Understanding preferences for receiving health communications and information about clinical trials: a cross-sectional study among US adults.

OBJECTIVE: Effective health communication is critical for understanding and acting on health information. This cross-sectional study explored participants' understanding of their health condition, their preferences for receiving health communications, and their interest in receiving clinical trial results across several therapeutic areas. METHODS: The study recruited participants via social media, email newsletters, and advocacy organizations. An online screener captured demographic information (health conditions, age, race/ethnicity, gender, and education). Eligible participants were emailed an online survey assessing preferred sources and formats for receiving health information, interest in learning about topics related to the results of clinical trials, and health literacy levels. RESULTS: In total, 449 participants (median age, 35 years [range, 18-76]; White, 53%; higher education, 65%; mean (range) health literacy score, 1.9 [0.4-3.0]) from 45 US states completed the survey representing 12 disease indications (bipolar, blood and solid tumor cancers, irritable bowel syndrome, inflammatory bowel disease, major depressive disorder, migraine, Parkinson's, psoriasis/atopic dermatitis, retinal vein occlusion/macular degeneration, rheumatoid arthritis, and spasticity). Healthcare providers were the preferred source of health information (59%), followed by Internet searches (11%). Least preferred sources were social media (5%), friends/family (3%), and email newsletters (2%). Participants preferred multiple formats and ranked reading materials online as most preferred (33%), along with videos (28%) and infographics (27%). Printed materials (14%) and audio podcasts (9%) were the least preferred formats. A majority of the participants reported that the health information they found was hard to understand (57%) and confusing (62%). Most participants (85%) were somewhat/very interested in learning about clinical trial results, with the highest interest in short summaries of safety (78%) and efficacy (74%) results. CONCLUSION: Effective health communication may be achieved via multiple formats shared directly by healthcare providers.

Researchers wanted to learn how people preferred to receive health-related communications, including information about the results of clinical trials. They surveyed 449 people from 45 US states with 12 different health conditions. The survey questions asked people about their preferred sources and ways of getting health information. It also asked about their interest in learning about clinical trials related to their health condition. The results showed that most people preferred to get health information from their healthcare providers (59%). The Internet was the second most popular choice (11%) for getting health information. People did not like getting health information from social media, friends or family, or email newsletters as much. When it came to how health information was shared, people liked reading materials online (33%), watching videos (28%), and looking at infographics (27%). They did not like printed materials and audio podcasts as much. Most people (85%) were interested in learning about the results of clinical trials in short summaries. They wanted to know about the safety (78%) and how well the treatments worked (74%) in the short summaries. In conclusion, people liked getting health information from healthcare providers like doctors, nurses, and others in different formats. Sharing information in different formats through healthcare providers may improve communication for patients with different health conditions.

Ethnic discrimination and alcohol-related problem severity among Hispanic/Latin drinkers: The role of social anxiety in the minority stress model.

INTRODUCTION: Hispanic/Latin individuals in the U.S. experience many health disparities, including worse alcohol-related outcomes. Thus, identifying psycho-sociocultural factors that may play a role in alcohol-related problems among these individuals is vital to informing prevention and treatment efforts. Minority stress-based models of alcohol misuse posit that some Hispanic/Latin individuals may drink (and continue to drink despite drinking-related problems) to alleviate negative affect associated with experiencing ethnic discrimination. Yet, little research has directly tested this hypothesis. Given the social nature of both ethnic discrimination and drinking, it follows that experiencing more ethnic discrimination could be related to greater social anxiety and some individuals may misuse alcohol to cope with this type of negative affect. METHODS: Participants were 373 Hispanic/Latin current drinking undergraduates. RESULTS: Ethnic discrimination was significantly, positively correlated with alcohol-related problems, social anxiety, and coping motivated drinking, even after controlling for drinking frequency and quantity, traumatic life events, and several relevant demographic variables. Discrimination was indirectly related to alcohol-related problems via the sequential relations of social anxiety and coping motives. Alternative model testing indicated that social anxiety was not related to alcohol problems via discrimination, strengthening confidence in directionality of proposed relations. CONCLUSIONS: Discrimination is associated with greater anxiety about negative evaluation among Hispanic/Latin individuals. The current study extended understanding of the impact of this type of anxiety by determining that social anxiety appears to play an important role in the relation between discrimination and alcohol-related problems among Hispanic/Latin young adults.

