Pilot study comparing sleep logs to a commercial wearable device in describing the sleep patterns of physicians-in-training.

With the increasing burden of professional burnout in physicians, attention is being paid to optimizing sleep health, starting in training. The multiple dimensions of physicians' sleep are not well described due to obstacles to easily and reliably measuring sleep. This pilot study tested the feasibility of using commercial wearable devices and completing manual sleep logs to describe sleep patterns of medical students and residents. Prospective pilot study of 50 resident physicians and medical students during a single year of training. Participants completed a manual sleep log while concurrently wearing the Fitbit Inspire device for 14-consecutive days over three clinical rotations of varying work schedules: light, medium, and heavy clinical rotations. Study completion was achieved in 24/50 (48%) participants. Overall correlation coefficients between the sleep log and Fitbit were statistically low; however, the discrepancies were acceptable, i.e., Fitbit underestimated time in bed and total sleep time by 4.3 and 2.7 minutes, respectively. Sleep onset time and waketime were within 8 minutes, with good agreement. Treatment of sleep episodes during the day led to variance in the data. Average missingness of collected data did not vary between medical students or residents or by rotation type. When comparing the light to heavy rotations, hours slept went from 7.7 (±0.64) to 6.7 (±0.88), quality-of-life and sleep health decreased and stress, burnout, and medical errors increased. Burnout was significantly associated with worse sleep health, hours worked, and quality-of-life. Prospective data collection of sleep patterns using both sleep logs and commercial wearable devices is burdensome for physicians-in-training. Using commercial wearable devices may increase study success as long as attention is paid to daytime sleep. In future studies investigating the sleep of physicians, the timing of data collection should account for rotation type.

Predisposing, Precipitating, and Perpetuating Factors of Insomnia in Cancer Survivors.

OBJECTIVES: To explore and characterize predisposing, precipitating, and perpetuating factors of subthreshold, moderate, and severe insomnia in cancer survivors. SAMPLE & SETTING: 135 cancer survivors who self-reported symptom severity on the Insomnia Severity Index during the baseline phase of a randomized clinical trial on insomnia treatment. METHODS & VARIABLES: Participants completed measures assessing predisposing factors (age, sex, race and ethnicity, body mass index), precipitating factors (number of years since cancer diagnosis, depression and anxiety symptoms, health-related quality of life), and perpetuating factors (frequency of consuming alcoholic and caffeinated beverages, napping behavior, dysfunctional beliefs about sleep). RESULTS: In the multivariate model, being female was protective against insomnia, and being a person of color, having higher anxiety, having more depression symptoms, and having stronger dysfunctional beliefs about sleep were significantly associated with greater insomnia severity. IMPLICATIONS FOR NURSING: By fostering interprofessional collaboration and implementing evidence-based interventions, nurses can contribute to the well-being of cancer survivors and address their sleep-related challenges. This study underscores the importance of regular insomnia screenings for cancer survivors, with nurses as essential facilitators.

Sleep-wake state discrepancy among cancer survivors with insomnia symptoms.

PURPOSE: To evaluate the discrepancy and correlation between sleep-wake measures (i.e., time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE%)) reported on sleep diary and measured by actigraphy among cancer survivors with insomnia symptoms; and examine the influences of sociodemographic and clinical variables on these measurement differences. METHODS: A heterogenous sample of cancer survivors with insomnia symptoms (n = 120; M age = 63.7 ± 10.1; female = 58.3%) was included. Seven consecutive days of sleep diary and actigraphic data were obtained along with information on demographic, sleep, and mental health symptoms. Bland-Altman plot, Pearson correlation coefficient, concordance correlation coefficient, and mixed linear model approach were used to conduct the analysis. RESULTS: Self-reported TIB, SOL, and WASO were longer than measured by actigraphy (TIB: 8.6 min. (95% CI, 3.7, 13.5; p < .001); SOL: 14.8 min. (95% CI, 9.4, 20.2; p < .0001); and WASO: 20.7 min. (95% CI, 9.4, 20.2; p < .0001), respectively); and self-reported TST and SE% were shorter than measured by actigraphy (TST: 6.8 min. (95% CI, -18.7, 5.13); and SE%: 0.7% (95%CI, -3.0, 2.0), respectively), but were not statistically significant. Sex, higher insomnia severity, and poor sleep quality were associated with discrepancy between several sleep-wake measures. CONCLUSION: Subjective and objective sleep-wake measures may present discrepant finding among cancer survivors with symptoms of insomnia. Future research is needed to validate appropriate sleep-wake assessment, and better understand factors that influence the discrepancy that exists between measures among this population. CLINICAL TRIAL REGISTRATION: Clinical trials identifier: NCT03810365. Date of registration: January 14, 2019.

