects), muscle OB-Fab was increased at 67% V O 2 peak ${\rm{V}}_{{{\rm{O}}}_{\rm{2}}{\rm{peak}}}$ (per wet-weight, P = 0.005; per protein P = 0.001) and at fatigue (per protein, P = 0.003), whilst [K+ ]a , [K+ ]v and [K+ ]a-v were each increased at fatigue (P = 0.001). During FF, in DIG (main effects), time to fatigue, [K+ ]a , [K+ ]v and [K+ ]a-v were unchanged; with exercise (main effects), plasma [K+ ]a , [K+ ]v , [K+ ]a-v and muscle K+ efflux were all increased at fatigue (P = 0.001). Thus, muscle strength declined, but functional muscle NKA content was preserved during DIG, despite elevated plasma digoxin and muscle NKA-digoxin occupancy, with K+ disturbances and fatiguability unchanged. KEY POINTS: The Na+ ,K+ -ATPase (NKA) is vital in regulating skeletal muscle extracellular potassium concentration ([K+ ]), excitability and plasma [K+ ] and thereby also in modulating fatigue during intense contractions. NKA is inhibited by digoxin, which in cardiac patients lowers muscle functional NKA content ([3 H]-ouabain binding) and exacerbates K+ disturbances during exercise. In healthy adults, we found that digoxin at clinical levels surprisingly did not reduce functional muscle NKA content, whilst digoxin removal by Digibind antibody revealed an ∼8% increased muscle total NKA content. Accordingly, digoxin did not exacerbate arterial plasma [K+ ] disturbances or worsen fatigue during intense exercise, although quadriceps muscle strength was reduced. Thus, digoxin treatment in healthy participants elevated serum digoxin, but muscle functional NKA content was preserved, whilst K+ disturbances and fatigue with intense exercise were unchanged. This resilience to digoxin NKA inhibition is consistent with the importance of NKA in preserving K+ regulation and muscle function.

Intersections between Young Women's Racial/Ethnic Identities and Sexual Orientation on Rates of Sexual Violence and Substance Use.

BACKGROUND: Little is known about whether there are differences in rates of sexual violence and its association with substance use based on women's identities, specifically the intersection of their race/ethnicity and sexual orientation. METHOD: Women (N = 546; 18 to 29 years of age) recruited from a reproductive healthcare clinic reported their race, ethnicity, sexual orientation, sexual violence history and substance use. Five logistic regressions examined (a) rates of sexual violence, and (b) the strength of the associations between sexual violence and four substance use outcomes (heavy alcohol use, marijuana use, cigarette use, number of cigarettes used) based on sexual orientation. Subsequent logistic regressions examined race/ethnicity as a moderator of the associations between sexual orientation and (a) rates of sexual violence and (b) substance use. RESULTS: Most women surveyed were heterosexual (64%), and 35% of all women reported unwanted sex. Sexual minority women (SMW) reported higher rates of sexual violence and substance use than heterosexual women. Sexual violence was more strongly associated with heavy alcohol use, but not with marijuana or cigarette use, for SMW than heterosexual women. Rates of sexual violence varied based on the intersection of sexual orientation and race/ethnicity. Although SMW were more likely to report sexual violence than heterosexual women, this association was weaker for Black/Latinx women than for non-Hispanic White women (aOR = 0.39, 95%CI [0.18, 0.82]). Race/ethnicity did not moderate the strength of associations between sexual violence and substance use. CONCLUSIONS: SMW exhibit increased risk for sexual violence and substance use, and victimization was associated with heavy alcohol use. Few racial/ethnic differences emerged as a function of sexual orientation, so SMW are a group with unique needs around sexual violence experiences and substance use, regardless of race/ethnicity. Healthcare providers should be aware of the link between substance use and prior victimization when treating SMW.

The impact of menthol flavoring in combusted tobacco on alternative product purchasing: A pilot study using the Experimental Tobacco Marketplace.

