Confirmatory Factor Analysis and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults in Kenya.

Understanding the levels of power that adolescent girls and young women exercise in their sexual and reproductive lives is imperative to inform interventions to help them meet their goals. We implemented an adapted version of the Sexual and Reproductive Health Empowerment (SRE) Scale for Adolescents and Young Adults among 500 adolescent girls and young women aged 15-20 in Kisumu, Kenya. We used confirmatory factor analysis (CFA) to assess factor structure, and logistic regression to examine construct validity through the relationship between empowerment scores and ability to mitigate risk of undesired pregnancy through consistent contraceptive use. Participants had a mean age of 17.5, and most were students (61 percent), were currently partnered (94 percent), and reported having sex in the past 3 months (70 percent). The final, 26-item CFA model had acceptable fit. All subscales had Cronbach's alpha scores >0.7, and all items had rotated factor loadings >0.5, indicating good internal consistency and robust factor-variable associations. The total SRE-Kenya (SRE-K) score was associated with increased odds of the consistent method used in the past three months (adjusted odds ratio: 1.98, 95 percent CI: 1.29-3.10). The SRE-K scale is a newly adapted and valid measure of sexual and reproductive empowerment specific to adolescent girls and young women in an East African setting.

A randomized controlled trial testing theory-driven enhancements to increase the efficacy of and engagement in a brief cognitive-behavioural therapy text-message intervention for co-occurring posttraumatic stress disorder symptoms and alcohol misuse.

OBJECTIVE: Engaging individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol misuse (AM) in effective treatments is difficult. Brief, self-directed approaches that deliver empirically supported intervention techniques, such as cognitive-behavioural therapy (CBT) strategies, via technology may be effective and easier-to-access alternatives to traditional in-person therapy approaches for PTSD + AM. This paper describes the protocol for an intervention development study (NCT05372042) that evaluates a text-message intervention combining CBT texts with techniques from cognitive psychology (message framing) and social psychology (growth mindsets) for treatment of PTSD + AM. METHOD: The study uses a 3 (message framing: gain vs. loss vs. no framing) × 2 (mindset: growth mindsets vs. not) factorial design to test enhancements to CBT texts. Individuals age 18+, who report symptoms of PTSD and AM, will be recruited to participate. Participants will complete screening, verification, and baseline measures. They will be randomized to condition and receive 3 text messages per week for 4 weeks. Participants will be assessed at post-, 1-, and 3-month follow-up. RESULTS: Analyses will evaluate whether framing and growth mindsets enhance the efficacy of CBT texts. A priori decision rules will be applied to select the intervention condition that is both the most effective and the simplest, which will be tested in a follow-up randomized controlled trial. CONCLUSIONS: This study will identify the simplest, most efficacious CBT intervention for PTSD + AM. Its use of cognitive and social psychology-based enhancement and of a factorial decision can serve as examples of how to enhance and increase engagement in brief, self-directed CBT interventions.

Young Adult Alcohol and Cannabis Impaired Driving After the Opening of Cannabis Retail Stores in Washington State.

Motor vehicle crashes are a leading cause of death for young adults (YA) in the USA, and driving under the influence of alcohol (DUIA), cannabis (DUIC), and simultaneous use of both substances (DUIAC) are prominent risk factors. Trends in YA impaired driving behaviors after opening of cannabis retail stores have been understudied. We examined YA trends in DUIA, DUIC, and DUIAC from immediately prior through 5 years following the opening of cannabis retail outlets in Washington State (2014-2019). Differences in trends were assessed across age, sex, and urbanicity. Weighted logistic regressions assessed yearly change in prevalence of DUIA, DUIC, and DUIAC from 2014 to 2019, using annual statewide data from the Washington Young Adult Health Survey (n = 12,963; ages 18-25). Moderation of trends by age, sex, and urbanicity was assessed. Prevalence of DUIA decreased overall (AOR = 0.93, 95% CI 0.90, 0.97) and among drinkers (AOR = 0.95, 95% CI 0.91, 0.99) but remained at concerning levels in 2019 (10% overall; 16% among drinkers). Overall DUIC did not change significantly (AOR = 0.99, 95% CI 0.96, 1.03; 11% by 2019) but decreased among those who used cannabis (AOR = 0.91, 95% CI 0.86, 0.96; 33% by 2019). DUIAC decreased but not significantly (overall: AOR = 0.89, 95% CI 0.78, 1.01; those who used alcohol and cannabis: AOR = 0.84, 95% CI 0.74, 1.04). Prevalence of YA DUI remained concerning. Trends may reflect some success in reducing DUI, but additional detection and prevention are needed.

