Trajectories of loneliness during COVID-19 pandemic and associations with mental health and substance use.

We examined patterns of longitudinal trajectories of loneliness during the COVID-19 pandemic using six time points (January 2020 [pre-pandemic] to March/April 2021) and whether trajectories were associated with psychological distress (depression/anxiety) and substance use (alcohol/cannabis) outcomes in Spring 2021. Participants were 644 young adults who completed online assessments. Outcomes were regressed on most-likely loneliness trajectory adjusting for pre-pandemic measures. Three loneliness trajectories varied from consistently lower to consistently higher. Pre-pandemic social support was associated with lower odds of a higher loneliness trajectory. Higher loneliness trajectories were associated with greater odds of past-month cannabis use compared to Low trajectories, but not significantly associated with depression, anxiety, or alcohol use in Spring 2021. Interventions addressing co-occurring loneliness and cannabis use are needed.

Negative evaluation of role transitions is associated with perceived stress and alcohol consequences: Examination of the Transitions Overload Model in young adulthood using two years of monthly data.

BACKGROUND: Young adulthood is characterized by transitions into and out of social roles in multiple domains. Consistent with self-medication models of alcohol use, the Transitions Overload Model (J Stud Alcohol Suppl, 14, 2002, 54) hypothesizes that one cause of increased alcohol use during young adulthood may be the stress of navigating simultaneous role transitions. This study examined the simultaneous occurrence of major developmental role transitions in the domains of education, employment, romantic relationships, and residential status and their associations with perceived stress, heavy episodic drinking (HED), and negative alcohol-related consequences. Further, we extended the Transitions Overload Model to explore whether the number of transitions rated as having a negative impact on one's life was related to perceived stress, HED, and alcohol-related consequences. METHODS: A community sample of young adult drinkers (N = 767, 57% women, ages 18 to 25 years) in the Pacific Northwest provided monthly data across 2 years. Multilevel models were used to assess the average (between-person) and month-to-month (within-person) associations of role transitions with perceived stress, HED, and negative alcohol-related consequences. RESULTS: Although having more role transitions was positively associated with HED frequency and alcohol-related consequences at both the between- and within-person (monthly) levels, it was not associated with increased stress. The number of transitions rated as having a negative impact on one's life, however, was positively associated with stress. Thus, rather than the total number of transitions, it is the number of negatively perceived major developmental role transitions that is associated with perceived stress and increased risk for negative alcohol-related consequences. CONCLUSIONS: Contrary to Transitions Overload Model assumptions, more transitions were not a significant predictor of more perceived stress; rather, the evaluation of the transition as negative was associated with stress and negative alcohol-related outcomes. This distinction may help elucidate the etiology of stress and subsequent alcohol consequences and identify individuals at-risk of these effects.

A Marijuana Consequences Checklist for Young Adults with Implications for Brief Motivational Intervention Research.

Measures assessing marijuana-related consequences or problems experienced by young adults have typically been adapted from measures assessing alcohol consequences. These measures may not fully reflect the specific unwanted or perceived "not so good" effects of marijuana that are experienced by young adults. Thus, using these measures may present a gap, which needs to be addressed, given that reports of consequences are often utilized in brief motivational personalized feedback interventions. Data from three different studies of young adults were used to (1) examine self-reported "not so good" effects or consequences of marijuana use among frequent marijuana-using college students (Study 1), (2) create a new version of a marijuana consequences list and compare it to an existing marijuana consequences measure (Study 2), and (3) assess convergent and divergent validity between a finalized Marijuana Consequences Checklist (MCC, 26-items) and marijuana use and risk for cannabis use disorder (Study 3). The most frequently endorsed self-reported effects of marijuana included the impact on eating (the "munchies"), dry mouth, trouble concentrating, and acting foolish or goofy. Higher scores on the MCC were associated with more frequent use and a higher probability of meeting criteria for cannabis use disorder. The MCC represents a range of negative consequences of marijuana use derived from frequent users' own accounts and includes consequences not assessed by other measures. The MCC captures marijuana-specific negative consequences relevant for young adults, which can be incorporated in brief motivational personalized feedback interventions.