What Can Customers See? Exposed Information on E-Cigarette Online Retail Website: A Systematic Review.

BACKGROUND: The internet is the main channel for electronic nicotine delivery systems sales that the media uses to publicize electronic cigarettes (e-cigarettes). Once e-cigarettes entered the market, they quickly became widely available online and in retail stores in many countries and regions around the world. This systematic review aims to explore the online marketing strategies for e-cigarette retail websites including the design of e-cigarette retail websites and how the information of retail websites was exposed to the public. METHOD: Studies were searched in five databases: Cumulative Index to Nursing and Allied Health Literature, EMBASE, Web of Science, Communication & Mass Media Complete, and PubMed. Included studies were published between 2007 and 2019. RESULTS: Eight studies were included in this review. Topics covered included smoking cessation claims, nicotine content claims, health or harmful substance exposure claims, age restriction/verification, membership and discounts, and media and celebrity effect. Most of the claims included information about the benefits of e-cigarettes, such as helping to quit smoking, being more environmentally friendly than traditional paper cigarettes, and not containing nicotine. Common marketing techniques included celebrity endorsements, showing discounts or membership offers, or getting a link to buy from the media. CONCLUSIONS: The marketing of e-cigarettes is complex, and the authenticity of the information presented on the websites needs to be thoroughly understood. Such information will undoubtedly increase the interest and desire of potential buyers for e-cigarettes. Therefore, it is critical to establish necessary regulations regarding e-cigarette product information.

Pediatric sleep: current knowledge, gaps, and opportunities for the future.

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

Sleep health, its intraindividuality, and perceived stress in college students during the COVID-19 pandemic.

Objective: To describe the changes in sleep health domains and examine the associations between the repeated measures and intraindividual variability (IIV) of these domains and perceived stress. Participants: A diverse racial and ethnic group of first-year college students (N = 23, 78.3% female, aged 17-18) attending in-person classes during the COVID-19 pandemic. Methods: Sleep health domains were determined using 7-day wrist actigraph and daily sleep diaries, and perceived stress scale was completed at 1-month intervals across 3 months. Results: Sleep timing, regularity, and alertness during daytime demonstrated statistically significant changes between three timepoints. Greater stress was associated with more irregularity (B = 2.25 [.87-3.62], p < .001), more dissatisfaction in sleep (B = .04 [.02-.19], p < .01), alertness during daytime (B = .18 [.05-.31], p < .001), and greater IIV (ie, fluctuations) in sleep satisfaction (B = .083 [.02, .15], p < .01). Conclusion: These findings offer insights for future researchers to facilitate intervention development to promote mental and sleep health among college students.

A nurse-delivered intervention to reduce insomnia in cancer survivors: Study protocol for a randomized-controlled trial.

