Comparison of Pre-Diagnosis Physical Activity and Its Correlates between Lung and Other Cancer Patients: Accelerometer Data from the UK Biobank Prospective Cohort.

Purpose: Physical activity (PA) plays an important role in health outcomes for people with cancer, and pre-diagnosis PA influences PA behaviors after cancer treatment. Less is known about the PA of lung cancer patients, and the strong history of smoking could influence pre-diagnosis levels of PA and place them at risk for health problems. This study aimed to compare pre-diagnosis PA and its correlates in patients with lung cancer and other types of cancer (female breast, colorectal, and prostate cancer) and examine the relationship between pre-diagnosis PA and all-cause mortality. Methods: This study used data from the UK Biobank, which is a national cohort study with accelerometry data. We included 2662 participants and used adjusted linear regressions and survival analyses. Results: Male and female lung cancer groups spent a mean of 78 and 91 min/day in pre-diagnosis moderate to vigorous PA (MVPA), respectively; this is lower than the 3 other types of cancer (p < 0.001). Younger age and faster walking pace had a strong association with PA in all the four types of cancer (p < 0.01). Smoking status had a strong association with PA in the lung cancer group, while obesity had a strong association with PA in female breast, colorectal, and prostate cancer (p < 0.01). Higher levels of pre-diagnosis MVPA (≥1.5 h/day) were associated with a significantly lower all-cause mortality risk. Conclusions: The present study suggests that lung cancer patients are the most inactive population before diagnosis. The identified difference in correlates of PA suggest that cancer-specific approaches are needed in PA research and practices. This study also highlights the importance of high PA for individuals with high cancer risk.

Physical activity in surgical lung cancer patients: a systematic review.

PURPOSE: Perioperative exercise could improve health outcomes of surgical lung cancer patients, but less is known about their natural physical activity (PA) behavior before exercise interventions. This review aimed to synthesize evidence on PA, regarding the following: (1) proportion of patients meeting PA guidelines, (2) amount of PA, (3) PA trajectory following surgery, and (4) correlates of PA before or after surgery. METHODS: We conducted a systematic review using PubMed, CINHAL, Scopus, and SPORTDiscus (July 2021). Observational or experimental studies that measure PA of lung cancer patients before/after surgery were included. We assessed methodological quality using the NIH Quality Assessment Tools and extracted data using a standardized form. RESULTS: Seventeen studies (25 articles, N = 1737 participants) published between 2009 and 2021 were included. Fourteen studies had sample sizes less than 100. Thirteen studies were of fair quality and four studies were of good quality. Only 23-28% of patients met PA guideline (150 min/week moderate-vigorous PA) at 6 months-6 years after surgery. Patients took an average of 3822-10,603 daily steps before surgery and 3934-8863 steps at 1-3 months after surgery. Physical activity was lower at 1 day-3 months after surgery, compared with preoperative levels. Perioperative PA was positively associated with exercise capacity, quality of life and reduced postoperative complications. CONCLUSION: This review suggests that PA is low among surgical lung cancer patients, and it may not recover within 3 months following surgery. Physical activity has the potential to improve postoperative outcomes. However, the existing evidence is weak, and future larger longitudinal studies are needed.

Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults Living in the United States.

INTRODUCTION: This study examines the proportion of the United States adolescents and adults who are variable (ie, at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates. METHODS: We fit multivariable logistic regression models to data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n = 33 197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability over three waves with tobacco use at wave 4 (2016-2018). Differences in any past 30-day tobacco, cigarette, e-cigarette, other tobacco, and poly-tobacco use were assessed among cisgender-stable, transgender-stable, and gender-varying respondents. RESULTS: An estimated 1.0% of adolescents and adults were classified as gender-varying. Prevalence of any past 30-day tobacco use was higher among gender-varying individuals (42.7%) than among gender-stable individuals (transgender-stable, 37.8% and cisgender-stable, 26.7%). There were no significant differences in the odds of nicotine/tobacco use between the two gender-stable groups. However, gender-varying respondents had significant increased odds of any past 30-day tobacco use (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.3 to 3.0), cigarette use (AOR = 1.7, 95% CI = 1.1 to 2.5), e-cigarette use (AOR = 2.2, 95% CI = 1.4-3.5), other tobacco use (AOR = 2.2, 95% CI = 1.4 to 3.4), and poly-tobacco use (AOR = 2.0, 95% CI = 1.3 to 3.1) compared with cisgender-stable individuals. CONCLUSIONS: Gender-varying individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for tobacco-related health consequences. IMPLICATIONS: Despite increased knowledge about transgender health in recent years, there remains a paucity of research about gender-varying individuals. This study is the first to examine the proportion of gender-varying individuals in the United States using a longitudinal, nationally representative sample and to explore differences in nicotine/tobacco use among gender-varying and gender-stable individuals. Our findings suggest that gender-varying people have an increased risk for nicotine/tobacco use, placing them at higher risk for tobacco-related health consequences. This study increases knowledge about nicotine/tobacco use among this under-represented population in research and underscores the importance of developing an awareness of gender diversity.