A Daily Study Comparing Alcohol-Related Positive and Negative Consequences for Days With Only Alcohol Use Versus Days With Simultaneous Alcohol and Marijuana Use in a Community Sample of Young Adults.

BACKGROUND: Alcohol and marijuana are psychoactive substances commonly used by young adults and are independently associated with numerous acute and long-term consequences. Many young adults engage in simultaneous alcohol and marijuana (SAM) use to cross-fade (i.e., to enhance the effects of intoxication), although the extent to which alcohol use and alcohol-related consequences increase on SAM occasions compared to alcohol-only occasions is unclear. This study examines daily data among a sample of SAM users comparing SAM days to other days when young adults only used alcohol. METHODS: A sample of 409 young adults (age 18 to 25; Mage  = 21.6, SD = 2.2; 50.9% women) who reported SAM use in the past month completed 2 bursts of 14 days of daily surveys (28 days in total) assessing alcohol use, alcohol-related consequences, and SAM use. RESULTS: Multilevel models based on alcohol-only and SAM days (n = 3,016 days; 391 individuals) indicated young adults drank more alcohol on SAM days compared to alcohol-only days (with no marijuana use). Similarly, days with SAM use were associated with more alcohol-related positive and negative consequences. The daily association between SAM use and positive consequences was statistically significant, after accounting for the amount of alcohol consumed; in contrast, the association between SAM use and negative consequences was diminished and nonsignificant. CONCLUSIONS: Among young adult SAM users, days with SAM use were associated with more alcohol use and positive consequences compared to days they only drank alcohol. Further examination of the motivational context for engaging in SAM use, as well as potential physiological interactions between alcohol and marijuana use on alcohol's effects, is warranted. Alcohol interventions might benefit from addressing increased alcohol use and alcohol-related consequences as risks associated with SAM use.

Behavioral economic demand for alcohol among young adults who engage in simultaneous alcohol and marijuana use.

Background: Young adults (YAs) who engage in simultaneous alcohol and marijuana use (SAM) may combine substances due to enhanced subjective effects, and as a result, may place greater value (e.g., spend more resources) on alcohol relative to YAs who consume alcohol but do not engage in SAM. The aim of the current study was to evaluate behavioral economic demand for alcohol among YAs who reported SAM (n = 101) relative to alcohol use only (n = 316), and concurrent alcohol and marijuana use (CAM; n = 63). Methods: YAs (18-25 years old) recruited from the community completed an online assessment that included the Alcohol Purchase Task as well as past month alcohol, marijuana, and SAM use. Results: Analyses of covariance demonstrated that YAs who reported SAM had significantly higher Omax values (maximum overall expenditures on alcohol) than those who reported CAM, and both YAs who reported SAM and alcohol-only had significantly higher Pmax values (maximum inelastic price per drink) than YAs who reported CAM. Conclusions: YAs that engage in SAM show an increased willingness to spend resources on alcohol. Elevated demand is not associated with concurrent use of multiple substances, but rather the combined (i.e., overlapping) use of substances.

Young Adult Mental Health: a Prospective Examination of Service Utilization, Perceived Unmet Service Needs, Attitudes, and Barriers to Service Use.

Most young adults with mental health symptoms do not receive treatment or access services. It remains important to identify barriers to service utilization to improve access to care. The current study was a prospective analysis examining predictors of (a) mental health service utilization and (b) perceived unmet need for mental health services. Barriers to service utilization were examined by prior depression severity status and college student status. Participants included a subsample of young adults ages 18-23 at time of recruitment who were participating in a longitudinal monthly study who completed both baseline and a 15-month follow-up assessment (N = 622, 80% of larger study). At month 15, 23% of young adults reported receiving mental health services in the past 12 months; 26% of young adults reported a perceived unmet need for mental health services at some point in the past 12 months. There were differences in demographic and mental health predictors of service utilization and perceived unmet need for services. Women, sexual minorities, those with moderate depression, those with more impairment from depression, and perceived past year poor mental health were associated with greater likelihood of receiving services. Similar demographic characteristics were associated with greater likelihood of perceiving unmet need for services. Barriers to service utilization differed by severity of depression symptoms and student status. Young adults have distinct reasons for not accessing mental health services; addressing these to improve accessibility to care remains critical.