The Impact of Brief Mindfulness Training on Postevent Processing Among Individuals With Clinically Elevated Social Anxiety.

Postevent processing (PEP), the engagement in detailed and repetitive self-focused review of one's performance in social situations, is theorized to maintain pathological social anxiety. However, little is known about interventions that may impact this maintenance factor. The current study examined the impact of brief mindfulness training (BMT) on PEP among socially anxious individuals. There were 77 participants (75.32% female, 63.64% non-Hispanic/Latinx White) with clinically elevated social anxiety who attended one appointment in the laboratory during which they were randomized to receive a brief mindfulness-based training (n = 37) or no training (i.e., thinking as usual control group; n = 40). After the training period, participants underwent a 3-minute social anxiety induction task, after which they were instructed to apply their thinking strategy. Participants were then asked to complete 2 weeks of daily online surveys that included a PEP induction task, instructions to use their thinking strategy following PEP induction, and a measure of state PEP. Individuals in the BMT condition reported a significant reduction in state anxiety posttraining compared to individuals in the control condition. Conditions did not differ on state PEP after the social anxiety induction task. However, compared to those in the control condition, participants in the BMT condition reported significantly greater decreases in state PEP over the 14-day follow-up period. Thus, this brief mindfulness-based strategy may be useful for individuals with clinically elevated social anxiety who engage in PEP, a cognitive vulnerability factor implicated in the maintenance of social anxiety.

Biopsychosocial Model Social Anxiety and Substance Use Revised.

PURPOSE OF REVIEW: To review data published in the past 5 years to evaluate the utility of our biopsychosocial model of social anxiety's relation to substance misuse to evaluate the model's utility and update it. RECENT FINDINGS: Data support the utility of our revised model-e.g., socially anxious persons report using substances to manage subjective anxiety, despite evidence that some substances may not have a direct effect on physiological responding. Other factors with promise include social influence, cognitive processes (e.g., post-event processing), and avoidance. Data highlight the importance of context as socially anxious persons use some substances more in some high-risk situations, despite lack of relation between social anxiety and use generally. Sociocultural factors remain understudied. This updated model is a theory- and data-driven model of the relations between social anxiety and substance misuse that can inform future work to improve substance-related outcomes among this especially vulnerable group.

Brief Motivation-Based Interventions for Students Sanctioned for Violating Campus Cannabis Use Policies.

College cannabis use continues to rise, yet few students voluntarily seek treatment for cannabis use, despite use-related problems. Thus, the campus judicial system may be one way to identify high-risk cannabis users and intervene with them. Despite research indicating that brief motivational interventions (BMIs) decrease risky alcohol use among students sanctioned for psychological services following campus alcohol policies violations, extant data do not support BMI for students who violate cannabis polices. Thus, the aims of this review paper are to (a) review the extant literature of BMI for cannabis use among sanctioned students, (b) discuss some unique issues concerning BMI for cannabis use, and (c) provide case examples of promising novel ways BMI may be used to address unique needs of these students. Given the wide range of cannabis use and related problems experienced by these students, personalized approaches to BMI-based interventions may improve outcomes for these students.

Increases in distress during stay-at-home mandates During the COVID-19 pandemic: A longitudinal study.

The Coronavirus disease 2019 (COVID-19) pandemic has contributed to over 500,000 deaths, and hospitalization of thousands of individuals worldwide. Cross-sectional data indicate that anxiety and depression levels are greater during the pandemic, yet no known prospective studies have tested this assertion. Further, individuals with elevated trait anxiety prior to a global pandemic may theoretically be more apt to experience greater pandemic-related anxiety and/or impairment. The current study tested whether anxiety and depression increased from the month before the state's Stay-At-Home order to the period of the Stay-At-Home order among 120 young adults in Louisiana, a state with especially high rates of COVID-19 related infections and deaths. We also tested whether pre-pandemic social anxiety was related to greater pandemic related anxiety, depression, and COVID-related worry and impairment. Depression but not anxiety increased during the Stay-At-Home order. Further, pre-pandemic trait anxiety, social anxiety, and depression were statistically significant predictors of anxiety and depression during the Stay-At-Home order, although only social anxiety was robustly related to COVID-related worry and impairment. Emotional distress increased during the COVID-19 pandemic Stay-At-Home order and this is especially the case among individuals with pre-pandemic elevations in trait anxiety (especially social anxiety) and depression.