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.

Substance-Specific Risk Factors for Cannabis and Alcohol Use Among Young Adults Following Implementation of Nonmedical Cannabis Legalization.

Laws regarding cannabis are rapidly changing in the USA as more states legalize nonmedical cannabis for adults aged 21 and older. Previous research has examined whether legalization has led to an increase in cannabis use as well as the use of other substances. The current study examined changes in cannabis- and alcohol-specific risk factors following legalization of nonmedical cannabis. We used 6 years of annual cross-sectional data (2014-2019) from 12,951 young adults age 18 to 25 who resided in Washington state. Risk factors examined include perceiving that use was common among same-age peers, believing use was acceptable, having easy access, and low perceived physical and psychological harm from use. Logistic regression models estimated annual rate of increase in these risk factors. All cannabis-specific risk factors increased among those aged 21+ (range of ORs for annual rate of change: 1.07-1.31) while significant increase in cannabis-related risk factors among those under age 21 was limited to perceptions of cannabis use being common (medical use: OR=1.08, 95% CI: 1.03, 1.12; nonmedical use: OR=1.13, 95% CI: 1.08, 1.18) and low perceived physical harm of occasional use (OR=1.08, 95% CI: 1.03, 1.13). Although descriptive norms for past-year use of alcohol among those aged 21+ increased (OR = 1.09, 95% CI: 1.02, 1.17), other risk factors for alcohol did not change significantly or, in the case of low perceived physical and psychological harm, decreased among both those under age 21 and those aged 21+ (range of ORs = 0.90-0.94). Given these findings show an increase in cannabis-specific risk factors since legalization was implemented, particularly among those young adults aged 21+, preventive interventions correcting risk misperceptions and related risk factors among young adults aged 21+ may prove efficacious in reducing use and resultant negative consequences.

Prospective Associations between Childhood Exposure to Living with Adult Alcohol Misuse and Major Depressive Disorder in Adulthood: The Role of Child Maltreatment.

BACKGROUND: Many children grow up with adult alcohol misuse in the home. A clearer understanding of this exposure's long-term mental health consequences and the role of associated child maltreatment experiences and potential protective factors could guide relevant intervention strategies. OBJECTIVE: To prospectively evaluate the association between living with adult alcohol misuse during childhood and major depressive disorder (MDD) during adulthood; whether child maltreatment explains the association; and whether sex, school bonding, or neighborhood bonding moderate the association.Participants and setting: This study used longitudinal data from 783 individuals followed from childhood to age 39. METHODS: At grade 9, participants were asked whether they lived with adults who misused alcohol. Diagnostic assessments of MDD were conducted across three time-points during participants' thirties and participants were categorized as having met diagnostic criteria 0, 1, or 2 or more times. RESULTS: Ordinal logistic regressions found that children living with adult alcohol misuse showed greater chronicity of adult MDD (OR = 1.63; 95% CI: 1.05, 2.52). There was a 49% reduction in the odds ratio and the association was no longer statistically significant when child maltreatment was included in the model (OR = 1.32; 95% CI: 0.84, 2.07). No statistically significant moderation of associations was observed. CONCLUSIONS: Children exposed to adult alcohol misuse, and maltreatment often associated with this misuse, may be at risk for mental health challenges well into adulthood. Interventions that address childhood exposure to adult alcohol misuse and associated maltreatment may be important to mitigate long-term mental health challenges to exposed children.

Cannabis Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis.

Objectives. To examine changes in prevalence of cannabis use and of cannabis use disorder symptomatology among young adults from 2014 to 2019 in Washington State, where nonmedical (or "recreational") cannabis was legalized in 2012 and retail stores opened in July 2014. Methods. We used 6 years of cross-sectional data collected annually from 2014 (premarket opening) to 2019 from 12 963 (∼2000 per year) young adults aged 18 to 25 years residing in Washington. Logistic regression models estimated yearly change in prevalence of cannabis use at different margins and related outcomes. Results. Prevalence of past-year, at least monthly, at least weekly, and daily use of cannabis increased for young adults, although increases were driven by changes among those aged 21 to 25 years. There was also a statistically significant increase in prevalence of endorsing at least 2 of 5 possible symptoms associated with cannabis use disorder. Conclusions. Among young adults in Washington, particularly those of legal age, prevalences of cannabis use and cannabis use disorder symptomatology have increased since legalization. This trend may require continued monitoring as the nonmedical cannabis market continues to evolve. (Am J Public Health. 2022;112(4):638-645. https://doi.org/10.2105/AJPH.2021.306641).