The Efficacy of an Event-Specific, Text Message, Personalized Drinking Feedback Intervention.

Tailgating drinking prior to a football game is a type of event-specific drinking associated with increased alcohol use and related problems. Personalized drinking feedback interventions (PFI) are efficacious in reducing alcohol use and problems. The current study aimed to advance understanding of event-specific interventions by examining: (1) the efficacy of an event-specific, text message PFI on tailgating alcohol outcomes, and (2) the extent to which intervention effects generalize to "typical" alcohol outcomes at 1-month follow-up. College students (N = 130; 71% female; 92% white) who reported tailgating within the past 30 days and binge drinking when tailgating in the past year completed assessments on tailgating and typical alcohol use. They were randomly assigned to one of two text message conditions delivered on the morning of a home football game: event-specific PFI (TXT PFI) or a control condition. Multilevel modeling examined the association of treatment condition on tailgating and 1-month alcohol outcomes. When tailgating, participants in TXT PFI reported lower estimated peak blood alcohol concentration (eBAC) and consumed less drinks than the control condition. At the 1-month "typical" drinking follow-up, participants in TXT PFI reported lower peak eBAC and fewer alcohol-related problems than the control condition. Perceived tailgating drinking norms were found to statistically mediate the relationship between condition and alcohol outcome at tailgating and 1-month follow-ups. Findings provide preliminary support for the efficacy of an event-specific, text message PFI in reducing both tailgating and typical drinking alcohol outcomes. Event-specific TXT PFI can be used for prevention/intervention of alcohol misuse.

Application of Generalizability Theory to the Big Five Inventory.

The purpose of the present study was to examine the Big Five Personality Inventory score reliability (BFI: John, Donahue, & Kentle, 1991) utilizing Generalizability Theory analyses. Participants were recruited from a large public Midwestern university and provided complete data for the BFI on three measurement occasions (n = 264). Results suggested score reliability for scales with 7-10 items were adequate. However, score reliability for two item scales did not reach a .80 threshold. These findings have indicated BFI score reliability was, in general, acceptable and demonstrated the advantages of using Generalizability Theory analyses to examine score reliability.

Protective Behavioral Strategies, Social Norms, and Alcohol-Related Outcomes.

The present study examined the unique contributions of protective behavioral strategies and social norms in predicting alcohol-related outcomes. Participants were 363 students from a large public university in the Midwest who reported at least one binge-drinking episode (5+/4+ drinks for men/women in one sitting) in the past 30 days. Data were collected 1/2010-3/2011. We used SEM to test models where protective behavioral strategies (PBS) and social norms were predictors of both alcohol use and alcohol-related problems, after controlling for the effects of gender. Both PBS and descriptive norms had relationships with alcohol use. PBS also had a relationship with alcohol-related problems. Overall, the findings suggest that PBS and social norms have unique associations with distinct alcohol-related outcomes.

The longitudinal association of cumulative depression with cannabis use disorder among young adults.

OBJECTIVE: This study examined whether the cumulative experience of elevated depressive symptoms from age 19 to 23 was associated with cannabis use disorder (CUD) at age 26, and whether the association varied by perceived ease of access to cannabis and perceived risk for harms from cannabis use. METHOD: Data were from 4407 young adults participating in the Community Youth Development Study. Cumulative experience of elevated depressive symptoms was calculated by summing the number of times a participant scored 10+ on the 9-item Patient Health Questionnaire across three biennial survey waves (age 19 to 23). To assess CUD, the Diagnostic Interview Schedule was used. Participants also self-reported their ease of access to cannabis and the perceived harm of regular cannabis use at the age 19, 21, and 23 waves. Marginal structural modeling was used to account for multiple time-varying and time-fixed covariates through use of inverse probability weights. RESULTS: In final weighted models, a greater number of time points (i.e., study waves) showing elevated depressive symptoms was associated with an increased likelihood of CUD at age 26 (Prevalence Ratio = 1.46; 95% CI: 1.20, 1.77). There was no strong evidence for moderation of this association by perceived ease of access or perceived risk for harms due to regular cannabis use. CONCLUSIONS: Persistent experience of elevated depressive symptoms may place young adults at risk for cannabis use disorder. Strategies to reduce the burden of depressive symptoms among young adults may lead to downstream effects such as reducing the prevalence of cannabis-related problems.