INTRODUCTION: Menthol cigarette smokers may switch to other combusted products like menthol little cigars and cigarillos (LCCs) or switch to non-combusted products like menthol vapes if menthol cigarettes are banned or otherwise restricted. This pilot study used a behavioral economics task to understand (a) menthol cigarette demand across a range of increasing prices in the context of available alternative products and (b) how the availability of menthol LCCs affected cigarette demand and alternative product substitution. METHODS: Menthol smokers completed the Experimental Tobacco Marketplace task during two sessions. Cigarettes, LCCs, smokeless tobacco, vapes, and medicinal nicotine were available from an online store. The price of menthol cigarettes increased across trials while the prices of the alternative products remained constant. Menthol LCCs were available in one session and excluded in the other. Cross-price elasticity beta estimates identified significant product substitutes. RESULTS: When menthol LCCs were available, increasing the price of menthol cigarettes led to substitution with non-menthol cigarettes (ß = 0.65, 95%CI = 0.34, 0.96), menthol little cigars (ß = 0.39, 95%CI = 0.08, 0.70), and menthol vapes (ß = 0.26, 95%CI = 0.16, 0.35). When menthol LCCs were not available, increasing the price of menthol cigarettes led to substitution with non-menthol cigarettes (ß = 0.59, 95% CI = 0.08, 1.11), non-menthol cigarillos (ß = 0.62, 95%CI = 0.19, 1.04), and menthol vapes (ß = 0.13, 95%CI = 0.08, 0.18). CONCLUSIONS: As the price of menthol cigarettes increased, demand for menthol cigarettes decreased and demand for combusted and non-combusted products increased, indicating significant substitution for menthol cigarettes. Policies targeting menthol combusted tobacco could result in some menthol smokers switching to non-combusted products like vaping devices.

Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic.

BACKGROUND: To describe sexual risk behavior, alcohol (and other substance) use, and perceived health promotion needs among young adult women seeking care from an urban reproductive health care clinic in the Northeastern United States, and to examine if these needs differ by race and ethnicity. METHODS: Women 18-29 years old presenting for a routine medical visit were invited to participate. Of 486 eligible women, 466 (96%) agreed to participate and completed a brief survey on a tablet computer. Most of the sample (53%) identified as non-Hispanic White. One-quarter (25%) identified as Hispanic/Latina. A smaller proportion of women identified as African American (19%). RESULTS: One-third (31%) of women reported a history of sexually transmitted infection (STI), and women reported infrequent condom use with recent sexual partners. Regarding behavioral health needs, nearly three-quarters of women (72%) reported regular alcohol use, approximately one-third had used marijuana (37%) or tobacco (33%) in the last month, and 19% reported clinically significant depressive symptoms in the last two weeks. Women reported moderate-to-strong interest in receiving information about relationships and sexual health; however, the majority were not interested in information about their substance use. Hispanic and African-American women were more likely to report STI history despite reporting fewer sexual partners than non-Hispanic White women. Minority women also reported significantly less alcohol and cigarette use, but more water pipe tobacco use, and reported significantly greater interest in interventions to promote sexual health. Hispanic women also evidenced significantly elevated rates of depressive symptoms, with 26% of Hispanic women reporting a clinically significant level of depressive symptoms. CONCLUSIONS: Reproductive health centers are opportune settings to address a broad range of healthcare needs, including sexual health, substance use, and mental health. These centers engage a diverse group of women, which is important given observed disparities in health outcomes based on race/ethnicity. Young women, particularly racial and ethnic minority women, report the most interest in services addressing sexual and relationship health.

Chemotherapy-Induced Peripheral Neuropathy in Long-term Survivors of Childhood Cancer: Clinical, Neurophysiological, Functional, and Patient-Reported Outcomes.

