The Role of Emotion Differentiation in the Association Between Momentary Affect and Tobacco/Nicotine Craving in Young Adults.

INTRODUCTION: Tobacco/nicotine use is commonly initiated during adolescence or young adulthood, which increases the likelihood of continued use into adulthood and related adverse health outcomes. Despite interest in cessation, achieving and maintaining abstinence is difficult among this population. Cravings are often a barrier to abstinence, which have been associated with intensity of affect at the moment level. Emotion differentiation involves the ability to distinguish between discrete emotion states, and previous work suggests it may moderate the effect of momentary affect on craving, which has never been explored among young adults who are smoking or vaping nicotine. AIMS AND METHODS: In a sample of young adults (N = 37, observations = 2020, ages 18-25, 51% female, and 78% white) interested in quitting smoking or vaping, we used real-time, naturalistic data capture via mobile phones to examine the interaction of momentary affect and trait emotion differentiation on nicotine craving. Participants were prompted with four surveys per day for 35 days and asked to make a 48-h quit attempt on day 7. RESULTS: Multilevel models showed moments of higher-than-average momentary negative affect (NA; b = 0.39, p < .001), and positive affect (PA; b = 0.26, p = .001) were associated with greater levels of craving. NA emotion differentiation significantly moderated the associations between PA and craving (b = -0.63, p = .031) and NA and craving (b = -0.67, p = .003). CONCLUSIONS: Findings from this exploratory analysis suggest that for young adults engaging in a nicotine quit attempt, greater ability to differentiate NA weakens the momentary association between intense affect and craving. IMPLICATIONS: Results of this study show that the ability to differentiate between discrete emotional experiences may protect young adults against nicotine craving during moments of intense affective experience. These preliminary findings suggest that emotion differentiation, a modifiable construct, could be an important treatment target for individuals engaged in treatment for nicotine dependence.

Cannabis use prevalence, patterns, and reasons for use among patients with cancer and survivors in a state without legal cannabis access.

PURPOSE: Cannabis use among patients with cancer is common, yet data are limited regarding use patterns, reasons for use, and degree of benefit, which represents an unmet need in cancer care delivery. This need is salient in states without legal cannabis programs, where perceptions and behavior among providers and patients may be affected. METHODS: A cross-sectional survey of patients with cancer and survivors at the Hollings Cancer Center at the Medical University of South Carolina (no legal cannabis marketplace in SC) was completed as part of the NCI Cannabis Supplement. Patients (ages 18 +) were recruited using probability sampling from patient lists (N = 7749 sampled; N = 1036 completers). Weight-adjusted Chi-square tests compared demographics and cancer details among patients using cannabis since diagnosis versus those not using cannabis, while weighted descriptives are presented for cannabis use prevalence, consumption, symptom management, and legalization beliefs. RESULTS: Weighted prevalence of cannabis use since diagnosis was 26%, while current cannabis use was 15%. The most common reasons for cannabis use after diagnosis were difficulty sleeping (50%), pain (46%), and mood changes and stress, anxiety, or depression (45%). Symptom improvement was endorsed for pain (57%), stress/anxiety/depression (64%), difficulty sleeping (64%), and loss of appetite (40%). CONCLUSIONS: Among patients with cancer and survivors at a NCI-designated cancer center within SC, a state without legal access to medical cannabis, prevalence rates, and reasons for cannabis use are consistent with emerging literature in oncology populations. These findings have implications for care delivery, and work is needed to inform recommendations for providers and patients.

Emotion differentiation in early recovery from alcohol use disorder: Associations with in-the-moment affect and 3-month drinking outcomes.