Examining a curvilinear model of readiness to change and alcohol consumption.

Research examining the relationship between readiness to change and alcohol consumption among college students is inconsistent. The purpose of the present study was to extend these findings, using two different measures of readiness to change. We hypothesized a curvilinear effect would occur such that the relationship between readiness to change and alcohol use would be relatively low for students low and high on readiness to change, whereas the relationship would be relatively high for those with moderate levels of readiness to change. Data were collected from two studies: Study 1 consisted of 263 undergraduate students and Study 2 consisted of 245 undergraduates participating in either intercollegiate or recreational athletics at three US universities. In Study 1, we examined the association between both linear and quadratic scores on a readiness to change measure and alcohol use. In Study 2, we examined the relationship between scores on a stage of change measure that included subscales indicative of different levels of readiness to change and alcohol use. The pattern of relationships supported the existence of an effect where the highest levels of alcohol use occurred among those with scores representing moderate levels of readiness to change.

Multifaceted COVID-19-Related Stressors and Associations with Indices of Mental Health, Well-being, and Substance Use Among Young Adults.

Alongside direct health concerns pertaining to the SARS-CoV-2 virus, the stressors and life disruptions associated with the COVID-19 pandemic may provoke secondary concerns for health and well-being. The implications of COVID-19-related stressors may be particularly salient for young adults, who are at higher-risk for mental health concerns and substance use behaviors. We developed a multifaceted scale that assessed distinct domains of COVID-19-related stressors and examined associations between these stressors and indices of mental health, well-being, and substance use (alcohol and marijuana use). In April-June of 2020, 1181 young adults were recruited from two- and four-year colleges to participate in this study (M age = 20.40; 59.95% women). Exploratory factor analysis identified five domains of COVID-19-related stressors: job insecurity, social/relational, financial, illness-related, and school-related. The overall pattern of results indicated that COVID-19-related stressors were related to poorer mental health and well-being. Social/relational stressors emerged as a primary concern most strongly associated with indices of mental health and alcohol use, relative to other stressors. However, illness-related stressors and school-related stressors were associated with less alcohol use. Stressors associated with the COVID-19 pandemic may impact young adults' health and well-being but disentangling various stressor domains informs more tailored intervention and prevention strategies. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-021-00604-0.

Trajectory of depressive symptoms in the context of romantic relationship breakup: Characterizing the "natural course" of response and recovery in young adults.

Young adults face stressful role transitions as well as increased risk for poor mental health, but little is known about a "natural course" of response to such events. We used the PHQ-2 to characterize the trajectory of depressive symptoms before, during, and after relationship breakup and examined subjective appraisal and sense of control as moderators. In our sample of participants reporting a single breakup during the 2-year study period (N=156), breakup was associated with a temporary increase in depressive symptoms that returned to pre-breakup levels within three months. We observed increased symptoms among negatively appraised, but not positive or neutral, events. A general low sense of control was associated with higher depressive symptoms at all time points. Our results suggest that a natural course of response to young adult breakups is characterized by recovery within three months and that subjective appraisal and sense of control contribute to this adaptive response.

Using substances to cope with social anxiety: Associations with use and consequences in daily life.

OBJECTIVE: Using substances to cope with social anxiety is robustly related to negative consequences. The present study uses daily-level methods to test whether days young adults used substances to cope with social anxiety were associated with greater alcohol and cannabis use and consequences compared to use days without this motive. METHOD: Participants were a community sample of young adults enrolled in a study on alcohol and cannabis use, which involved a baseline survey and five 2-week bursts of online daily surveys across 2 years. Aims were tested using multilevel models among a subsample of 257 participants who reported social anxiety coping motives 1 day or more during the study period; Mage = 21.8 (SDage = 2.2), 51% female; 49% non-Hispanic/Latinx White. RESULTS: Compared to use days without social anxiety coping motives, days with social anxiety coping motives were associated with more drinks consumed and more positive and negative alcohol consequences on alcohol-only days, more negative cannabis consequences on cannabis-only days, and heavier use, more negative cannabis consequences, and more positive consequences for both substances on co-use days. Days with social anxiety coping motives were associated with a greater likelihood of positive item-level consequences (e.g., "was more sociable") on drinking days. Baseline social anxiety symptoms did not moderate associations. CONCLUSIONS: Days young adults used substances to cope with social anxiety were high-risk days for elevated substance use and consequences, regardless of baseline social anxiety. Positive consequences attained through drinking to cope with social anxiety may be an important pathway that reinforces coping motivated use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Injunctive Norms and Driving Under the Influence and Riding With an Impaired Driver Among Young Adults in Washington State.