Associations of Cumulative and Point-in-Time Neighborhood Poverty and Walkability with Body Mass from Age 30 to 39.

Few studies examining the effects of neighborhood exposures have accounted for longitudinal residential history. This study examined associations of body mass index (BMI, kg/m2) with neighborhood-level walkability and poverty, both assessed concurrently and cumulatively in the years leading up to BMI assessment. Participants (N = 808) were from a cohort study of individuals originally recruited from public schools in Seattle, Washington, in fifth grade in 1985. Height and weight for BMI were obtained at four assessments at ages: 30 (in 2005), 33, 35, and 39. Participants also completed residential timelines listing each address where they lived from ages 28 to 39, creating a continuous record of addresses and moves. Neighborhood-level walkability and poverty were based on census block groups of each address. Generalized estimating equation models estimated associations of standardized neighborhood variables, both at point-in-time concurrently with assessment of BMI and cumulatively up to the time of BMI assessment. Mean BMI across observations was 28.8 (SD = 7.1). After adjusting for covariates, cumulative walkability was associated with lower BMI (b = - 0.28; 95% CI: - 0.55, - 0.02), and cumulative neighborhood poverty was associated with higher BMI (b = 0.35; 95% CI: 0.09, 0.60). When examining point-in-time concurrent walkability and poverty with BMI, adjusted associations were close to the null and non-significant. This study provides evidence for a significant role of cumulative exposure to neighborhood built and socioeconomic environments predicting BMI. It underscores the relative strength and importance of cumulative assessments to capture neighborhood exposure not captured through point-in-time assessments.

Neighborhood greenspace exposure as a protective factor in dementia risk among U.S. adults 75 years or older: a cohort study.

BACKGROUND: Research suggests that greenspace may confer neurocognitive benefits. This study examines whether residential greenspace is associated with risk of dementia among older adults. METHODS: Greenspace exposure was computed for 3047 participants aged 75 years and older enrolled in the Gingko Evaluation of Memory Study (GEMS) across four U.S. sites that prospectively evaluated dementia and its subtypes, Alzheimer's disease (AD), vascular dementia (VaD), and mixed pathologies, using neuropsychiatric evaluations between 2000 and 2008. After geocoding participant residences at baseline, three greenspace metrics-Normalized Difference Vegetative Index, percent park overlap within a 2-km radius, and linear distance to nearest park-were combined to create a composite residential greenspace measure categorized into tertiles. Cox proportional hazards models estimated the associations between baseline greenspace and risk of incident all-cause dementia, AD, and Mixed/VaD. RESULTS: Compared to low residential greenspace, high residential greenspace was associated with a reduced risk of dementia (HR = 0.76 95% CI: 0.59,0.98) in models adjusted for multiple covariates. After additional adjustment for behavioral characteristics, Apolipoprotein E ɛ4 status, and other covariates, the association was slightly attenuated (HR = 0.82; 95% CI:0.63,1.06). Those exposed to medium levels of greenspace also had 28% lower risk (HR = 0.72; CI: 0.55, 0.95) of dementia compared to those with low greenspace in adjusted models. Subtype associations between high residential greenspace and AD were not statistically significant. Greenspace was not found to be significantly associated with mixed/vascular pathologies. CONCLUSIONS: This study showed evidence for an association between residential greenspace and all-cause dementia among older adults. Future research with larger sample size, precise characterization of different dementia subtypes, and assessment of residential greenspace earlier in life may help clarify the role between exposure to greenspace and dementia risk.

Mental Health and Well-Being Trends Through the First Year-and-a-Half of the COVID-19 Pandemic: Results from a Longitudinal Study of Young Adults in the USA.