Mental health-related quality of life by sex and sexual identity among U.S. adults with alcohol and tobacco use disorder.

INTRODUCTION: Alcohol use disorder (AUD) and tobacco use disorder (TUD) are more severe among some sexual minority subgroups. It is less understood whether mental health indicators also differ by sexual identity among those with more severe forms of AUD and TUD. We examined differences in mental health-related QoL by sex-specific sexual identity subgroup among those meeting criteria for moderate-to-severe AUD or moderate-to-severe TUD. METHODS: We analyzed data from the National Epidemiologic Study of Alcohol and Related Conditions-III (2012-2013; n = 36,309). Our analyses focused on those meeting criteria for past-year moderate-to-severe AUD (n = 2341) and past-year moderate-to-severe TUD (n = 3675). Using multivariable linear regression, we examined associations of sex-specific sexual identity subgroups with mental health-related QoL, while controlling for (a) sociodemographic characteristics, (b) disorder severity, and (c) risk and protective factors (adverse childhood experiences, parental history of substance misuse, stressful life events, and social support). RESULTS: Among those with past-year moderate-to-severe AUD, gay men and heterosexual, bisexual, and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual men in fully adjusted models. Among those with past-year moderate-to-severe TUD, gay men and heterosexual and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual women. Bisexual and heterosexual women were not significantly different in fully adjusted models. DISCUSSION: Clinicians should consider the variability in mental health-related QoL among those with moderate-to-severe AUD and TUD particularly for women and sexual minorities. Consideration of current and past stressors and the degree of social support may be beneficial when conducting assessments and forming treatment plans.

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.

Cannabis, Vaping, and Respiratory Symptoms in a Probability Sample of U.S. Youth.

PURPOSE: The purpose of this study was to explore the association between respiratory symptoms among U.S. adolescents who were current (past 30-day) users of cigarettes, e-cigarettes, and/or cannabis, as well as lifetime users of cannabis with electronic nicotine delivery systems (ENDS). METHODS: Wave 4 from a national probability sample (N = 14,798) of adolescents (12-17 years) using Population Assessment of Tobacco and Health Study data was used for this study. Retention rate was 88.4%. RESULTS: The odds of indicating "wheezing or whistling" in the chest were roughly two times higher among those who had used cannabis in ENDS (adjusted odds ratio 1.81, 95% confidence interval 1.47-2.22); neither e-cigarettes nor cigarettes had a significant association with all five respiratory symptoms in the fully adjusted models. CONCLUSIONS: This study provides preliminary evidence that adolescents' cannabis use with ENDS may have negative health consequences. Lifetime cannabis use with ENDS was substantially associated with higher odds of respiratory symptoms.

Assessing how the history of e-cigarette and cigarette use are associated with the developmental course of marijuana use in a sample of United States adolescents.

BACKGROUND: The purpose of this study was to determine the developmental course of marijuana use among adolescents based on their history of cigarette and e-cigarette use among a national U.S. sample of adolescents who were followed over a four year time-period. METHODS: The data for this study used four waves of the Population Assessment of Tobacco and Health (PATH) Study provided by a panel of 12 to 17-year-olds at Wave 1 (n = 11,059) who completed each of the four annual waves of the adolescent/adult survey. We examined recent use (i.e., past 30-day) of e-cigarettes, cigarettes, and marijuana use at each of the four waves. RESULTS: Respondents who had a history of non-concurrent dual use (AOR = 1.67, 95 % CI = 1.24, 2.24) and a history of concurrent dual use (AOR = 1.67, 95 % CI = 1.40, 1.99) had greater odds of past 30-day marijuana use when compared to respondents who had a history of past 30-day e-cigarette use only. Interaction effect models found that e-cigarette only users were at lower risk for past 30-day marijuana use at Wave 1, however, the risk of past 30-day marijuana use increased at a faster rate across the four waves for e-cigarette only users when compared to their peers who used cigarettes or a combination of cigarettes and e-cigarettes. CONCLUSION: While concurrent and non-concurrent dual use was strongly associated with marijuana use over the study period, marijuana use increased at a faster rate across the four-year span of the study among e-cigarette only users.

Alcohol, Tobacco, and Comorbid Psychiatric Disorders and Associations With Sexual Identity and Stress-Related Correlates.