Importance: In light of the excellent long-term survival of childhood cancer patients, it is imperative to screen for factors affecting health, function, and quality of life in long-term survivors. Objective: To comprehensively assess chemotherapy-induced peripheral neuropathy in childhood cancer survivors to define disease burden and functional effect and to inform screening recommendations. Design, Setting, and Participants: In this cross-sectional observational study, cancer survivors who were treated with chemotherapy for extracranial malignancy before age 17 years were recruited consecutively between April 2015 and December 2016 from a single tertiary hospital-based comprehensive cancer survivorship clinic and compared with healthy age-matched controls. Investigators were blinded to the type of chemotherapy. A total of 169 patients met inclusion criteria, of whom 48 (28.4%) were unable to be contacted or declined participation. Exposures: Chemotherapy agents known to be toxic to peripheral nerves. Main Outcomes and Measures: The clinical peripheral neurological assessment using the Total Neuropathy Score was compared between recipients of different neurotoxic chemotherapy agents and control participants and was correlated with neurophysiological, functional, and patient-reported outcome measures. Results: Of the 121 childhood cancer survivors included in this study, 65 (53.7%) were male, and the cohort underwent neurotoxicity assessments at a median (range) age of 16 (7-47) years, a median (range) 8.5 (1.5-29) years after treatment completion. Vinca alkaloids and platinum compounds were the main neurotoxic agents. Clinical abnormalities consistent with peripheral neuropathy were common, seen in 53 of 100 participants (53.0%) treated with neurotoxic chemotherapy (mean Total Neuropathy Score increase, 2.1; 95% CI, 1.4-2.9; P < .001), and were associated with lower limb predominant sensory axonal neuropathy (mean amplitude reduction, 5.8 µV; 95% CI, 2.8-8.8; P < .001). Functional deficits were seen in manual dexterity, distal sensation, and balance. Patient-reported outcomes demonstrating reduction in global quality of life and physical functioning were associated with the Total Neuropathy Score. Cisplatin produced long-term neurotoxicity more frequently than vinca alkaloids. Conclusions and Relevance: Clinical abnormalities attributable to peripheral neuropathy were common in childhood cancer survivors and persisted long term, with concurrent deficits in patient-reported outcomes. Both the type of neurotoxic agent and a targeted clinical neurological assessment are important considerations when screening survivors for long-term neuropathy. Further development of peripheral neuropathy-specific pediatric assessment tools will aid research into neuroprotective and rehabilitative strategies.

The impact of social support and partner relationship dynamics on engagement in HIV care and antiretroviral treatment adherence among MSM in Latin America.

In Latin America (LA), HIV prevalence among MSM is estimated at thirty times greater than in the general male population. Little is known about the role of social support or disclosure status in relation to the HIV care continuum among LA MSM. Using multivariable logistic generalized estimation equations, we assessed the impact of social support satisfaction and disclosure status on engagement in HIV care, ART initiation, and ART adherence with data from an online, multinational sample of HIV infected MSM in Latin America (N = 2,350). 80.0% were engaged in HIV care, 71% initiated ART, and among those, 37% reported missing at least one dose in the past month. In multivariable models, compared to being very satisfied with social support, being somewhat satisfied (aOR = 0.73, 95% CI 0.56, 0.95) or somewhat dissatisfied (aOR = 0.83, 95% CI 0.70, 0.98) were associated with reduced odds of reporting 100% ART adherence. Disclosure of status was associated with a greater odds of HIV care engagement (OR = 1.63, 95% CI 1.28, 2.07) and ART initiation (OR = 1.55, 95% CI 1.30, 1.84). Greater satisfaction with social support and comfort disclosing HIV status to these sources were associated with improved engagement in HIV care and greater initiation of ART among MSM in LA.

Examining residence status as a risk factor for health risk behaviors among college students.

OBJECTIVE: The current study is aimed to evaluate college student residence as a unique risk factor for a range of negative health behaviors. PARTICIPANTS: We examined data from 63,555 students (66% females) from 157 campuses who completed the National College Health Assessment Survey in Spring 2011. METHODS: Participants answered questions about the frequency of recent use of alcohol, tobacco, marijuana, and illicit drugs, as well as sexual risk behavior in the last 30 days. Sexual risk behaviors were operationalized as having unprotected vaginal sex (yes/no) and the number of sexual partners. RESULTS: Logistic regression analyses revealed that living off-campus is a unique predictor of alcohol, tobacco, marijuana, and illicit drug use, as well as engaging in unprotected sex and a greater number of sexual partners (all ps <. 01). CONCLUSIONS: Students living off-campus exhibit more substance use and sexual risk behaviors than students living on-campus, independent of gender, age, or race.