This study examined longitudinal trajectories of young adults' mental health and well-being before and throughout the first year-and-a-half of the COVID-19 pandemic. Repeated assessments of a young adult community cohort (N = 656; Mage = 25.6 years; 59.3% female) were conducted beginning prior to COVID-19 (January 2020) and extending through August 2021. Multilevel spline growth models estimated changes in three segments: (a) from pre-pandemic to April/May 2020, (b) from April/May 2020 to September 2020, and (c) from September 2020 to August 2021. Depression symptoms and loneliness increased significantly in the first segment, plateaued slightly, then decreased significantly across the final segment. Anxiety symptoms were unchanged across the first two segments, but significantly decreased in the final segment. Satisfaction with life decreased significantly across the first two segments, and then increased significantly in the final segment. Direct comparisons of pre-pandemic scores (January 2020) to the last follow-up (July or August 2021) showed a return to pre-pandemic levels of depression symptoms, loneliness, and satisfaction with life, as indicated by non-significant differences, and significantly lower anxiety symptoms, relative to pre-pandemic. Findings support concerns for young adults' mental health and well-being in the initial months of the COVID-19 pandemic, but also indicate that young adults' emotional well-being, on average, may be returning to pre-pandemic levels.

Substance-Specific Risk Factors among Young Adults: Potential Prevention Targets across Cannabis-Permissive Environments.

PURPOSE: This study examined levels of substance-specific risk factors such as perception of harm from substance use among young adults in a range of cannabis-permissive environments. The main objective was to inform future preventive interventions aimed at reducing cannabis use in the context of increasingly permissive environments. METHODS: Data came from the Community Youth Development Study (CYDS) collected in 2016 when participants were about 23 years old (n = 1,722 participants residing in 46 U.S. states). Young adults self-reported their perceptions about the harms related to cannabis, alcohol, and cigarette use; attitudes about and ease of access to cannabis and other substances; and perceived wrongfulness and social acceptability of cannabis, alcohol, and cigarette use and of selling of cannabis and other illegal drugs. RESULTS: Young adults in more permissive cannabis contexts reported higher levels of all cannabis-specific risk factors (e.g., greater access to and more favorable attitudes about cannabis use), except for perception of harm from regular cannabis use. However, permissiveness of the cannabis environment was not associated with heightened levels of risk factors for other substance use (such as alcohol, cigarettes, and opioids). CONCLUSIONS: Future preventive interventions for young adults living in more permissive cannabis contexts may need to focus on cannabis-specific risk factors in particular and go beyond considerations of harm from regular use. Future studies should replicate these findings with other samples.

Dual trajectories of cannabis and alcohol use among young adults in a state with legal nonmedical cannabis.

BACKGROUND: Understanding the nature of the association between cannabis and alcohol use within individuals over time in the era of legalized cannabis is of crucial importance for assessing the public health consequences of increasing cannabis use. An important unanswered question is whether cannabis and alcohol use substitute for one another. Specifically, is greater use of one substance associated with less use of the other substance (i.e., a negative association) or are the substances complementary and their association positive? METHODS: We used 24 consecutive months of data on a young adult sample (n = 774; 56% female, age 18-25 during the study) who drank alcohol in the year prior to enrollment. The sample was recruited in Washington State in 2015/2016 (after legalization of nonmedical cannabis) using media advertisements and community flyers and outreach. Using parallel process latent growth curve models, we assessed three types of association between cannabis and alcohol use across the 24-month period: (1) an association between average levels of cannabis and alcohol use; (2) an association between rates of change in cannabis and alcohol use; and (3) correlations between shorter-term deviations/fluctuations off of longer-term trajectories of level and change in cannabis and alcohol use. RESULTS: We found a positive association between the average frequency of cannabis and alcohol use; individuals who used cannabis more frequently on average also drank alcohol more frequently on average. Change over time in cannabis use was positively associated with change in alcohol use. There was also a contemporaneous positive association between fluctuations in cannabis and alcohol use. CONCLUSIONS: Overall, we found no evidence of substitution. Rather, the results suggest a complementary relationship between cannabis and alcohol use, such that the use of cannabis and alcohol rises and falls together.

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.

Transitions Catalyst Model: Testing within- and between-Person Associations between Social Relationships and Alcohol Use, Motives, and Consequences among Young Adults.