Insomnia has been frequently reported as one of the most burdensome symptoms among cancer survivors. To date, little research exists on strategies to effectively reduce insomnia in cancer survivors, especially in the application of cognitive behavioral therapy for insomnia (CBTI) at the bedside by nurses. The current objective is to determine efficacy and durability of a streamlined, individually delivered version of CBTI, specifically Brief Behavioral Therapy for Insomnia (BBTI) versus a healthy eating attention control, using a large heterogeneous sample of 158 cancer survivors. Study participants will be adults ≥18 years of age; ≥1 month from treatment (except hormones and targeted therapies are acceptable) for stages I through III breast, colorectal, lung or prostate cancers; meet criteria for insomnia defined by Insomnia Severity Index (ISI) >7; screen negative for obstructive sleep apnea <15 events/h; and ability to complete data collection instruments in English. Baseline, and then 1-, 3-, and 12-month objective (i.e., actigraphy) and subjective sleep, mood, and quality of life assessments after the interventions are planned. The primary outcome will be measured with the ISI, a psychometrically-sound instrument used to measure perceived insomnia severity. The results of this trial will demonstrate the application of BBTI in a larger heterogenous sample of cancer survivors for the first time and may lead to implementation strategies that will promote the dissemination and sustainability of this intervention. Clinical trials identifier: http://ClinicalTrials.gov, NCT03810365.

Instruments to measure e-cigarette related constructs: a systematic review.

BACKGROUND: Electronic cigarettes (e-cigarettes) are relatively new tobacco products that are attracting public attention due to their unique features, especially their many flavor options and their potential as an alternative to cigarettes. However, uncertainties remain regarding the determinants and consequences of e-cigarette use because current research on e-cigarettes is made more difficult due to the lack of psychometrically sound instruments that measure e-cigarette related constructs. This systematic review therefore seeks to identify the instruments in the field that are designed to assess various aspects of e-cigarette use or its related constructs and analyze the evidence presented regarding the psychometric properties of the identified instruments. METHODS: This systematic review utilized six search engines: PubMed, Medline, CINAHL, PsycINFO, Web of Science, and EMBASE, to identify articles published in the peer-reviewed journals from inception to February 2022 that contained development or validation processes for these instruments. RESULTS: Eighteen articles describing the development or validation of 22 unique instruments were identified. Beliefs, perceptions, motives, e-cigarette use, and dependence, were the most commonly assessed e-cigarette related constructs. The included studies reported either construct or criterion validity, with 14 studies reporting both. Most studies did not report the content validity; for reliability, most reported internal consistencies using Cronbach's alpha, with 15 instruments reporting Cronbach's alpha > 0.70 for the scale or its subscales. CONCLUSIONS: Twenty-two instruments with a reported development or validation process to measure e-cigarette related constructs are currently available for practitioners and researchers. This review provides a guide for practitioners and researchers seeking to identify the most appropriate existing instruments on e-cigarette use based on the constructs examined, target population, psychometric properties, and instrument length. The gaps identified in the existing e-cigarette related instruments indicate that future studies should seek to extend the validity of the instruments for diverse populations, including adolescents. Instruments that explore additional aspects of e-cigarette use and e-cigarette related constructs to help build a strong theoretical background and expand our current understanding of e-cigarette use and its related constructs, should also be developed.

Physical and mental health outcomes associated with adolescent E-cigarette use.

INTRODUCTION: Use of electronic cigarettes (e-cigarette) and other electronic nicotine delivery systems (ENDS) among adolescents has increased dramatically, creating a need for research to examine the consequences of e-cigarette use on adolescent health. Given the emergent state of the research literature, this integrative review sought to summarize what is currently known about the physical and mental health outcomes associated with e-cigarette use in an adolescent population, and to identify directions for future research. METHOD: The methodology for this integrative review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A methodical search was conducted in February 2020 in PubMed, CINAHL, and Web of Science databases. To be eligible for inclusion, studies had to address e-cigarette use, have samples that were between 13 and 24 years of age, be published in a peer-reviewed journal, and examine health outcomes associated with e-cigarette use. After the screening process, 18 studies were included. RESULTS: Physical health outcomes associated with e-cigarette use included oral health and respiratory problems as well as nicotine dependence. Mental health outcomes included depression and suicidal ideation. In studies that compared e-cigarette use to conventional cigarette use and non-use, e-cigarettes tended to be associated with more problems than non-use, but fewer problems than conventional cigarette use. Dual use, that is, use of both conventional cigarettes and e-cigarettes, was associated with the greatest harm. CONCLUSION: Although somewhat less harmful than conventional cigarettes, e-cigarette use is related to a variety of negative physical and mental health outcomes among adolescent users.

