General and Specific Predictors of Comorbid Substance Use and Internalizing Problems from Adolescence to Age 33.

The current study examines the continuity in comorbidity between substance use and internalizing mental health problems from adolescence to adulthood and investigates the general and specific predictors of comorbidity across development. Participants were drawn from the Seattle Social Development Project (N = 808), a gender-balanced, ethnically diverse longitudinal panel. Structural equation modeling was used to examine risk factors for comorbid substance use and internalizing problems in family and peer social environments; substance use- and mental health-specific social environments (family tobacco, alcohol, and marijuana use; family history of depression); and individual risk factors (behavioral disinhibition). Latent factors were created for comorbid substance use and mental health problems at ages 13-14 and comorbidity of substance abuse and dependence symptoms and mental health disorder symptoms at ages 30-33 and included indicators of anxiety, depression, alcohol, tobacco, and marijuana problems. Comorbid problems in adolescence predicted later comorbidity of disorders in adulthood. In addition, family tobacco environment and behavioral disinhibition predicted adolescent comorbidity, while family history of depression was associated with adult comorbidity. Finally, family and peer substance use in adolescence predicted substance use (alcohol, tobacco, and marijuana) both in adolescence and adulthood. The pattern of results suggests that comorbidity in adolescence continues into adulthood and is predicted by both general and behavior-specific environmental experiences during adolescence. Findings clarify the etiology of comorbid internalizing and substance use problems and suggest potential preventive intervention targets in adolescence to curb the development of comorbidity in adulthood.

The association between regular marijuana use and adult mental health outcomes.

OBJECTIVE: The present study is a prospective examination of the relationship between regular marijuana use from adolescence through young adulthood and mental health outcomes at age 33. METHODS: Data came from a gender-balanced, ethnically diverse longitudinal panel of 808 participants from Seattle, Washington. Outcomes included symptom counts for six mental health disorders. Regular marijuana use was tracked during adolescence and young adulthood. Regression analyses controlled for demographics and early environment, behaviors, and individual risk factors. RESULTS: Nonusers of marijuana reported fewer symptoms of alcohol use disorder, nicotine dependence, and generalized anxiety disorder than any category of marijuana users. More persistent regular marijuana use in young adulthood was positively related to more symptoms of cannabis use disorder, alcohol use disorder, and nicotine dependence at age 33. CONCLUSIONS: Findings highlight the importance of avoiding regular marijuana use, especially chronic use in young adulthood. Comprehensive prevention and intervention efforts focusing on marijuana and other substance use might be particularly important in the context of recent legalization of recreational marijuana use in Washington and other U.S. states.

The Relationship Between Marijuana and Conventional Cigarette Smoking Behavior from Early Adolescence to Adulthood.

Longitudinal analyses investigated (a) the co-occurrence of marijuana use and conventional cigarette smoking within time and (b) bidirectional associations between marijuana and conventional cigarette use in three developmental periods: adolescence, young adulthood, and adulthood. A cross-lag model was used to examine the bidirectional model of marijuana and conventional cigarette smoking frequency from ages 13 to 33 years. The bidirectional model accounted for gender, school-age economic disadvantage, childhood attention problems, and race. Marijuana use and conventional cigarette smoking were associated within time in decreasing magnitude and increased cigarette smoking predicted increased marijuana use during adolescence. A reciprocal relationship was found in the transition from young adulthood to adulthood, such that increased conventional cigarette smoking at age 24 years uniquely predicted increased marijuana use at age 27 years, and increased marijuana use at age 24 years uniquely predicted more frequent conventional cigarette smoking at age 27 years, even after accounting for other factors. The association between marijuana and cigarette smoking was found to developmentally vary in the current study. Results suggest that conventional cigarette smoking prevention efforts in adolescence and young adulthood could potentially lower the public health impact of both conventional cigarette smoking and marijuana use. Findings point to the importance of universal conventional cigarette smoking prevention efforts among adolescents as a way to decrease later marijuana use and suggest that a prevention effort focused on young adults as they transition to adulthood would lower the use of both cigarette and marijuana use.

Marijuana Legalization and Parents' Attitudes, Use, and Parenting in Washington State.

PURPOSE: The recent legalization of nonmedical marijuana use in several U.S. states has unknown implications for those who are actively parenting. This study examined parents' reactions to marijuana legalization and changes in attitudes and behaviors over time. METHODS: Data were from a gender-balanced, ethnically diverse sample of 395 parents in Washington State who were participating in the longitudinal Seattle Social Development Project. Participants were interviewed 15 times between 1985 (age 10) and 2014 (age 39). Adult nonmedical marijuana use was legalized in Washington in 2012 and retail outlets opened in 2014. RESULTS: Results showed (1) one third of parents incorrectly believed the legal age of nonmedical marijuana use to be 18; (2) significant increase in approval of adult marijuana use and decrease in perceived harm of regular use; (3) wide opposition to teen use and use around one's children; and (4) substantial increases in frequency of use and marijuana use disorder among parents who used. CONCLUSIONS: Despite increased acceptance and frequency of adult use, parents remain widely opposed to teen use but need facts and strategies for talking with their children about marijuana.

The Relationship between Interpersonal Violence Victimization and Smoking Behavior across Time and by Gender.