OBJECTIVE: The authors examined psychiatric comorbidities associated with alcohol use disorders and tobacco use disorders among heterosexual, bisexual, and gay and lesbian men and women in the United States and whether stress-related factors were predictive of comorbidities. METHODS: The authors used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, N=36,309) to examine the co-occurrence of past-year alcohol or tobacco use disorder with past-year anxiety disorders, mood disorders, and posttraumatic stress disorder by sexual identity (heterosexual, bisexual, gay or lesbian) and sex. The authors also examined the association of stress-related factors and social support with the presence of comorbidities. RESULTS: Comorbidities were more prevalent among women and sexual minorities, particularly bisexual women. More than half of bisexual (55%) and gay or lesbian (51%) individuals who met criteria for a past-year alcohol use disorder had a psychiatric comorbidity, while only one-third of heterosexual individuals who met criteria for a past-year alcohol use disorder did. Similar differences were found among those who met criteria for a past-year tobacco use disorder. Among sexual minorities, the frequency of sexual orientation discrimination (adjusted odds ratio range=1.08-1.10), number of stressful life events (adjusted odds ratio range=1.25-1.43), and number of adverse childhood experiences (adjusted odds ratio range=1.04-1.18) were significantly associated with greater odds of comorbidities. Greater social support was significantly inversely associated with tobacco use disorder comorbidities (adjusted odds ratio range=0.96-0.97). CONCLUSIONS: This research suggests that integrated substance use and mental health prevention and treatment programs are needed, particularly for individuals who identify as sexual minorities. The increased stressors experienced by sexual minority individuals may be important drivers of these high levels of comorbidities.

E-Cigarette and Cigarette Use Among U.S. Adolescents: Longitudinal Associations With Marijuana Use and Perceptions.

INTRODUCTION: Researchers have shown a connection between e-cigarette use and subsequent cigarette use. This study prospectively examines the connection between e-cigarette use and marijuana use. METHODS: This study used data from the Monitoring the Future panel study of 12th graders in 2014 who were followed up 1 year later (n=305). Past-30-day marijuana use and perceived riskiness of marijuana use for 12th graders who used neither e-cigarettes nor cigarettes (78.6%), only e-cigarettes (10.3%), and cigarettes (with or without e-cigarettes; 11.1%) were compared. Data was analyzed in 2019. RESULTS: At baseline, 40.1% of e-cigarette only users, 48.8% of cigarette users, and 13.2% of nonusers reported past-30-day marijuana use at baseline. E-cigarette only users were less likely to perceive any marijuana as risky at follow-up than nonusers (AOR=0.15, 95% CI=0.04, 0.65). Similarly, e-cigarette only users were more likely to report past-30-day marijuana use at follow-up than nonusers (AOR=3.82, 95% CI=1.45, 10.04), as were those who used cigarettes (AOR=7.63, 95% CI=2.65, 21.97). CONCLUSIONS: E-cigarette use, even when not in conjunction with cigarette use, may be a marker of marijuana use risk during the transition from adolescence to young adulthood. The e-cigarette and marijuana use link may strengthen in the future with the increasing trend of adolescents vaping marijuana.

Trajectories of prescription drug misuse during the transition from late adolescence into adulthood in the USA: a national longitudinal multicohort study.

BACKGROUND: Prescription drug misuse is most prevalent during young adulthood (ages 18-25 years). We aimed to identify prescription drug misuse trajectories for three drug classes (opioids, stimulants, and sedatives or tranquilisers) from adolescence into adulthood, assess the extent to which different trajectories are associated with symptoms of substance use disorder, and identity factors associated with high-risk prescription drug misuse trajectories. METHODS: For this longitudinal multicohort study, nationally representative probability samples of 51 223 adolescents in the USA were followed up across eight waves from age 18 years (cohorts 1976-96) to age 35 years. Data were collected via self-administered paper questionnaires. FINDINGS: Five prescription drug misuse trajectories were identified and the defining characteristic that differentiated the five trajectories was the age when past-year prescription drug misuse high frequency peaked: rare or no misuse at any age, peak at age 18 years, peak at ages 19-20 years, peak at age 23-24 years, and peak at ages 27-28 years. Similar prescription drug misuse trajectories were identified for each prescription drug class. The later peak misuse trajectory for sedatives and tranquilisers crested at an older age (35 years) than that for the other drug classes. Prescription drug misuse trajectories were all associated with significantly greater odds of having two or more substance use disorder symptoms at age 35 years, especially the later peak trajectories. In controlled analyses, risk factors associated with the high-risk latest peak prescription drug misuse trajectory included high school heavy drinking, cigarette smoking, marijuana use, poly-prescription drug misuse, white race, and not completing a 4-year university degree. INTERPRETATION: Prescription drug misuse trajectories are heterogeneous, and any high-frequency prescription drug misuse is a strong risk factor for development of substance use disorders during adulthood, especially later-peak prescription drug misuse trajectories. These findings might help practitioners identify individuals at greatest risk for substance use disorders and target intervention strategies. FUNDING: National Institute on Drug Abuse, National Institutes of Health.