Gender Differences in Relations among Perceived Family Characteristics and Risky Health Behaviors in Urban Adolescents.

BACKGROUND: Research regarding the role of gender in relations between family characteristics and health risk behaviors has been limited. PURPOSE: This study aims to investigate gender differences in associations between family processes and risk-taking in adolescents. METHODS: Adolescents (N = 249; mean age = 14.5 years) starting their first year at an urban high school in the northeastern USA completed self-report measures that assessed family characteristics (i.e., parental monitoring, family social support, family conflict) and health behaviors (i.e., tobacco use, alcohol use, marijuana use, sex initiation) as part of a prospective, community-based study. Multivariate logistic regression models were used to investigate gender differences in associations between the family characteristics and health behaviors. RESULTS: Among males, higher levels of perceived parental monitoring were associated with lower odds of using tobacco and having ever engaged in sex. Among females, higher levels of perceived parental monitoring were associated with lower odds of marijuana use, alcohol use, and having ever engaged in sex. However, in contrast to males, among females (a) higher levels of perceived family social support were associated with lower odds of alcohol use and having ever engaged in sex and (b) higher levels of perceived family conflict were associated with higher odds of marijuana use and having ever engaged in sex. CONCLUSION: Family processes were more strongly related to health behaviors among adolescent females than adolescent males. Interventions that increase parental monitoring and family social support as well as decrease family conflict may help to protect against adolescent risk taking, especially for females.

A preliminary evaluation of a web-based intervention for college marijuana use.

Young adults in college have high rates of marijuana use, abuse, and dependence. Web-based interventions are increasingly popular, but their dissemination exceeds empirical support. One popular but understudied program is The Marijuana eCHECKUP TO GO (e-TOKE) for Universities & Colleges (San Diego State University Research Foundation, 2009). The aim of the present study was to evaluate its short-term effectiveness in changing marijuana involvement and perceived norms in undergraduates. Participants were 317 undergraduates (52% female, 78% White) who reported marijuana use within the month preceding baseline; each was randomly assigned to 1 of 4 conditions formed by crossing e-TOKE versus assessment only, with brief versus extensive baseline assessment (to assess assessment reactivity). Thus, 161 (51%) received eTOKE (77 with extended baseline, 84 with brief baseline), and 156 (49%) received assessment-only control (85 with extended baseline, 71 with brief baseline). 1 month later, all participants reported on marijuana use, problems, abuse and dependence symptoms, and norms. Assessment reactivity analyses yielded no significant differences by assessment condition. Individuals completing the e-TOKE program reported less extreme descriptive norms (ps < 0.01) but no decrease in marijuana use frequency, problems, abuse or dependence symptoms, or changes in injunctive norms (ps > 0.10). Thus, e-TOKE reduces perceptions of others' use, but this study did not provide evidence for its utility in changing personal use and problem indicators in the short-term. More research with longer follow-ups is indicated, given the possibility that descriptive norms could mediate behavior change.

Sexual hookups and adverse health outcomes: a longitudinal study of first-year college women.

"Hookups" are sexual encounters between partners who are not in a romantic relationship and do not expect commitment. We examined the associations between sexual hookup behavior and depression, sexual victimization (SV), and sexually transmitted infections (STIs) among first-year college women. In this longitudinal study, 483 women completed 13 monthly surveys assessing oral and vaginal sex with hookup and romantic partners, depression, SV, and self-reported STIs. Participants also provided biological specimens that were tested for STIs. During the study, 50% of participants reported hookup sex and 62% reported romantic sex. Covariates included previous levels of the outcome, alcohol use, impulsivity, sensation seeking, and romantic sex. Autoregressive cross-lagged models showed that, controlling for covariates, hookup behavior during college was correlated with depression, Bs = .21, ps < .05, and SV, Bs = .19, ps < .05. In addition, precollege hookup behavior predicted SV early in college, B = .62, p < .05. Hookup sex, OR 1.32, p < .05, and romantic sex, OR 1.19, p < .05, were associated with STIs. Overall, sexual hookup behavior among college women was positively correlated with experiencing depression, SV, and STIs, but the nature of these associations remains unclear, and hooking up did not predict future depression.