Difficulties with emotion regulation and drinking during the COVID-19 pandemic among undergraduates: the serial mediation of COVID-related distress and drinking to cope with the pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has contributed to thousands of hospitalizations and deaths worldwide. Although alcohol use has increased in response to the pandemic, no known studies have identified transdiagnostic risk factors for greater drinking in response to COVID-related distress. Individuals with more difficulty with emotion regulation may drink more during the pandemic to manage pandemic-related distress. The current study tested whether difficulty with emotion regulation was related to greater estimated blood alcohol content (eBAC) during a typical week in the past month and if this was due to COVID-related distress and drinking to cope with the pandemic. The sample consisted of 347 past-month drinking undergraduates in Louisiana, a state with some of the U.S. highest rates of COVID-19 infections and related deaths. Difficulty with engaging in goal-directed behaviors was related to greater past-month eBAC and this relation was mediated by the sequential effects of COVID-related worry and drinking to cope with the pandemic. Results indicate that individuals with difficulty engaging in goal-directed behaviors are especially vulnerable to greater eBAC during the COVID-19 pandemic which may be due in part to their vulnerability to more COVID-related worry which may lead to more drinking to cope with the pandemic.

Online personalized feedback intervention reduces cannabis-related problems among college students with high problem distress.

Despite experiencing problems related to using cannabis, very few undergraduate cannabis users are interested in treatment for cannabis-related problems or benefit from cannabis-focused online personalized feedback interventions (PFIs). Thus, it may be important to determine whether individuals perceive their problems as distressing, as only those who are distressed by their problems may be motivated to change their cannabis use or benefit from cannabis-related interventions. The current study examined cannabis-related problem distress, its relation to motivation to change cannabis use, and whether problem distress impacted outcomes of a problem-focused online PFI. Past-month cannabis-using undergraduates who endorsed experiencing at least one cannabis-related problem in the past 3 months were randomized to a PFI (n = 102) or a personalized normative feedback (PNF)-only condition (n = 102). Problem distress was robustly related to readiness, importance, and confidence to change cannabis use at baseline. Among those with high levels of problem distress at baseline, those in the PFI condition reported a greater decrease in problems than those in the PNF-only condition. This was not the case among those with lower levels of problem distress. Further, the number of cannabis-related problems did not moderate intervention outcomes. Cannabis users who perceive their problems as more distressing may be more motivated to change their cannabis use and more likely to benefit from a problem-focused PFI relative to a PNF-only intervention. Results have implications for the personalization of cannabis-focused interventions to maximize the impacts of interventions and decrease cannabis-related problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Dose Timing of D-Cycloserine to Augment Exposure Therapy for Social Anxiety Disorder: A Randomized Clinical Trial.

Importance: Findings suggest that the efficacy of D-cycloserine (DCS) for enhancing exposure therapy may be strongest when administered after sessions marked by low fear at the conclusion of exposure practice. These findings have prompted investigation of DCS dosing tailored to results of exposure sessions. Objective: To compare tailored postsession DCS administration with presession DCS administration, postsession DCS administration, and placebo augmentation of exposure therapy for social anxiety disorder. Design, Setting, and Participants: This double-blind randomized clinical trial involved adults with social anxiety disorder enrolled at 3 US university centers. Symptom severity was assessed at baseline, weekly during treatment, and at 1-week and 3-month follow-up. Data analysis was performed from September 2019 to March 2020. Interventions: Participants completed a 5-session treatment and received pills commensurate with their condition assignment at sessions 2 through 5, which emphasized exposure practice. Main Outcomes and Measures: Symptom severity was evaluated by the Liebowitz Social Anxiety Scale and Social Phobic Disorders-Severity Form as administered by independent evaluators. Results: A total of 152 participants were enrolled (mean [SD] age, 29.24 [10.16] years; 84 men [55.26%]). Compared with placebo, presession and postsession conditions showed greater symptom improvement (b = -0.25; 95% CI, -0.37 to -0.13; P < .001; d = 1.07; and b = -0.20; 95% CI, -0.32 to -0.07; P = .002; d = 0.85) and lower symptom severity (b = -0.51; 95% CI, -0.81 to -0.21; P < .001; d = 0.76; and b = -0.49; 95% CI, -0.80 to -0.18; P = .002; d = 0.72) at 3-month follow-up. No differences were found between presession and postsession conditions. The tailored condition showed no advantage over placebo. Compared with the tailored condition, presession and postsession conditions evidenced greater decreases (b = -0.22; 95% CI, -0.34 to -0.10; P < .001; d = 0.94; and b = -0.17, 95% CI, -0.29 to -0.04; P = .008; d = 0.72) and lower symptom severity (b = -0.44, 95% CI, -0.73 to -0.14; P = .004; d = 0.64; and b = -0.41, 95% CI, -0.72 to -0.11; P = .008; d = 0.61) at 3-month follow-up. Conclusions and Relevance: Administration of DCS enhanced exposure therapy for social anxiety disorder when given before or after the exposure session. However, the study failed to achieve the aim to develop a tailored clinical application. Trial Registration: ClinicalTrials.gov Identifier: NCT02066792.