BACKGROUND: Early recovery from alcohol use disorder (AUD) is commonly associated with high levels of negative affect, stress, and emotional vulnerability, which confer significant relapse risk. Emotion differentiation-the ability to distinguish between discrete emotions-has been shown to predict relapse after treatment for a drug use disorder, but this relationship has not been explored in individuals recovering from AUD. METHODS: The current study used thrice daily random and up to thrice daily self-initiated ecological momentary assessment surveys (N = 42, observations = 915) to examine whether 1) moments of high affective arousal are characterized by momentary differences in emotion differentiation among individuals in the first year of a current AUD recovery attempt, and 2) individuals' average emotion differentiation would predict subsequent alcohol use measured by the timeline follow-back over a 3-month follow-up period. RESULTS: Multilevel models showed that moments (Level 1) of higher-than-average negative affect (p < 0.001) and/or stress (p = 0.033) were characterized by less negative emotion differentiation, while moments of higher-than-average positive affect were characterized by greater positive emotion differentiation (p < 0.001). At the between-person level (Level 2), participants with higher stress overall had lower negative emotion differentiation (p = 0.009). Linear regression showed that average negative, but not positive, emotion differentiation was inversely associated with percent drinking days over the subsequent 3-month follow-up period (p = 0.042). Neither form of average emotion differentiation was associated with drinking quantity. CONCLUSIONS: We found that for individuals in early AUD recovery, affective states are associated with acute shifts in the capacity for emotion differentiation. Further, we found that average negative emotion differentiation prospectively predicts subsequent alcohol use.

The Implicit Sexual Risk Assessment: A Pilot Study of a Novel Behavioral Task.

Risky sexual behaviors are a significant public health concern. Laboratory experiments are necessary to identify causal determinants of risky sexual behavior. However, experiments often rely on analogue sexual risk behavior, assessed by self-reported intentions in response to a sexual scenario. Using behavioral tasks to assess risk taking may be a valuable addition to self-reported intention outcome measures. The Balloon Analogue Risk Task (BART) is a commonly used measure of general risk-taking. However, BART's associations with sexual risk-taking have been mixed. In this pilot study, we developed a task akin to the BART, the Implicit Sexual Risk Assessment (ISRA), which incorporates sexual stimuli. We hypothesized sexual arousal would increase risk taking on ISRA relative to BART. Using a within-persons experimental design, 79 participants (52% women, mean age = 19.5 (SD = 1.42)) were randomized to condition (i.e., arousal versus neutral) and completed the BART and ISRA tasks. As expected, sexual arousal was associated with increased risk-taking (i.e., adjusted pumps) on ISRA relative to BART. However, this was unexpectedly the result of decreased pumps on BART instead of increased pumps on ISRA. Neither BART nor ISRA were significantly associated with sexual risk behavior or intentions. Null findings are qualified by the fact that sexual arousal was not significantly associated with sexual risk intentions.

Posttraumatic Stress Disorder and Conduct Problems: The Role of Self-Control Demands.

We tested within- and between-person effects of posttraumatic stress disorder (PTSD) symptoms on conduct problems and alcohol intoxication via self-control demands using multilevel structural equation modeling in a longitudinal burst-design study of 251 U.S. veterans who participated in the recent wars in Iraq and Afghanistan. We theorized that experiencing PTSD symptoms engenders efforts to regulate mood, control thoughts, and inhibit or control behavior that is taxing to the individual (i.e., it places demands on self-control) and hypothesized that this process results in subsequent deficits in regulatory control that manifest in heightened intoxication and conduct problems associated with PTSD. At the within-person level, daytime PTSD symptoms, IRR = 1.09, and self-control demands, IRR = 1.12, exhibited within-person associations with nighttime conduct problems over and above nighttime intoxication. Consistent with our hypothesis, daytime increases in self-control demands mediated the associations between daytime PTSD symptoms and subsequent nighttime conduct problems. The indirect effect between daytime PTSD symptoms and nighttime intoxication via self-control demands was nonsignificant. At the between-person level, self-control demands mediated the associations between PTSD symptoms and conduct problems; however, the expected between-person associations with intoxication were nonsignificant. Drinking behavior is related to but cannot fully account for various difficulties in psychosocial functioning associated with PTSD. The present results suggest that dysregulated behavior may, ironically, stem from individuals' concerted efforts to control and manage overwhelming symptoms. Self-control demands may be a common factor that accounts for a broad range of functional impairments associated with PTSD.