Do alcohol and marijuana use decrease the probability of condom use for college women?

Alcohol and marijuana use are thought to increase sexual risk taking, but event-level studies conflict in their findings and often depend on reports from a limited number of people or on a limited number of sexual events per person. With event-level data from 1,856 sexual intercourse events provided by 297 college women (M age = 18 years; 71% White), we used multilevel modeling to examine associations between alcohol and marijuana use and condom use as well as interactions involving sexual partner type and alcohol-sexual risk expectancies. Controlling for alternative contraception use, partner type, regular levels of substance use, impulsivity and sensation seeking, and demographics, women were no more or less likely to use condoms during events involving drinking or heavy episodic drinking than during those without drinking. However, for drinking events, there was a negative association between number of drinks consumed and condom use; in addition, women with stronger alcohol-sexual risk expectancies were marginally less likely to use condoms when drinking. Although there was no main effect of marijuana use on condom use, these data suggest marijuana use with established romantic partners may increase risk of unprotected sex. Intervention efforts should target expectancies and emphasize the dose-response relationship of drinks to condom use.

Hookah, cigarette, and marijuana use: a prospective study of smoking behaviors among first-year college women.

Better understanding of the temporal sequence of hookah, cigarette, and marijuana use will help to inform smoking prevention efforts. To address this gap in the literature, we assessed all three of these smoking behaviors in a sample of 424 first-year college women. Using a longitudinal design, we investigated whether hookah use predicts initiating/resuming cigarette and/or initiating marijuana use, and whether cigarette and/or marijuana use predicts initiating hookah use. Participants (67% White, M age = 18.1 years) completed nine monthly surveys. The initial (i.e., baseline) survey assessed demographics, sensation-seeking, impulsivity, and pre-college substance use. Follow-up surveys assessed past-month substance use; outcomes were initiating/resuming cigarette use, initiating marijuana use, and initiating hookah use during the first year of college. We controlled for sensation-seeking, impulsivity, binge drinking, and other smoking behaviors in our multivariate logistic regression models. The results showed that (a) pre-college hookah use predicted initiating/resuming cigarette use; (b) pre-college marijuana use predicted initiation of hookah tobacco smoking; and (c) pre-college cigarette use predicted neither hookah nor marijuana initiation. The findings highlight the co-occurrence of smoking behaviors as well as the need for bundling preventive interventions so that they address hookah, cigarette, and marijuana use.

Optimizing the scientific yield from a randomized controlled trial (RCT): evaluating two behavioral interventions and assessment reactivity with a single trial.

Randomized controlled trials (RCTs) remain the gold standard for evaluating intervention efficacy but are often costly. To optimize their scientific yield, RCTs can be designed to investigate multiple research questions. This paper describes an RCT that used a modified Solomon four-group design to simultaneously evaluate two, theoretically-guided, health promotion interventions as well as assessment reactivity. Recruited participants (N = 1010; 56% male; 69% African American) were randomly assigned to one of four conditions formed by crossing two intervention conditions (i.e., general health promotion vs. sexual risk reduction intervention) with two assessment conditions (i.e., general health vs. sexual health survey). After completing their assigned baseline assessment, participants received the assigned intervention, and returned for follow-ups at 3, 6, 9, and 12 months. In this report, we summarize baseline data, which show high levels of sexual risk behavior; alcohol, marijuana, and tobacco use; and fast food consumption. Sexual risk behaviors and substance use were correlated. Participants reported high satisfaction with both interventions but ratings for the sexual risk reduction intervention were higher. Planned follow-up sessions, and subsequent analyses, will assess changes in health behaviors including sexual risk behaviors. This study design demonstrates one way to optimize the scientific yield of an RCT.

Predictors of sexual hookups: a theory-based, prospective study of first-year college women.