Background: The Transitions Catalyst Model suggests increased drinking during young adulthood is due to the notion that alcohol facilitates friendships and romantic/sexual relationships during a developmental period when these relationships are highly valued. However, little research has tested the utility of this model. We examined (1) whether young adults reported greater drinking and related consequences on months when friendships were more important to them or when they were dating casually, and (2) the extent to which social drinking motives explain these associations on a given month. Methods: Data were drawn from 752 young adults (ages 18-23 at screening) living in the Seattle, WA area (56.4% female). For 24 consecutive months, surveys assessed past month alcohol use and consequences, social drinking motives, friendship importance, and dating/relationship status. Bayesian multilevel models were conducted, adjusting for time-fixed and time-varying covariates. Results: Analyses included 11,591 monthly observations. Between-persons, greater average friendship importance was associated with greater drinking. On months when participants reported greater friendship importance than their own average, they reported greater drinking and alcohol consequences. Those who reported more months of casual dating reported greater drinking and consequences on average. Relative to casual dating months, participants reported less drinking during months they were single or in a relationship and fewer consequences during months in a relationship. Associations were partially accounted for by social motives. Discussion: Findings support the Transitions Catalyst Model. Effective strategies for reducing drinking and associated risks among young adults include brief interventions focused on how social drinking motives and relationships relate to drinking decisions.

Neighborhood Structural Factors and Proximal Risk for Youth Substance Use.

This study examined associations of neighborhood structural factors (census-based measures, socioeconomic disadvantage, and residential stability); self-reported measures of general and substance use-specific risk factors across neighborhood, school, peer, and family domains; and sociodemographic factors with substance use among 9th grade students. Data drawn from the Seattle Social Development Project, a theory-driven longitudinal study originating in Seattle, WA, were used to estimate associations between risk factors and past month cigarette smoking, binge drinking, marijuana use, and polysubstance use among students (N = 766). Results of logistic regression models adjusting for neighborhood clustering and including all domains of risk factors simultaneously indicated that neighborhood socioeconomic disadvantage was associated with a significantly higher likelihood of cigarette smoking, binge drinking, and polysubstance use, but not marijuana use. In fully controlled models, substance use-specific risk factors across neighborhood, school, peer, and family domains were also associated with increased likelihood of substance use and results differed by the outcome considered. Results highlight substance-specific risk factors as an intervention target for reducing youth substance use and suggest that further research is needed examining mechanisms linking neighborhood socioeconomic disadvantage and youth substance use.

Neighborhood Deprivation Moderates Shared and Unique Environmental Influences on Hazardous Drinking: Findings from a Cross-Sectional Co-Twin Study.

Background: There has been increased interest in the interplay of genetic and environmental factors in the development of problematic alcohol use, including socioeconomic conditions of the neighborhood. Using a co-twin design, we examined the extent to which contributions of genetic, shared environmental, and unique environmental influences on hazardous drinking differed according to levels of neighborhood socioeconomic deprivation. Method: Data came from 1,521 monozygotic (MZ) and 609 dizygotic (DZ) twin pairs surveyed in Washington State. A measure of neighborhood deprivation was created based on census-tract-level variables and the Alcohol Use Disorders Identification Test 3-item instrument was used to assess level of hazardous drinking. We tested a series of nested structural equation models to examine associations among hazardous drinking, neighborhood deprivation, and the variance components (genetic [A], shared [C] and unique environmental [E] influences) of these two constructs, testing for both main effects and moderation by neighborhood deprivation. Results: Neighborhood deprivation was significantly associated with increased hazardous drinking, after accounting for A and C variance common to both phenotypes. Adjusting for within-pair differences in income and education, neighborhood deprivation moderated the magnitude of variance components of hazardous drinking, with the variance attributable to shared environment and non-shared environment increasing in more deprived neighborhoods. Conclusions: Findings point to amplification of early childhood as well as unique adulthood environmental risk on hazardous drinking in areas of greater deprivation.

A Daily-Level Analysis of Moderators of the Association between Alcohol Expectancies and Alcohol Use among College Student Drinkers.