Severity of Alcohol, Tobacco, and Drug Use Disorders Among Sexual Minority Individuals and Their "Not Sure" Counterparts.

PURPOSE: Sexual minority individuals have heightened risk for substance use; however, previous studies have not assessed severity of alcohol use disorders (AUDs), tobacco use disorders (TUDs), and drug use disorders (DUDs) among lesbian/gay and bisexual individuals and those "not sure" of their sexual identity compared with heterosexual individuals. This study examined how three dimensions of sexual orientation (identity, attraction, and behavior) relate to severity of AUD, TUD, and DUD. METHODS: This study used cross-sectional national data (N = 36,309) from the National Epidemiologic Survey on Alcohol and Related Conditions-III, and well-validated alcohol, tobacco, and drug measures that align with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Data were collected through in-person interviews in 2012-2013. RESULTS: Sexual minority respondents, based on sexual identity, had higher odds of severe AUD or TUD than heterosexual respondents. Opposite- and same-sex behavior was a predictor of severe AUD (adjusted odds ratio [AOR] = 2.44; 95% confidence interval [CI] = 1.24-4.79) and TUD (AOR = 2.16; 95% CI = 1.19-3.93), but not DUD. Those "not sure" of their sexual identity had higher odds of severe AUD, TUD, and DUD: AUD (AOR = 5.05; 95% CI = 2.78-9.16), TUD (AOR = 4.18; 95% CI = 2.29-7.64), and DUD (AOR = 4.40; 95% CI = 1.72-11.2), than heterosexual respondents. There were few significant differences between "not sure" and bisexual respondents. CONCLUSIONS: These findings provide strong evidence that bisexual and "not sure" U.S. adults are more likely to have a severe AUD and TUD. They also demonstrate the importance of treatment strategies that address sexual minority-specific risks, particularly for bisexual individuals and those "not sure" of their sexual identity.

High-intensity and simultaneous alcohol and marijuana use among high school seniors in the United States.

BACKGROUND: Simultaneous alcohol and marijuana (SAM) use poses threats to health, particularly among adolescents. These risks would be exacerbated to the extent that high-intensity drinking (e.g., 10+ drinks in a row) and marijuana use (e.g., 1+ joints per day) are associated with a higher likelihood of SAM use. The current study examines the extent to which the intensity of alcohol use and of marijuana use are associated with adolescent SAM use prevalence, and whether associations remain after controlling for key covariates known to associate with both alcohol and marijuana use; it identifies alcohol and marijuana use intensity levels associated with the highest risk of adolescent SAM use. METHODS: Data come from nationally representative samples of US 12th graders who participated in the Monitoring the Future study from 2005 to 2014 (N = 24,203 respondents; 48.4% boys, 51.6% girls). RESULTS: SAM use during the past year was reported by 20% of 12th graders overall. SAM use prevalence was strongly and positively associated with alcohol and marijuana use intensity even after controlling for covariates. High school seniors at highest risk for engaging in SAM use were those who reported 10+ drinks and those smoking at least 1 joint/day. Approximately 60% of those who had 10-14 or 15+ drinks in a row during the past 2 weeks and 76%-80% of those who had 1 or 2+ joints per day on average during the past 30 days reported SAM use. CONCLUSIONS: Results suggest that high school seniors who consume high quantities of alcohol and marijuana are very likely to consume these substances so that their effects overlap.

Adolescents' Use of Medical Marijuana: A Secondary Analysis of Monitoring the Future Data.

PURPOSE: To examine adolescents' annual use of medical marijuana and determine if legal medical marijuana users are at lower risk for frequent marijuana use and other substance use when compared to adolescents who use diverted medical marijuana or from an illicit source. METHODS: Public access Monitoring the Future data were used for this secondary analysis. The total weighted sample size was 4394 12th graders. RESULTS: Users of medical marijuana and diverted medical marijuana had notable odds of using daily, using prescription drugs, and using illicit drugs among other substance use behaviors. Medical marijuana users had much higher odds of using medical marijuana because of being "hooked" when compared to diverted medical users and illicit users. CONCLUSION: This study is the first to provide nationally representative data on three groups of adolescent marijuana users. Although most adolescents use illicit sources, more adolescents appear to be using diverted medical marijuana, than using medical marijuana legally.