Hooking up, or engaging in sexual interactions outside of committed relationships, has become increasingly common among college students. This study sought to identify predictors of sexual hookup behavior among first-year college women using a prospective longitudinal design. We used problem behavior theory (Jessor, 1991) as an organizing conceptual framework and examined risk and protective factors for hooking up from three domains: personality, behavior, and perceived environment. Participants (N = 483, 67 % White) completed an initial baseline survey that assessed risk and protective factors, and nine monthly follow-up surveys that assessed the number of hookups involving performing oral sex, receiving oral sex, and vaginal sex. Over the course of the school year, 20 % of women engaged in at least one hookup involving receiving oral sex, 25 % engaged in at least one hookup involving performing oral sex, and 25 % engaged in at least one hookup involving vaginal sex. Using two-part modeling with logistic and negative binomial regression, we identified predictors of hooking up. Risk factors for sexual hookups included hookup intentions, impulsivity, sensation-seeking, pre-college hookups, alcohol use, marijuana use, social comparison orientation, and situational triggers for hookups. Protective factors against sexual hookups included subjective religiosity, self-esteem, religious service attendance, and having married parents. Race/ethnicity, socioeconomic status, hookup attitudes, depression, cigarette smoking, academic achievement, injunctive norms, parental connectedness, and being in a romantic relationship were not consistent predictors of sexual hookups. Future research on hookups should consider the array of individual and social factors that influence this behavior.

Acceptability of sexually transmitted infection testing using self-collected vaginal swabs among college women.

OBJECTIVE: To assess the acceptability of sexually transmitted infection (STI) testing using self-collected vaginal swabs (SCVS) among college women. PARTICIPANTS: First-year female students (N=483). METHODS: Participants were offered free testing for 3 STIs using SCVS in April 2010 and later completed a survey regarding their testing decision and experiences. RESULTS: Sixty-four percent (n=310) accepted testing; of these, 98% found it easy or very easy to understand the SCVS instructions, and 93% found it easy or very easy to collect the specimen. Among the 36% who did not participate in testing, most had scheduling conflicts or did not perceive a risk for STIs; only 26% felt uncomfortable about the SCVS procedure. Among all women, SCVS was preferred over other STI testing methods. CONCLUSIONS: STI testing using SCVS was acceptable to the majority of college women and could increase the uptake of testing among sexually active college women.

Pros and cons: prospective predictors of marijuana use on a college campus.

Marijuana use on college campuses is prevalent and associated with high rates of abuse and dependence. The Marijuana Decisional Balance (MDB) scales measure perceived pros and cons toward marijuana use. Evidence supports reliability and concurrent validity of these scales, but the predictive validity has not yet been assessed. The current study evaluated the prospective predictive validity of pros and cons scales for marijuana use, as well as explored predictive validity for marijuana problem indicators. Secondary analyses included test-retest reliability and internal consistency, to provide additional evidence of psychometric properties. A total of 149 college students (57% recent marijuana users, 77% lifetime users) participated in a baseline survey, then completed a second survey one month later. All provided data on marijuana pros and cons, as well as use status in the past month. Users at each time point reported on use frequency, problems, and disorder symptoms. In the month between assessments, 55% of the students used marijuana. Both pros and cons subscales prospectively predicted use status in the subsequent month, but not use frequency. Pros prospectively predicted marijuana problems and dependence symptoms at follow-up, and remained a significant predictor of later dependence symptoms even after controlling for baseline dependence symptoms. In contrast, pros only marginally predicted abuse. Cons did not predict problems, abuse, or dependence symptoms. Pros and cons showed strong test-retest reliability (rs = 0.80-0.85) and internal consistency (alphas = 0.92-0.95). In a college sample, pros and cons of marijuana use demonstrated stability over one month, and prospectively predicted use. Pros may also have utility in predicting problems and dependence potential on college campuses.

Condom negotiation, HIV testing, and HIV risks among women from alcohol serving venues in Cape Town, South Africa.