Force of Habit: the Role of Routinized, Automatic Behaviors along the Path of Self-Regulation and Alcohol-Related Problems.

BACKGROUND: Dual-Process models of self-regulation suggest different facets of self-regulation predict adaptive (e.g., academics, exercise) and maladaptive (e.g., drinking) behaviors. Engagement in these behaviors may ultimately result in automatic habits that either promote or inhibit alcohol use and related problems. METHOD: This study tested a structural equation model of relationships between self-regulation constructs, health and drinking habits and automaticity, effortful inhibition, and alcohol problems in a college student sample (N = 405). RESULTS: As expected, effortful control was positively associated with health habits, which were positively associated with health automaticity. Automaticity was inversely associated with effortful inhibition. Thus, effortful control was indirectly associated with less effortful inhibition, as hypothesized. Contrary to hypothesis, effortful inhibition was inversely associated with alcohol-related problems, which resulted in a positive indirect association between effortful control and alcohol problems. Reactivity was positively associated with drinking automaticity via drinking habits and positively associated with effortful inhibition and alcohol problems. CONCLUSIONS: Results indicate effortful control and reactivity exhibit unique associations with health and drinking habits, automaticity, and effortful inhibition. Results suggest a somewhat paradoxical process whereby effortful control achieves its ends via decreased effort to engage in adaptive behaviors. Validity of using self-report and word association measures of automaticity was supported by the observed associations with predictors and outcomes.

Perfectionism discrepancy and falling short of the ideal self: Investigating drinking motives and impaired control on the road to alcohol-related problems.

Self-Discrepancy Theory (Higgins, 1987) predicts that the difference between the ideal and the actual self will be associated with impaired-control-over-drinking (IC; dysregulated drinking beyond one's own limits) as well as alcohol-related-problems. According to Slaney et al. (2001) perfectionism is a multi-faceted personality trait which represents both adaptive (e.g. high-standards) and maladaptive (e.g. discrepancy) aspects. In particular, discrepancy has been associated with poorer coping approaches, which may suggest a Self-Medication route to IC. Yet, to date, no one has examined whether drinking-motives (e.g., social, enhancement, coping and conformity) mediate the relations between discrepancy and high standards and alcohol-outcomes such as IC. We used a structural equation model to test indirect associations of discrepancy and high-standards to both heavy-episodic-drinking and alcohol-related-problems through the mediating mechanisms of drinking-motives and IC. Results supported the distinction between discrepancy and high-standards consistent with the Self-Medication Hypothesis (Hersh & Hussong, 2009). Discrepancy was associated with poorer alcohol-outcomes through greater coping-motives, conformity-motives and IC. In contrast, higher-standards were associated with fewer alcohol-outcomes through less coping-motives, conformity-motives, and IC. This study illustrates the importance of personality factors such as discrepancy in the development of problematic alcohol-use suggesting that it might be a good target for intervention.

The Direct and Indirect Influences of Parenting: The Facets of Time-Perspective and Impaired Control Along the Alcohol-related Problems Pathway.