The current study examined relationships between interpersonal violence victimization and smoking from childhood to adulthood. Data were from a community-based longitudinal study (N = 808) spanning ages 10 - 33. Cross-lag path analysis was used to model concurrent, directional, and reciprocal effects. Results indicate that childhood physical abuse predicted smoking and partner violence in young adulthood; partner violence and smoking were reciprocally related in the transition from young-adulthood to adulthood. Gender differences in this relationship were not detected. Social work prevention efforts focused on interpersonal violence and interventions targeting smoking cessation may be critical factors for reducing both issues.

Association of serum intact parathyroid hormone with lower estimated glomerular filtration rate.

BACKGROUND AND OBJECTIVES: The prevalence of mineral metabolism abnormalities is almost universal in stage 5 chronic kidney disease (CKD), but the presence of abnormalities in milder CKD is not well characterized. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data on adults > or =20 yr of age from the National Health and Nutrition Examination Survey 2003-2004 (N = 3949) were analyzed to determine the association between moderate declines in estimated GFR (eGFR), calculated using the Modfication of Diet in Renal Disease formula, and serum intact parathyroid hormone (iPTH) > or = 70 pg/ml. RESULTS: The geometric mean iPTH level was 39.3 pg/ml. The age-standardized prevalence of elevated iPTH was 8.2%, 19.3%, and 38.3% for participants with eGFR > or = 60, 45 to 59, and 30 to 44 ml/min/1.73 m(2), respectively (P-trend < 0.001). After adjustment for age; race/ethnicity; sex; menopausal status; education; income; cigarette smoking; alcohol consumption; body mass index; hypertension; diabetes mellitus; vitamin D supplement use; total calorie and calcium intake; and serum calcium, phosphorus, and 25-hydroxyvitamin D levels-and compared with their counterparts with an eGFR > or = 60 ml/min/1.73 m(2)-the prevalence ratios of elevated iPTH were 2.30 and 4.69 for participants with an eGFR of 45 to 59 and 30 to 44 ml/min/1.73 m(2), respectively (P-trend < 0.001). Serum phosphorus > or = 4.2 mg/dl and 25-hydroxyvitamin D < 17.6 ng/ml were more common at lower eGFR levels. No association was present between lower eGFR and serum calcium < 9.4 mg/dl. CONCLUSIONS: This study indicates that elevated iPTH levels are common among patients with moderate CKD.

Parathyroid hormone status does not influence blood and bone lead levels in dialysis patients.

Elevated blood lead levels, a risk factor for cardiovascular disease, have been reported among patients with end-stage renal disease. We evaluated whether these higher levels are due to release of lead from the skeleton because of uremic bone disease. Fifty-one African-American patients with end-stage renal disease were recruited from 3 Tulane University dialysis programs between January and July 2005. An interviewer-administered questionnaire, blood specimen collection and 109Cd-based x-ray fluorescence measurement of tibia lead occurred during a single study visit. Levels of serum parathyroid hormone (PTH), calcium, phosphorus, and albumin were abstracted from the patients' charts. The distributions of tibia and blood lead were similar across levels of serum PTH. Specifically, for participants with serum PTH <300 pg/mL and > or =300 pg/mL, median tibia lead was 21 microg/g and 17 microg/g, respectively, and geometric mean blood lead levels were 6.7 microg/dL and 6.6 microg/dL, respectively (P = 0.70 and 0.87, respectively). After adjustment for age, gender, education, cigarette smoking, and dialysis vintage, natural log transformed blood lead was 0.022 lower in patients with serum PTH > or =300 pg/mL (P = 0.87). There were no differences in tibia and blood lead across levels of serum calcium, serum phosphorus, and the calcium phosphorus product (all P > 0.40). The high blood lead levels observed among dialysis patients do not appear to be the result of increased bone turnover. The causes of higher blood lead levels for these patients need to be identified and attenuated.

Comparison of percent of United States adults weighing>or=300 pounds (136 kilograms) in three time periods and comparison of five atherosclerotic risk factors for those weighing>or=300 pounds to those<300 pounds.

The radiologic tables used for many imaging procedures have maximum weight limits. Many United States (US) adults may have a body weight that exceeds these limits and may be ineligible for diagnostic imaging procedures. Using data from the National Health and Nutrition Examination Surveys in 1976 to 1980, 1988 to 1994, and 1999 to 2004, we determined the increase in the percentage and number of US adults weighing>or=300 pounds (i.e., the weight limit for an electron beam computed tomography table). In addition, the prevalence and clustering of 5 cardiovascular disease risk factors (current smoking, hypertension, diabetes mellitus, low high-density lipoprotein cholesterol, and elevated C-reactive protein) was determined for US adults weighing>or=300 pounds, and compared with their counterparts weighing<300 pounds. The percentage of US adults, >or=20 years, weighing>or=300 pounds was 0.10%, 0.79%, and 1.50% in 1976 to 1980, 1988 to 1994, and 1999 to 2004, respectively (p trend<0.001). This corresponds to an increase from 130,000 US adults weighing>or=300 pounds in 1976 to 1980, to 1,390,000 in 1988 to 1994 and 3,020,000 in 1999 to 2004 (p trend<0.001). After age standardization, in 1999 to 2004, 34.1% and 24.0% of adults weighing>or=300 pounds had 2 and >or=3, respectively, of the 5 cardiovascular disease risk factors, compared with 17.7% and 5.3%, respectively, of adults weighing<300 pounds (each p<0.001). In conclusion, morbid obesity has increased dramatically among US adults. The clustering of cardiovascular disease risk factors associated with morbid obesity and the exclusion from diagnostic imaging may affect those most in need of such procedures.