Mindfulness training for clinically elevated social anxiety: The impact on peak drinking.

Social anxiety is related to more drinking in high-risk drinking situations and to more drinking-related problems. Given the rise in mindfulness-based interventions for social anxiety, it is important to test whether drinking impacts outcomes among individuals with clinically elevated social anxiety. Undergraduates with clinically elevated social anxiety were randomly assigned to mindfulness training (n = 29) or thinking-as-usual control (n = 29). They were encouraged to practice mindfulness or thinking-as-usual in response to social events daily for two-weeks following baseline. Follow-up measures were completed one month post-baseline. The interaction of baseline peak estimated blood alcohol content (eBAC) X condition predicted one-month follow-up peak eBAC such that among those with greater (but not lower) baseline eBAC, mindfulness was related to lower follow-up eBAC compared to control. Similarly, mindfulness training resulted in less post-training anxiety among those with greater (but not lower) baseline eBAC. However, this effect was not evident during a two-week practice period nor at one-month follow-up. Rather, at one-month follow-up, the interaction of baseline eBAC X condition predicted follow-up mindfulness (non-reactivity); among those with higher (but not lower) baseline eBAC, mindfulness training was associated with less follow-up mindfulness than the control condition. Results indicate that among those with greater baseline peak eBAC, mindfulness practice resulted in lower follow-up eBAC compared to control among those with clinically elevated social anxiety. However, although mindfulness training may result in less anxiety in the short-term among heavy drinkers with social anxiety, this effect did not last longer-term. Rather, heavier drinkers evinced poorer longer-term mindfulness-related outcomes.

Cannabis-Related Impairment and Social Anxiety: The Role of Use to Manage Negative and Positive Affect in Social Situations.

Background and Objectives: Individuals with elevated social anxiety are thought to be at high risk for developing cannabis-related problems because they use cannabis to cope with anxiety-provoking social situations. Social anxiety is unique among the anxiety conditions in that it is characterized by both elevated negative affect (NA) and lower positive affect (PA). Yet it is unclear whether persons with elevated social anxiety use cannabis to decrease their NA or to increase their PA. Methods: This study examined the role of PA and NA (including cannabis use to increase PA and to decrease NA in social situations) on cannabis use frequency and related problems among current (past three-month) cannabis users (N = 278). Results: Social anxiety was significantly correlated with NA, PA, cannabis use to decrease NA, and use to increase PA. Serial mediation analyses tested the paths between social anxiety, affect, use to manage affect, typical cannabis use frequency, and cannabis use-related problems. Contrary to prediction, social anxiety was not indirectly related to use frequency or related problems via NA or PA generally. Rather, social anxiety was indirectly related to cannabis problems via the serial effect of use to cope with NA and typical use frequency and via the serial effect of use to increase PA and typical use frequency. Conclusions/Importance: Social anxiety may be associated with using cannabis to decrease NA and increase PA specifically in social situations, which increases cannabis use frequency and thus, problem risk.

Mental Health Problems and Suicide Risk: The Impact of Acute Suicidal Affective Disturbance.