BACKGROUND: Social Learning Theory suggests how one conceptualizes time will be passed from parent to child (Bandura & Walters, 1963). Through the lens of Behavioral Economics Theory (Vuchinich & Simpson, 1998), impaired control may be characterized as consuming alcohol as a form of immediate gratification as a choice over more distal rewards. Because impaired control reflects a self-regulation failure specific to the drinking situation, it may be directly related to time-perspectives. OBJECTIVES: This investigation explored whether or not the indirect influences of perceived parenting styles on alcohol use and related problems is mediated by both facets of time-perspective (e.g. hedonism, present-fatalism, future, past-positive, past-negative) and impaired control over drinking. METHODS: We examined a structural equation model with 391 (207 women; 184 men) college student drinkers. We used an asymmetric bias-corrected bootstrap technique to conduct mediational analyses (MacKinnon, 2008). RESULTS: Higher levels of past-positive time-perspective were indirectly linked to both less alcohol use and fewer alcohol-related problems through less impaired control. In contrast, higher levels of present-fatalism were indirectly linked to more alcohol use through more impaired control. Higher levels of father permissiveness and mother authoritarianism were indirectly linked to both more impaired control and alcohol use through more present-fatalism. In addition, higher levels of father authoritarianism were indirectly linked to more alcohol use through more hedonism. CONCLUSIONS/IMPLICATIONS: Our results support the notion that drinking beyond one's self-prescribed limits is associated with time-perspectives related to negative aspects of the parent-offspring socialization process, such as fatalism.

Characterizing the dimensions of positive emotion functioning in young adult alcohol use and alcohol-related problems.

Emotional functioning figures prominently in most contemporary models of alcohol use (Kassel & Veilleux, 2010). These models posit that alcohol use becomes reinforced due to its ability to regulate a person's affect (Sher & Grekin, 2007). A growing body of literature suggests that for youth, positive reinforcement (i.e., using alcohol to enhance positive feelings or to increase their duration) is a leading mechanism facilitating increased use (Emery & Simons 2020; Howard et al., 2015). However, few, if any, studies have examined the unique associations between multiple indicators of positive emotional functioning and alcohol use as well as alcohol-related problems. We aimed to fill this gap by using secondary data from large college student sample (N = 402) to characterize the unique associations between trait indicators of positive emotional functioning (i.e., positive affect, anhedonia, savoring, positive emotion dysregulation) and alcohol use as well as alcohol-related problems. Results indicated trait positive emotion dysregulation (difficulty managing intense positive emotions) was positively related to both alcohol consumption (IRR = 1.03, p =.019) and alcohol-related problems (IRR = 1.03, p =.001). Interestingly, trait savoring (i.e., ability to increase the intensity/duration of positive emotions) was positively related to alcohol consumption (IRR = 1.18, p =.049) and inversely related to problems (IRR = 0.86, p =.019). None of the other positive emotion indicators were significantly associated with either alcohol use or problems.

Temporal associations linking alcohol and cannabis use to cigarette smoking in young adults engaged in a tobacco cessation and relapse monitoring study.

Young adulthood remains a developmental period in which cigarette smoking initiation and progression to dependence and regular use is common. Moreover, co-use of alcohol and/or cannabis with tobacco is common in this age group and may have detrimental effects on tobacco use rates and cessation outcomes. Although young adults are interested in quitting smoking, achieving abstinence remains difficult, even with evidence-based treatment strategies. Understanding proximal associations between other substance use (e.g., alcohol and cannabis) and smoking may have important treatment implications. This exploratory analysis investigated the role of alcohol and/or cannabis use in contributing to smoking events on the same day or next day among young adults engaged in a smoking cessation and relapse monitoring study. We used ecological momentary assessment (EMA) data from 43 young adults (ages 18-25; 932 observations) who smoked cigarettes daily and agreed to participate in a 5-week study that included a 2-day smoking quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence (incentives were provided only during the 2-day quit attempt). We tested multilevel time-series models of daily associations between alcohol use, cannabis use, and smoking. Consistent with hypotheses, days on which participants were more likely to drink alcohol predicted increased likelihood of smoking the next day (OR = 2.27, p =.003). This effect was significant after controlling for both the one-day lagged effect of smoking (i.e., autoregression) and the concurrent (i.e., same day) effects of drinking and cannabis use. Although there was a positive concurrent effect of cannabis use on smoking (OR = 12.86, p =.003), the one-day lagged effect of cannabis use and the concurrent effect of drinking was not significant, contrary to hypotheses. Results indicate that alcohol use presents a potential threat to successful smoking cessation that extends to the following day. This suggests a risk-window in which treatment could be supplemented with just-in-time interventions and extending the focus on co-use to include this lagged impact on cessation outcomes.