Background: Alcohol expectancies, or the perceived likelihood of experiencing certain effects after consuming alcohol, are associated with college student drinking such that heavier drinkers expect a greater likelihood of positive effects. However, less is known as to whether day-to-day within-person deviations in expectancies are associated with drinking that same day and for whom and when these associations may be strongest. Objectives: The aim of this study was to examine daily-level associations of positive and negative alcohol expectancies with alcohol use, and whether associations differed according to demographic characteristics and additional alcohol-related constructs. Methods: College student drinkers (N = 327, 53.8% female) participated in an intensive longitudinal study that captured daily-level data. Alcohol use and expectancy measures were utilized from a baseline session and at the daily-level using Interactive Voice Response (IVR). Results: Results found that on days when participants reported stronger positive and negative expectancies than their average, they were more likely to drink as well as consume more alcohol when drinking. Moderation analyses revealed that positive expectancies were more positively associated with the likelihood of any drinking for women relative to men, and more positively associated with the quantity of alcohol consumption for younger students, students with lower baseline rates of drinking, and students with greater overall positive alcohol expectancies. Conclusions/Importance: The findings demonstrate that alcohol expectancies fluctuate within-person across days and these fluctuations are meaningful in predicting same-day drinking. Interventions that seek to modify expectancies proximal to drinking events may be considered to reduce college student drinking.

Moderation of relation between psychological risk factors and alcohol use by sex.

Alcohol consumption is a significant public health concern among young adults, with most recent research suggesting that the sex gap in alcohol consumption among young adults is closing. Thus, the present study tested sex as a moderator for known risk factors for alcohol use (impulsivity, sensation seeking, mindfulness). We examined sex differences by surveying young adults (n = 1,437) from across Washington state between 2011 and 2013 on alcohol risk factors (impulsivity, sensation seeking, mindfulness), alcohol consumption (quantity and frequency), and alcohol related negative consequences. Zero inflated Poisson and Zero inflated Negative Binomial models revealed that sex moderated the relationship between Peak Blood Alcohol Content (BAC) and impulsivity such that higher impulsivity was more strongly related to higher Peak BAC for women than for men. Overall, these results suggest that very few sex differences exist in alcohol consumption and alcohol-related negative consequences. Future research should look beyond the risk factors studied here to identify other important mechanisms that vary by sex that may be important targets for clinical or prevention efforts related to alcohol consumption.

Patterns of Young Adult Social Roles Transitions Across 24 Months and Subsequent Substance Use and Mental Health.

Young adults experience social role transitions across multiple life domains, and a deeper understanding of the ways in which these simultaneous transition experiences are associated with substance use and mental health will inform targeted interventions for this population. Data from the current study include24 repeated monthly assessments of young adults (N = 778; 56% female; age range 18 to 24 at baseline; 60% White, 18% Asian, 12% Multiracial, 5% Black or African American, 1% American Indian, 1% Pacific Islander, 3% Other, 9% Latinx) and outcomes 6 months later. Monthly assessments across 2 years were used to identify latent classes of frequency of social role transitions in four key domains (education, residential, employment, and romantic relationships) and associations between these classes and later outcomes. Three classes of social role transitions were identified: Infrequent Transitions (30.4%), Transitions except in Relationships (38.5%), and Frequent Transitions (31.1%). Compared to the Infrequent Transitions class, the other classes had greater typical drinking and hazardous alcohol use six months later; the Frequent Transitions class also had more hazardous cannabis use, depressive symptoms, and anxiety symptoms. Young adults experiencing frequent transitions across multiple domains appear to be at risk for substance use and mental health problems and may benefit from targeted intervention to address substance use and mental health issues.

Emergence of Depressive Symptoms from Kindergarten to Sixth Grade.

This study documents the emergence of symptoms of anxiety and depression in a community sample of school-age children and describes the temporal progression of symptoms leading to depressive episodes. Caregivers of 468 seventh graders reported retrospectively the manifestation of 14 symptoms of depression and anxiety in their children from kindergarten through sixth grade. The sample was balanced by sex and reflected the racial and economic diversity of the urban school district. Childhood period prevalence was calculated for each symptom, and discrete time survival analyses compared likelihoods of early symptom emergence in children who did and did not meet diagnostic criteria for major depressive disorder (MDD) by ninth grade. Symptom prevalence ranged between 20% (excessive guilt) and 50% (concentration problems) during the elementary school years. The 4-year period prevalence of MDD was 8.9%, 95% confidence interval [6.5%, 12.1%]. Low energy, excessive worry, excessive guilt, anhedonia, social withdrawal, and sadness or depressed mood were each associated with a significantly higher likelihood of onset of MDD. Compared to girls, boys were more likely to exhibit sad mood, fatigue, and trouble concentrating. Children who later met criteria for MDD demonstrated a significantly higher likelihood of showing core features of depressive and anxiety disorders during their elementary school years. The findings underscore the importance of recognizing early signs and developing interventions to help children manage early symptoms and prevent later psychiatric illness.