Acute Suicidal Affective Disturbance (ASAD) is a suicide-specific, episodic clinical entity that is theorized to characterize acute suicide risk. Little work has examined the role of ASAD in mental health conditions linked to suicide risk. Thus, the current study examined whether depression, social anxiety, panic, and alcohol-related problems were related to suicide risk via ASAD history. A total of 527 undergraduates completed an online survey. Depression, social anxiety, and alcohol problem risk (but not panic) were robustly, significantly related to suicide risk, but only social anxiety and depression were robustly related to ASAD history. Depression and social anxiety symptoms were indirectly related to suicide risk via ASAD. ASAD may serve as a potential explanatory pathway through which some mental health conditions may lead to greater suicide risk.

On-line personalized feedback intervention for negative affect and cannabis: A pilot randomized controlled trial.

Cannabis is the most commonly used illicit substance and many users report difficulty quitting. Situations involving stress and negative affect are the most difficult in which to abstain during quit/reduction attempts. Further, cannabis users with elevated social anxiety experience greater cannabis-related impairment than individuals with more normative levels of social anxiety. Yet, although most persons with cannabis-related problems are interested in quitting and endorse negative emotional symptoms, the vast majority do not seek in-person treatment. Thus, the current study tested the utility of an online personalized feedback intervention (PFI) that integrates feedback regarding cannabis with strategies to manage negative affect (PFI-NAC). Current (past month) cannabis using undergraduates (who used cannabis weekly, on average) were randomly assigned to the 1-session PFI-NAC (n = 37) or an assessment-only control (n = 26) and completed a 2-week follow-up assessment. After controlling for baseline negative affect and cannabis use frequency, social anxiety interacted with condition to predict follow-up cannabis use frequency. Specifically, among those with moderate or high levels of social anxiety, those in PFI-NAC reported less use at follow up than controls; this was not the case among those with lower social anxiety. Results of this pilot study indicate a 1-session intervention that teaches simultaneously teaching skills to manage negative affect and cannabis may benefit some cannabis users with moderate to high social anxiety. Future work with larger samples and a wider range of cannabis users, with longer follow-up assessments, are important next steps. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Smoking and social anxiety: the role of false safety behaviors.

Despite the negative health consequences associated with smoking, most smokers find it difficult to quit. This is especially true for smokers with elevated social anxiety. One factor that may play a role in maintaining smoking with elevated anxiety is false safety behavior (FSB), behaviors geared toward decreasing anxiety short-term but that maintain or increase anxiety long-term. The present study tested whether FSB explained the relation of social anxiety severity with smoking among 71 current smokers. Avoidance-related FSB was the only type of FSB related to cigarettes smoked per day (CPD) and it was robustly related to more CPD. Further, social anxiety was related to CPD indirectly via FSB-Avoidance. Findings suggest that more frequent use of avoidance behaviors to manage anxiety may maintain smoking and may partially explain the high rates of smoking among those with elevated social anxiety. Thus, FSB may be a promising target in smoking cessation interventions, especially among those with elevated social anxiety.

Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing.

Individuals with clinically elevated social anxiety are especially vulnerable to alcohol-related problems, despite not drinking more than those with less anxiety. It is therefore important to identify contexts in which socially anxious persons drink more to inform intervention efforts. This study tested whether social anxiety was related to greater drinking before, during, or after a social event and whether such drinking was related to the psychosocial factors anticipatory anxiety or post-event processing (PEP; review of the social event). Among past-month drinkers, those with clinically elevated or higher social anxiety (HSA; n = 212) reported more anticipatory anxiety, more pre-event drinking to manage anxiety, and PEP than those with normative or lower social anxiety (LSA; n = 365). There was a significant indirect effect of social anxiety on pre-drinking via anticipatory anxiety. Social anxiety was related to more drinking during the event indirectly via the serial effects of anticipatory anxiety and pre-drinking. Unexpectedly, PEP did not mediate or moderate the relation between social anxiety and post-event drinking. In sum, anticipatory anxiety was related to more drinking before, during, and after a social event and HSA drinkers were especially vulnerable to drinking more to manage this anxiety, which increased drinking before and during the event. This effect was specific to anticipatory anxiety and not evident for another social anxiety-specific risk factor, PEP. Thus, anticipatory anxiety may be an important therapeutic target for drinkers generally and may be especially important among HSA drinkers.

Drinking Problems and Social Anxiety among Young Adults: The Roles of Drinking to Manage Negative and Positive Affect in Social Situations.