Cannabis Perceptions and Patterns of Use Among Older Adult Cancer Survivors.

Objectives: To descriptively assess cannabis perceptions and patterns of use among older adult cancer survivors in a state without a legal cannabis marketplace. Methods: This study used weighted prevalence estimates to cross-sectionally describe cannabis perceptions and patterns of use among older (65+) adults (N = 524) in a National Cancer Institute-designated center in a state without legal cannabis access. Results: Half (46%) had ever used cannabis (18% following diagnosis and 10% currently). Only 8% had discussed cannabis with their provider. For those using post-diagnosis, the most common reason was for pain (44%), followed by insomnia (43%), with smoking being the most common (40%) mode of use. Few (<3%) reported that cannabis had worsened any of their symptoms. Discussion: Even within a state without a legal cannabis marketplace, older cancer survivors might commonly use cannabis to alleviate health concerns but unlikely to discuss this with their providers.

Tobacco-cannabis co-use among cancer patients and survivors: findings from 2 US cancer centers.

BACKGROUND: Cannabis use is prevalent among cancer patients and survivors and may provide some therapeutic benefits for this population. However, benefits may be attenuated when cannabis is co-used with tobacco, which is associated with more severe tobacco and cannabis use and adverse outcomes in noncancer populations. We compared cannabis use, primary mode of use, and therapeutic and/or nontherapeutic use among 3 groups of patients and survivors based on cigarette smoking status. METHODS: Survey data was collected from patients and survivors with cancer (n = 1732) at 2 US National Cancer Institute-designated cancer centers in states with varying cannabis regulatory policy. Prevalence of cannabis use (prior to diagnosis, after diagnosis, before treatment, after treatment), primary mode of use, and therapeutic and/or nontherapeutic use were assessed by cigarette smoking status (current, former, never) within and across centers using weighted bivariate analyses and multivariable logistic regression, controlling for demographic and clinical variables. RESULTS: Current cigarette use was associated with greater rates of cannabis use prior to diagnosis, after diagnosis, during treatment, and after treatment within each center (all P < .001) and in pooled analyses across centers (all P < .001). Primary mode of use, knowledge of cannabis products, and therapeutic and/or nontherapeutic use also statistically differed by tobacco status and study site. CONCLUSIONS: Results illustrate the importance of conducting assessments for both tobacco and cannabis use among cancer patients during and after cancer treatment, regardless of the cannabis regulatory environment. Given previous data indicating harms from co-use and continued tobacco use during cancer treatment, this issue introduces new priorities for cancer care delivery and research.

Short-changing the future: The systemic gap between psychology internship stipends and living wages.

Introduction: Providing doctoral internship stipends below living wages may harm interns, the clinical services they provide, and the field of health service psychology as a whole. This study evaluated the extent to which doctoral psychology internship stipends from the 2021-2022 training year for APA-accredited, APPIC-member programs in the US are consistent with living wages in the geographic region where sites are located. Methods: We obtained data reflecting internship sites' geographic location and stipends for the 2021-2022 academic year. Using the Massachusetts Institute of Technology Living Wage Calculator, we computed a living wage for the county in which each internship site is located. Descriptive statistics, discrepancies, ratios, and correlations were calculated to reflect the associations between internship sites' stipends and their local living wages. Results: The average internship stipend was $31,783, which was lower than the average living wage by $2,091. Stipends ranged widely, from a low of $15,000 to a high of $94,595-reflecting a six-fold difference in wages. Although internship sites in higher cost of living areas paid higher stipends, over two-thirds (67.0%) of sites did not pay a stipend that equaled or exceeded a living wage. Ninety-eight sites (15.3%) had deficits of over $10,000 when comparing their stipends to local living wages, with $33,240 as the highest deficit. Discussion: Eliminating obstacles to educating health service psychologists by decreasing the financial burden of training will likely have subsequent critical benefits towards bridging the workforce gap between mental healthcare service needs and available providers, ultimately leading to improved population health.