Nurses' Experience and Perception of Technology Use in Practice: A Qualitative Study Using an Extended Technology Acceptance Model.

The purposes of this study are to provide insight into the factors identified as benefits and drawbacks of technology use by nurses and obtain suggestions on improving technology, based on challenges identified to improve patient outcomes. Holden's extended technology acceptance model was used to describe nurses' perception of technology use in practice. A descriptive design and thematic analysis were used to evaluate participants' logged reflections of their experiences and suggestions for improvements of health information technology. Findings indicate that nurses' experiences and perceptions regarding the use of various types of technology (electronic health records, large databases, crowdsourcing, bio-surveillance) were positive. New subdomains emerged for job performance and efficiency, usefulness for public health, contribution to nursing science, and better communication. Identified challenges were insufficient training and support, lack of interoperability, risk of low-quality care from reliance on technology, increased cost, glitches, and alarm fatigue. Understanding nurses' perceptions of technology is anticipated to enhance care quality and possibly lead to improved outcomes. Nurses' perceptions of the use and acceptance of technology are important as their view is associated with performance and may directly influence clinical outcomes and patient satisfaction. Thematic findings include recommendations from participants to improve patient outcomes and patient care.

Brief Behavioral Treatment for Insomnia: A Meta-Analysis.

PURPOSE: The current study aims to quantify the effect of brief behavioral treatment for insomnia (BBTI) studies through meta-analysis. METHOD: Searches were performed from inception to February 2020, reporting on the effects of BBTI using randomized controlled trials (RCT) (adults aged 32 to 84). The main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE%), and total sleep time (TST). RESULTS: BBTI showed improved SOL compared with control group in mean difference at early (-15.42 [95% CI: -33.05 to -12.01; I2 =49%]) and late follow-up (-10.52 [95% CI: -1.12 to 0.54; I2=93%]). This was statistically significant at early follow-up, but not at late follow-up. The improvement of WASO by BBTI over the control group was shown at early follow-up (-17.47 [95% CI: -2.67 to 0.45; I2=90%]), and was statistically significant. For WASO, a non-statistically significant improvement of BBTI over the control group was shown at late follow-up (-12.77 [95% CI: -22.47 to -3.08; I2=0%]). SE% was shown improved statistically significant by BBTI over control group at early (4.47 [95% CI: -0.35 to 9.29; I2=98%]) and at late follow-up (6.52 [95% CI: -4.00 to 17.05; I2=89%]). The TST was shown no improvement by BBTI at early follow-up in mean difference (-2.97 [95% CI -38.83 to 32.90; I2=96%]). At late follow-up, TST was shown improvement in BBTI with mean difference (14.52 [95% CI: -31.64 to 60.68; I2=94%]) compared with the control group. CONCLUSION: Current evidence suggests that BBTI can be considered preliminarily efficacious and can be used for samples of middle-aged and older adults.

Flipping the Classroom: Incorporating Video Production in Public Health Nursing Education.

A video production activity utilizing a flipped-classroom approach was used in a public health nursing course to educate undergraduate nursing students about infectious diseases. After reviewing an audio-recorded lecture at home, students were divided into small groups to create short video clips on selected infectious diseases. Four themes emerged from the subsequent participant survey: engagement, in-depth understanding but concerns for new knowledge acquisition, practical, and room for improvement. The flipped classroom approach with video production encouraged students to engage in their public health nursing class and provided them with an opportunity to practice important communication skills.

Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews.

BACKGROUND: Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. OBJECTIVE: This study aims to explore the usability and content validity of DHLI. METHODS: Upon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. RESULTS: Clarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. CONCLUSIONS: The initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy.

Association Between Substance Use and Insufficient Sleep in U.S. High School Students.