PURPOSE: Alcohol- and cannabis-impaired driving behaviors remain a public health concern especially among young adults (i.e., ages 18-25). Limited updates to prevention efforts for these behaviors may be due, in part, to limited understanding of malleable psychosocial predictors. The current study assessed associations between perceived injunctive norms (i.e., acceptability) of driving under the influence of alcohol (DUI-A) and cannabis (DUI-C), and riding with a driver under the influence of alcohol (RWI-A) and cannabis (RWI-C) in Washington State young adults. METHODS: Participants included 1,941 young adults from the 2019 cohort of the Washington Young Adult Health Survey. Weighted logistic regressions assessed the associations between peer injunctive norms and impaired driving-related behaviors. RESULTS: A weighted total of 11.5% reported DUI-A, 12.4% DUI-C, 10.9% RWI-A, and 20.9% RWI-C at least once in the past 30 days. Overlap between the outcomes was observed, indicating some young adults had engaged in multiple impaired driving-related behaviors. After controlling for substance use frequency, weighted logistic regressions indicated more positive perceived injunctive norms were associated with nearly 2 ½ times higher odds of DUI-A, 8 times higher odds of DUI-C, 4 times higher odds of RWI-A and six and a half times higher odds of RWI-C. DISCUSSION: Results increase the understanding of how injunctive norms-a potentially malleable psychosocial factor-are associated with four impaired driving-related outcomes. Prevention programs that focus on assessing and addressing the norms of these outcomes individually and collectively, such as normative feedback interventions and media campaigns, may be helpful in reducing these behaviors.

Assessing the Dependability of Drinking Motives via Generalizability Theory.

This study assessed the score reliability of the Drinking Motives Questionnaire-Revised (DMQ-R) via generalizability theory. Participants (n = 367 college students) completed the DMQ-R at three time points. Across subscale scores, persons, persons × occasions, and persons × items interactions accounted for meaningful variance. Findings illustrate advantages of generalizability theory-based techniques.

Physical and mental health issues facing community college students.

ObjectiveTo examine health concerns among community college (CC) students by (1) identifying and coding the self-reported health issues facing CC students and (2) examining demographic and psychosocial variables associated with health categories. Participants: 946 CC students (Mage = 26.37) recruited from January 2017 to February 2017 who completed a screening survey for a larger study. Students were asked to "List three health issues facing Community College students today." Methods: Health issues were coded into broad categories and subcategories. Results: Among the 2,601 health issues reported, one-third were medical health (36%), one-third were mental health (33%), with substance use (14%), other health (14%), and access to health care (3%) also reported. The most commonly identified health issues were "general medical issues," "stress," "depression," and "sleep." Conclusions: Programmatic efforts to support CC students and promote prevention/intervention strategies for mental health, sleep, substance use, access to health care, and general medical concerns, remain essential.

Examining daily associations between mental health symptoms and simultaneous alcohol and marijuana use and consequences among young adults.