Affective dependence, self-regulation, and alcohol problems: Between- and within-person associations.

Positive affect (PA) and negative affect (NA) are associated with goal pursuit in addition to dysregulated behavior. Affective dependence (i.e., the correlation between PA and NA) may be a marker for good self-regulation on the one hand (weaker dependence) and poor self-regulation on the other (stronger dependence). This study sought to elucidate the role of affective dependence as a predictor of goal pursuit and alcohol problems at the within- and between-person levels. Participants were 100 college students aged 18-25 years, who drank alcohol at least moderately, and completed a 21-day ecological momentary assessment study regarding affect, academic goal pursuit, idiographic goal pursuit, alcohol use, and alcohol problems. Multilevel time series models were estimated. Consistent with hypotheses, affective dependence predicted more alcohol problems and decreased academic goal pursuit at the within-person level. Importantly, effects on academic goal pursuit included perceived achievement and progress related to academics, as well as time spent studying, an objective marker for academic engagement. Effects were significant controlling for autoregressive effects, lagged residuals of PA and NA, concurrent alcohol use, day of the week, age, gender, and trait affective dependence. Thus, this study provides robust tests of lagged within-person effects of affective dependence. The effect of affective dependence on idiographic goal pursuit was not significant, contrary to hypothesis. Affective dependence was not significantly associated with alcohol problems or goal pursuit at the between-person level. Results suggest that affective dependence is a common factor explaining problems related to alcohol use and psychological functioning more broadly. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Determining the impact of cannabis use and severity on tobacco cessation outcomes: study protocol for a prospective tobacco treatment trial.

BACKGROUND: Several evidence-based tobacco cessation treatment strategies exist, though significant barriers to cessation remain which must be addressed to improve abstinence rates for sub-populations of those smoking cigarettes. Cannabis co-use among those who use tobacco is common and appears to be increasing among adults in the United States (US). The literature evaluating the impact of cannabis use on tobacco cessation has been mixed and has several important limitations, which precludes development of treatment recommendations specific to individuals who use tobacco and co-use cannabis. To date, no prospective studies have evaluated the impact of cannabis use and severity on tobacco cessation or quantified cannabis use changes during tobacco treatment to assess for concurrent reductions, abstinence, or compensatory (i.e., increased) cannabis use. This study's aims are to: (1) evaluate tobacco cessation outcomes among participants who co-use cannabis compared to participants only using tobacco, (2) using daily diaries and biochemical verification, assess changes in cannabis use during tobacco treatment, and (3) assess for a dose-dependent impact of cannabis use on tobacco cessation. METHOD: A multi-site, prospective, quasi-experimental 12-week tobacco treatment trial enrolling treatment-seeking adults (ages 18-40; N = 208) from three sites across South Carolina (US) who use tobacco daily and oversampling (2:1) those who co-use cannabis. Participants receive tobacco cessation pharmacotherapy (varenicline) paired with behavioral support, while cannabis use is not addressed as part of treatment. The primary outcome is 7-day point prevalence tobacco abstinence at the week 12 end of treatment visit, measured via biochemical verification and self-report. Secondary outcome measures include changes in cannabis use (via biochemical verification and self-report) during tobacco cessation treatment. DISCUSSION: Results from this trial have the potential to inform tobacco treatment among those co-using cannabis, which may require a tailored approach to address the role of cannabis in quitting tobacco. TRIAL REGISTRATION: The trial is registered with ClinicalTrials.gov: NCT04228965. January 14th, 2020.

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study.