Background: Socially anxious individuals seem to be at a high risk for alcohol-related problems because they drink to cope. Yet social anxiety is unique among the anxiety conditions in that it is characterized by lower positive affect (PA). It is unclear whether drinking to cope is related to drinking to decrease negative affect (NA) or increase PA. Objectives: We tested whether social anxiety was related to more drinking problems via the sequential relations between affect (NA or PA), drinking to change affect (decrease NA or increase PA), and drinking quantity. We also tested whether the indirect effect of drinking to increase PA was significantly less than that of drinking to decrease NA. Methods: Past-month drinkers with clinically elevated social anxiety (n = 174) and those with more normative or lower social anxiety (n = 362) completed an online survey. Results: Social anxiety was indirectly related to drinking problems via the sequential effect of NA, drinking to decrease NA, and drinking quantity. Social anxiety was indirectly related to drinking problems via the sequential relations of PA and drinking quantity and of drinking to increase PA and drinking quantity. The indirect effect of drinking to increase PA did not significantly differ from drinking to decrease NA. Conclusions/Importance: Socially anxious drinkers may drink not only to decrease NA but also to increase PA in social situations. Both of these drinking motives appear to play important roles in socially anxious drinkers' experience of drinking-related problems.

Cannabis use motives on weekends versus weekdays: Direct and indirect relations with cannabis use and related problems.

College cannabis users report using more cannabis during the weekend than on weekdays, yet little attention has been paid to the role of weekend and weekday-specific motives for use. The present investigation evaluated the impact of weekend and weekday-specific cannabis motives on cannabis use and related problems among current (past-3 month) cannabis using undergraduates (N = 276). Participants reported more cannabis use motives during the weekend than weekday. Enhancement and social motives were greater than coping, conformity, and expansion motives during weekends. Enhancement and conformity motives were indirectly related to problems via cannabis use frequency for both weekdays and weekends. Yet social, coping, and expansion motives were indirectly related to problems via cannabis use frequency for only weekdays. Findings support the differential impact of weekend and weekday-specific motives on cannabis use and related problems.

Integrated cognitive behavioral therapy for comorbid cannabis use and anxiety disorders: A pilot randomized controlled trial.

Cannabis use disorder (CUD) is the most common illicit substance use disorder and individuals with CUD have high rates of comorbid anxiety disorders. Comorbidity between CUD and anxiety disorders is of public health relevance given that although motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for CUD, outcomes are worse for patients with elevated anxiety. The current study tested the acceptability and efficacy of the integration of a transdiagnostic anxiety CBT (i.e., treatment of patients with any anxiety disorder) with MET-CBT (integrated cannabis and anxiety reduction treatment, or ICART) for CUD compared to MET-CBT alone. Treatment-seeking cannabis users (56.4% male, Mage = 23.2, 63.3% non-Hispanic White) with CUD and at least one comorbid anxiety disorder were randomly assigned to ICART (n = 27) or MET-CBT (n = 28). Patients in the ICART condition attended significantly more treatment sessions than those in the MET-CBT condition. Patients in the ICART condition were more likely to be abstinent post-treatment than those in MET-CBT. Further, treatment produced decreases in cannabis use and related problems. Notably, therapy type did not moderate the impact of treatment on frequency of use and related problems. Together, these data suggest that ICART may be at least as efficacious as a gold-standard psychosocial CUD treatment, MET-CBT, for a difficult-to-treat subpopulation of cannabis users.

Risky sexual behavior among cannabis users: The role of protective behavioral strategies.

Cannabis users tend to use condoms less often than cannabis abstainers, placing them at risk for sexually transmitted disease and unplanned pregnancies. This is especially problematic among college students, who experience such problems at especially high rates. Despite accumulating data indicating that cannabis users are less likely to use condoms, little research has identified potentially malleable cognitive vulnerability factors that may be related to condom use in this vulnerable population. Thus, the current study tested whether cannabis users believed others use condoms less often and/or whether they engaged in less condom-related protective behavior strategies (PBS) than cannabis abstainers and whether cannabis use status was indirectly related to condom use via these vulnerability factors. Among 214 college students (64 past-month cannabis users), cannabis users engaged in less PBS (although cannabis use was unrelated to normative beliefs). Cannabis use status was indirectly related to condom use via PBS and cannabis use status was unrelated to condom use after controlling for PBS. Results highlight the importance of PBS use among cannabis users, a group at particular risk for risky sexual behaviors.