Multidimensional causes of insufficient sleep among adolescents are not fully explored, particularly, the association between substance use and sleep duration. The 2017 Youth Risk Behavior Surveillance System (YRBSS) of high school students (N = 14,638; 51% female, 14-18 years old) was used to examine the association between substance use, namely cigarette, electronic vapor, alcohol, and marijuana use in the past 30 days, and insufficient sleep (<8 hr) using logistic regression analyses. Findings suggest that the use of alcohol (adjusted odds ratio [AOR], 1.42; 95% CI [1.22, 1.65]) and marijuana (AOR, 1.19; 95% CI [1.00, 1.41]) was significantly associated with having insufficient hours of sleep adjusting for age, sex, race, and computer use ≥3 hr per day. Moreover, interaction effects were examined for sex and age, which revealed that the association between marijuana use and having insufficient sleep was stronger for male and younger students. It highlights the potential value of sleep assessment among adolescent substance users.

Access to Cancer Care Resources in a Federally Qualified Health Center: a Mixed Methods Study to Increase the Understanding of Met and Unmet Needs of Cancer Survivors.

Assessing the met and unmet needs of cancer survivors is critical in optimizing access to cancer services especially in underserved populations. The purpose of this study is to expand our understanding of the priority needs for cancer survivorship within racial/ethnic and underserved populations that speak either English or Spanish and seek health care in a federally qualified health center (FQHC). A convergent mixed methods design integrating survey and focus group data was utilized for this study. A total of 17 participants were enrolled in the study. The meta-inferences were drawn by looking across the top ten matched survey and focus group met and unmet needs including psychological, informational, and health system as well as patient care and support. The preferred languages of participants were Spanish 53% (n = 9) and English 47% (n = 8), and the survival breakdown was 65% (n = 11) within 0-5 years with 17.5% (n = 3), 6-10 years and 17.5% (n = 3), and 17.5% (n = 3) > 11 years. The most frequently met needs included health care providers and hospital staff being attentive to their physical and emotional needs and feeling they were treated with respect. Unmet needs were often related to physical and daily living needs such as pain, fatigue, sadness, depression, and not being able to work. Providing a needs-based approach of cancer health services in a FQHC or similar community-based health center is critical to meet the needs of cancer survivors to improve health outcomes and quality of life.

Sleep Quality as a Mediator of the Relationship Between Cyber Victimization and Depression.

PURPOSE: Cyber victimization is a national mental health concern, especially among adolescents who are digital natives. The current study examined sleep quality as a mediator of the association between cyber victimization and depressive symptoms among adolescents. DESIGN AND METHOD: A prospective study design was utilized with a community sample of adolescents (N = 801; 57% female; mean age = 14.45, SD = .85) from the eastern United States. Participants completed (a) the Pittsburgh Sleep Quality Index; (b) the Cyber Victimization Scale; and (c) the Center for Epidemiologic Studies Depression Scale Revised via online surveys at baseline and 6-month follow-up. The inter-relationship between variables was analyzed by Hayes' mediation approach. FINDINGS: Cyber victimization was not directly associated with having depressive symptoms 6 months later when controlling for adolescents' poor sleep quality, sex, and age (direct effect [c'] = .012, t(676) = 1.12, p < .05, confidence interval [CI] -.008, .036). The mediation analysis indicated a significant indirect effect of poor sleep quality on the relationship between cyber victimization and depressive symptoms (ab = .005, bootstrapped standard error [SE] = .003, bootstrapped CI .001, .011; a is the effect of cyber victimization on poor sleep quality; b is the effect of poor sleep quality on depressive symptoms). Specifically, adolescents' cyber victimization led to poor sleep quality (a = .039, SE = .041, p < .05), which also led to increased depressive symptoms (b = .116, SE = .019, p < .001), after controlling for depressive symptoms at baseline, sex, and age. The indirect effect of cyber victimization on depressive symptoms was estimated through poor sleep quality (a*b = .039(.116) = .0045). CONCLUSIONS: The findings suggest that poor sleep quality may be a mechanism through which cyber bullying is related prospectively to depressive symptoms. Interventions for cyber-victimized adolescents should include assessment of sleep quality and incorporate sleep hygiene education. CLINICAL RELEVANCE: Adolescents should be screened for cyber victimization and sleep quality. Moreover, promotion of sleep hygiene among cyber-victimized adolescents may help to reduce depression.