BACKGROUND: Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments. OBJECTIVE: The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase. METHODS: Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study. RESULTS: No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group. CONCLUSIONS: Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report.

Nexus of despair: A network analysis of suicidal ideation among veterans.

The objective of this study was to estimate a network model of risk and resilience factors of suicidal ideation among veterans. Two network models of suicidal ideation among Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn veterans (N = 276) incorporated key disorders, traumatic stress, and resilience constructs to contextualize suicidal ideation. Childhood trauma was positively connected with suicidal ideation and harassment and inversely connected with social support and distress tolerance. This exemplifies long-lasting associations between childhood trauma and re-victimization, emotion regulation, and ability to form supportive social relationships. A subsequent model including lower-order facets indicated that combat trauma was predominantly associated with posttraumatic stress disorder-intrusion symptoms. This study highlights the importance of addressing both risk and resilience to reduce suicide risk among veterans and increases understanding of factors that contribute to suicidal ideation.

Self-control demands and alcohol-related problems: Within- and between-person associations.

This study tested a multilevel structural model of associations between two aspects of self-control (effortful control and reactivity), self-control demands, alcohol consumption, and alcohol problems and related risk behaviors using daily diary data from 196 young adults (4,177 person-days). Self-control demands were hypothesized to be positively associated with alcohol consumption and alcohol problems and related risk behaviors both within- and between-persons. At the between-person level, self-control demands were hypothesized to mediate the association between trait self-control and alcohol problems and related risk behaviors. At the within-person level, self-control demands had a direct positive effect on alcohol problems and related risk behaviors, over and above alcohol consumption. However, contrary to expectation, self-control demands were inversely associated with alcohol consumption. In contrast, self-control demands were positively associated with alcohol consumption at the between-person level and partially mediated the positive effects of reactivity on consumption and alcohol problems and related risk behaviors. That is, reactivity was associated with higher perceived self-control demands, which in turn predicted higher rates of consumption and alcohol problems and related risk behaviors. Effortful control was not significantly associated with alcohol consumption or self-control demands. The pattern of self-control demand effects at the within-person level suggest that young adults are less likely to drink when struggling to manage their day-to-day behavior, yet if they do drink they are more susceptible to negative consequences. Trait effects suggest that individual differences in self-control may be associated with alcohol use patterns in part attributable to development of, and response to, structured daily routines. (PsycINFO Database Record

Daily associations between alcohol and sexual behavior in young adults.

We tested within-person effects of alcohol on sexual behavior among young adults in a longitudinal burst design (N = 213, 6,487 days) using data collected from a previously published parent study. We differentiated effects of alcohol on likelihood of sexual activity versus use of protection against sexually transmitted diseases (STDs) or pregnancy on intercourse occasions by testing a multilevel multinomial model with 4 outcomes (no sex, oral sex without intercourse, protected intercourse, and unprotected intercourse). At the within-person level, effects of alcohol were hypothesized to be conditional upon level of intoxication (i.e., curvilinear effect). We also tested effects of four between-person moderators: gender, typical length of relationship with sexual partners, and two facets of self-control (effortful control and reactivity). Consistent with our hypothesis, low-level intoxication was associated with increased likelihood of engaging in oral sex or protected intercourse (relative to no sex) but was not related to likelihood of unprotected intercourse. The effect of intoxication on unprotected versus protected intercourse was an accelerating curve, significantly increasing likelihood of unprotected intercourse at high levels of intoxication. Between-person factors moderated associations between intoxication and sexual behavior. Effects of intoxication on both protected and unprotected intercourse were diminished for individuals with more familiar sexual partners. Effortful control exhibited a protective effect, reducing the effects of intoxication on likelihood of unprotected intercourse. Hypothesized effects of reactivity were not supported. Intoxication was a stronger predictor of oral sex and protected intercourse (but not unprotected intercourse) for women relative to men. Results highlight the inherent complexities of the alcohol-sexual behavior nexus. (PsycINFO Database Record