OBJECTIVE: The present study examined daily associations between mental health symptoms (i.e., depression and anxiety symptoms) and simultaneous alcohol and marijuana (SAM) use and use-related negative consequences among young adults. METHOD: Participants were a community sample of 409 young adults between the ages of 18-25 who drank alcohol at least three times in the past month and reported SAM use in the past month (Mage = 21.6, 50.9% female). A baseline assessment included a measure of SAM use motives, after which participants completed five 14-day bursts reporting daily mental health symptoms and alcohol/marijuana use. RESULTS: Daily mental health symptoms were not associated with SAM use likelihood. However, baseline SAM coping motives moderated the association between mental health symptoms and use such that young adults with stronger coping motives showed a stronger positive association between mental health symptoms and SAM use. Further, on SAM use days, reporting more mental health symptoms relative to one's average was associated with experiencing more use-related negative consequences, even after controlling for daily levels of alcohol and marijuana use (RR = 1.03, 95% CI = 1.01-1.05, p = .002). CONCLUSIONS: The association between daily mental health symptoms and SAM use depended on whether the young adults had coping motives for use. Daily fluctuations in mental health were associated with negative use-related consequences experienced on SAM use days regardless of motives. These findings highlight the potential importance of prevention and intervention strategies particularly on days when young adults are experiencing increased mental health symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Young adult birthday celebrations as windows of risk for alcohol and cannabis use: 21st birthdays compared to other young adult birthdays.

OBJECTIVE: Alcohol use among college students during 21st birthday celebrations constitutes a well-known example of event-specific drinking when alcohol use is both pervasive and heavy. Less is known about how 21st birthday alcohol use compares to other birthday celebrations during young adulthood, whether similar increases occur for cannabis use on 21st birthdays, and whether the "21st birthday effect" is similar for noncollege young adults. Alcohol and cannabis use during 19th to 25th birthday celebrations were explored among college and noncollege students. METHOD: Participants were 720 young adults of ages 18 to 23 (M = 21.1, SD = 1.7) at enrollment who completed 24 monthly surveys, and 204 reported on a 21st birthday. Participants resided in a state where cannabis was legal and were asked the month following their birthday whether they engaged in alcohol and cannabis use as part of their birthday celebration. RESULTS: Multilevel models found a 21st birthday effect for alcohol use as individuals consumed over twice as many drinks on their 21st birthday than would have been expected given age trends in birthday drinking, and this effect held for college and noncollege students. A 21st birthday effect for cannabis was not found. CONCLUSIONS: 21st birthday celebrations represent a high-risk drinking event for young adults in general, and the current findings suggest event-specific prevention programs targeting all young adults turning 21 are warranted. Unlike alcohol where turning 21 is associated with socially and culturally normative use, a similar 21st birthday effect was not found for cannabis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Daily level predictors of impaired driving behaviors in young adults: Protocol design for utilizing daily assessments.

BACKGROUND: Motor vehicle crashes remain a leading cause of death among young adults (ages 18-25) in the United States. Many drivers implicated in these crashes are under the influence of alcohol, cannabis, or the simultaneous use of alcohol and cannabis. Extremely limited research has assessed impaired driving behaviors and their predictors at the daily level. Perceived norms and motives to use substances have empirical support suggesting they may impact impaired driving-related behavior. Novel approaches to assess these associations at the daily level are needed and may inform future intervention and prevention programs. OBJECTIVE: The goal of the current study is to utilize electronic daily assessments to assess driving under the influence of alcohol, cannabis, or simultaneous use and riding with a driver impaired by these substances to assess variability and predictors of these impaired driving-related behaviors at the daily level. This present manuscript details a protocol, measures, and a plan of analyses to assess how within-person differences in perceived norms and motives to use are associated with the likelihood of engaging in impaired driving-related behaviors. METHODS: Participants include young adults in Washington State who report simultaneous use in the past month and either driving under the influence of alcohol, cannabis, or simultaneous use, or riding with a driver under the influence of both substances in the past 6 months. Individuals who verify their identity and meet eligibility requirements will complete a baseline assessment after which they will be scheduled for training on the daily assessment procedure via Zoom. Next, they will be invited to complete daily surveys on Thursday, Friday, Saturday, and Sunday every other week for 6 months and a 6-month follow up assessment. Analyses will utilize multilevel models with days nested within individuals. RESULTS: The study is currently recruiting participants. A total of 192 participants have been recruited and 100 have completed the study protocol. Data collection is expected to be completed in Fall 2022. CONCLUSIONS: This study utilizes a novel design to assess impaired driving and predictors at the daily level among young adults at high risk of impaired driving-related behaviors. Findings will provide unique data that will shape the knowledge base in the field of social science and public health substance use research and that may be helpful for future prevention and intervention efforts on impaired driving.