Perceptions and Sentiments About Electronic Cigarettes on Social Media Platforms: Systematic Review.

BACKGROUND: Electronic cigarettes (e-cigarettes) have been widely promoted on the internet, and subsequently, social media has been used as an important informative platform by e-cigarette users. Beliefs and knowledge expressed on social media platforms have largely influenced e-cigarette uptake, the decision to switch from conventional smoking to e-cigarette smoking, and positive and negative connotations associated with e-cigarettes. Despite this, there is a gap in our knowledge of people's perceptions and sentiments on e-cigarettes as depicted on social media platforms. OBJECTIVE: This study aimed to (1) provide an overview of studies examining the perceptions and sentiments associated with e-cigarettes on social media platforms and online discussion forums, (2) explore people's perceptions of e-cigarette therein, and (3) examine the methodological limitations and gaps of the included studies. METHODS: Searches in major electronic databases, including PubMed, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Web of Science, and Communication and Mass Media Complete, were conducted using the following search terms: "electronic cigarette," "electronic vaporizer," "electronic nicotine," and "electronic nicotine delivery systems" combined with "internet," "social media," and "internet use." The studies were selected if they examined participants' perceptions and sentiments of e-cigarettes on online forums or social media platforms during the 2007-2017 period. RESULTS: A total of 21 articles were included. A total of 20 different social media platforms and online discussion forums were identified. A real-time snapshot and characteristics of sentiments, personal experience, and perceptions toward e-cigarettes on social media platforms and online forums were identified. Common topics regarding e-cigarettes included positive and negative health effects, testimony by current users, potential risks, benefits, regulations associated with e-cigarettes, and attitude toward them as smoking cessation aids. CONCLUSIONS: Although perceptions among social media users were mixed, there were more positive sentiments expressed than negative ones. This study particularly adds to our understanding of current trends in the popularity of and attitude toward e-cigarettes among social media users. In addition, this study identified conflicting perceptions about e-cigarettes among social media users. This suggests that accurate and up-to-date information on the benefits and risks of e-cigarettes needs to be disseminated to current and potential e-cigarette users via social media platforms, which can serve as important educational channels. Future research can explore the efficacy of social media-based interventions that deliver appropriate information (eg, general facts, benefits, and risks) about e-cigarettes. TRIAL REGISTRATION: PROSPERO CRD42019121611; https://tinyurl.com/yfr27uxs.

Adolescent E-cigarette use trajectories and subsequent alcohol and marijuana use.

INTRODUCTION: As electronic cigarette (e-cigarette) use has become more prevalent among adolescents, there is a growing body of evidence linking e-cigarette use to the initiation of other substances. Whether there is a threshold level of e-cigarette use that is predictive of other substance use is unknown. The current study examines patterns of e-cigarette use over time and determines whether different patterns of early adolescent e-cigarette use are concurrently and prospectively associated with alcohol and marijuana use in late adolescence. METHOD: Eight hundred and one adolescents (13-15 years old at baseline recruitment) completed five on-line surveys over a two-year period. Latent class growth analysis was used to model different developmental courses of e-cigarette, alcohol (drinking to intoxication), and marijuana use. Logistic regression was used to test the association between e-cigarette use trajectory patterns and alcohol and marijuana use trajectories. RESULTS: Three developmental courses of e-cigarette use were identified: 1) high and increasing, 2) low and increasing, and 3) never. Compared to adolescents who had never used e-cigarettes, those in the other two groups were more likely to have been intoxicated and to be in the moderate and increasing marijuana use group. CONCLUSION: Both high and low levels of e-cigarette use patterns are associated with increasing use of other substances (alcohol and marijuana use) over time. Findings highlight the need for early intervention and prevention of e-cigarette use among adolescents.