BACKGROUND: Women in South Africa are at particularly high-risk for HIV infection and are dependent on their male partners' use of condoms for sexual risk reduction. However, many women are afraid to discuss condoms with male partners, placing them at higher risk of HIV infection. PURPOSE: To examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women. METHOD: Women (N = 1333) residing in a primarily Xhosa-speaking African township in Cape Town and attending informal alcohol-serving venues (shebeens) completed anonymous surveys. Logistic regression was used to test the hypothesis that fear of condom negotiation would be associated with increased risk for HIV. RESULTS: Compared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex. CONCLUSIONS: For women in South Africa, fear of condom negotiation is related to higher risk of HIV. HIV prevention efforts, including targeted HIV counseling and testing, must directly address gender issues.

Correcting exaggerated marijuana use norms among college abstainers: a preliminary test of a preventive intervention.

OBJECTIVE: College students have high rates of marijuana initiation and use, and they report exaggerated perceptions of peers' use. Computerized norm-correcting intervention programs have been developed, but minimal efficacy research has been conducted, especially with regard to preventing the onset of marijuana use. The purpose of this pilot study was to evaluate the efficacy of the Marijuana eCHECKUP TO GO (e-TOKE) for Universities & Colleges program in (a) correcting descriptive norms, (b) correcting injunctive norms, and (c) preventing initiation of marijuana use in a group of college-age abstainers. METHOD: Participants were 245 college students (73% female) recruited from psychology courses for course credit who reported no marijuana use in the past month at baseline. Participants were randomized to receive the e-TOKE program or assessment only. All participants reported on marijuana use, descriptive norms, and injunctive norms 1 month later. RESULTS: Participants receiving the e-TOKE program estimated lower descriptive norms than the control group (p < .01), and fewer believed friends disapproved of their choice to abstain (p < .05). However, rates of use/initiation did not differ between the two conditions (p = .18). CONCLUSIONS: The current study provides preliminary evidence for the utility of the e-TOKE program in correcting abstainers' misperceptions about others' marijuana use as well as making them perceive less disapproval for their abstention. However, more research with longer follow-ups is necessary to determine if changes in norms affect initiation rates over time.

Predictors of initiation of hookah tobacco smoking: a one-year prospective study of first-year college women.

Hookah tobacco smoking has become increasingly prevalent among American college students over the past decade. Hookah smoking is associated with poor health outcomes and exposes users to high levels of nicotine, carbon monoxide, and smoke. Research on the correlates of hookah use has begun to emerge, but all studies thus far have been cross-sectional. Little is known about hookah use during the transition to college, psychosocial factors related to hookah smoking, or prospective predictors of hookah initiation and frequency of use. This longitudinal cohort study examined risk and protective factors predicting initiation of hookah tobacco smoking during the first year of college. First-year female college students (n = 483; 64% White) provided data on demographic, behavioral, and psychosocial variables and precollege hookah use at baseline; they then completed 12 monthly online surveys about their hookah use from September 2009 to August, 2010. Among the 343 participants who did not report precollege use, 79 (23%) initiated hookah tobacco smoking during the year after college entry. Zero-inflated negative binomial regression showed that alcohol use predicted the likelihood of initiating hookah use; impulsivity, social comparison orientation, and marijuana use predicted the frequency of hookah use. These findings suggest that hookah prevention and intervention efforts may need to address other forms of substance use as well as hookah use.

Prevalence, frequency, and initiation of hookah tobacco smoking among first-year female college students: a one-year longitudinal study.

Hookah tobacco smoking has become increasingly prevalent among college students, but little is known about frequency of use or patterns of use over time, including during the transition to college. The goals of this longitudinal cohort study were to assess the: (a) lifetime prevalence, (b) current prevalence, (c) frequency of use, and (d) pattern of initiation of hookah tobacco smoking among female students during the first year of college. First-year female college students (N=483) at a large private university in upstate New York completed 13 monthly online surveys about their hookah tobacco use from August 2009 to August 2010. Lifetime prevalence of hookah use increased from 29% at college entry to 45% at one-year follow-up. The highest rates of hookah initiation occurred in the first two months of students' first semester of college. Current (past 30 days) hookah use ranged from 5% to 13% during the year after college entry. On average, hookah users reported smoking hookah two days per month. Hookah tobacco use is common among female college students. The transition to college is a vulnerable time for hookah initiation. Preventive efforts should begin in high school and continue through college, with a focus on students' first few months on campus.