Barriers and facilitators of colorectal cancer screening among East African men in Minnesota: a qualitative investigation.

Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota.Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy.Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation.Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers.

Biobehavioral and affective stress responses during nicotine withdrawal: Influence of regular cannabis co-use.

BACKGROUND: Co-use of cannabis is increasing in nicotine users and presents additional challenges in addressing nicotine dependence. This study examined the links between regular co-use of cannabis and nicotine with biobehavioral and affective changes in response to stress during nicotine withdrawal and ad libitum use. METHODS: Participants (N = 79) who regularly used nicotine-only, cannabis-only, both substances, or neither substance were invited to attend two laboratory stress assessment sessions. For nicotine users, one session occurred during ad libitum nicotine use and one occurred after abstinence from nicotine. During the stress sessions, participants provided saliva samples for cortisol assay and completed measures of subjective states. Cardiovascular measures were collected during resting baseline, exposure to acute stressors, and a recovery rest period. RESULTS: Nicotine-only users had higher average cortisol levels in the second lab session (nicotine withdrawal) relative to the first lab session (ad libitum nicotine use). Compared to nicotine non-users, nicotine users reported less positive affect and exhibited attenuated cortisol and systolic blood pressure (BP) stress responses. Cannabis users exhibited exaggerated diastolic BP responses to stress compared to cannabis non-users, and co-users of nicotine and cannabis had higher levels of cannabis craving than cannabis-only users (p < .01). CONCLUSIONS: This study partially replicated earlier findings on the effects of chronic nicotine use and provided novel results regarding the influence of cannabis co-use on physiological and affective responses to stress in nicotine users during nicotine withdrawal.

Acculturation Style Is Associated with Stress and Tobacco Use among East African Immigrants.

While tobacco use rates are relatively high among East African immigrants in the U.S., factors contributing to this high rate are largely unknown. Acculturation is associated with stress and substance use. Whether acculturation styles are related to stress and current tobacco use has not been tested among this population. We conducted a cross-sectional study that included 376 East African adults who provided information on demographic background, acculturation style, acculturative stress, depressive symptoms, and tobacco use. Multivariate analysis indicated that individuals who were distant to both the culture of the host country and the culture of origin (marginalization style) had greater levels of acculturative stress than those who adopted both cultures (integration style; p < .001). Marginalized people were four to eight times and assimilated people were three to four times more likely than integration people to be a current tobacco user (p < .04). This relationship did not change after controlling for demographic information and stress. In this study, acculturation style was associated with perceived stress and current tobacco use among East African immigrants. Research focused on characterizing integrated individuals may guide efforts to develop culturally-relevant strategies to reduce tobacco-related disparities among East African individuals.

Circulating ghrelin changes as a biomarker of the stress response and craving in abstinent smokers.

RATIONALE: There has been growing interest in the role of ghrelin in stress and addiction. Ghrelin regulates central reward mechanisms by mediating the mesolimbic dopaminergic system. Stress also induces neurophysiological activations related to drug reward. However, the extent to which psychosocial stress is associated with changes in ghrelin levels has not been tested in individuals with nicotine dependency undergoing withdrawal, a condition known to induce stress-like symptoms. OBJECTIVES: We investigated the association of stress-induced ghrelin, craving, and smoking lapse. METHODS: Thirty-six smokers attended a laboratory session that included acute stress tasks during the initial phase of quitting. Self-report measures and biochemical samples were collected for the assessment of smoking status. Blood samples for the measurement of ghrelin and self-report measures of craving were collected multiple times throughout the session RESULTS: Multivariate analysis of variance controlling for gender found a significant main effect of sampling time and lapse group (p < 0.05). Ghrelin levels significantly increased over the pre-stress and post-stress periods (ps < 0.001), suggesting a delayed stress response. Those who lapsed during the study had higher ghrelin levels than those who were able to successfully abstain. A ghrelin stress response was calculated and a significant association was found between this response and craving, which changed across time points (ps < 0.008). CONCLUSIONS: The results of this study demonstrate that ghrelin is sensitive to acute manipulation of stress and that there is potential usefulness for ghrelin as a marker of stress, craving, and smoking lapse.

A Culturally Adapted Colorectal Cancer Education Video for the Somali Community in Minnesota: A Pilot Investigation.

PURPOSE: This study aims to develop and test feasibility of a colorectal cancer (CRC) education video appropriate for Somali immigrants. DESIGN: One-group pretest-posttest design. SETTING: Minneapolis, MN. SAMPLE: Thirty-one Somali men (mean age = 60.6; SD = 13.0). INTERVENTION: A CRC education video was developed in the Somali language with Somali community partners. Participants were invited to a workshop and watched the video. MEASURES: Levels of understanding about CRC and screening were assessed before vs after the video. ANALYSIS: Binomial tests were conducted to examine changes in level of understanding. RESULTS: Analysis on pre-post, within-person changes in understanding about cancer, and CRC screening showed that proportions with a positive change in understanding risks of cancer (80%) and benefits of CRC screening (90%) were significantly higher than expected if the video had no effect (50%; P = .012, P < .001, respectively). Ninety-three percent of participants agreed that the video contained useful information. CONCLUSION: These results provide evidence of usefulness of culturally tailored videos to facilitate CRC screening in the Somali community. Results of this study were limited by a small sample size and lack of a control group.

Psychosocial Correlates of Experience and Intention to Receive Colorectal Cancer Screening: A Cross-Sectional Study Among East African Men in the U.S.

Cancer screening is an important approach to reducing disease burden. The rate of colorectal cancer (CRC) screening among immigrants in the U.S. is very low. Our study's aim was to examine correlates of experience with, and intention to, receive CRC screening among East African men who were up-to-date (UTD) with CRC screening (n = 64, mean age 65) and those who had never been screened or were overdue for one (NOD; n = 47, mean age 60), compared on demographic characteristics, attitudes toward cancer, psychosocial stress, and health behaviors. UTD men had significantly less emotional concerns about cancer screening and experienced significantly greater distress and lower resiliency than NOD men. However, these results were attenuated after controlling for demographic confounders. Perceived risk, trust in the medical system, and PTSD symptoms were significantly associated with an intention to undertake CRC screening in the next 12 months. These results should be used to guide efforts toward increasing CRC screening rates among immigrant communities.

Stress and pain: modality-specific opioid mediation of stress-induced analgesia.

Preclinical research has demonstrated that exposure to acute stress is associated with attenuated pain perception, so called stress-induced analgesia (SIA). Mechanisms of SIA in humans have not been reliably demonstrated. This study examined the role of the endogenous opioid system in the impact of combined interpersonal and mental stressors on evoked pain responses in 84 participants (34 women). Using a within-subject, double-blinded, counterbalanced design, participants were administered either oral placebo or the opioid antagonist naltrexone (50 mg) across two testing sessions. In each session, they experienced two evoked pain stimuli (cold pressor test [CPT], heat pain) after an extended rest period (rest condition) and after exposure to an acute stressor (a combination of public speaking and mental arithmetic challenge; stress condition). Results showed that both stress and opioid blockade produced significant changes in hormonal and cardiovascular measures, consistent with successful induction of acute stress. Stress was associated with attenuated pain perception (SIA) as indicated by significantly increased CPT tolerance. These effects were particularly pronounced in individuals experiencing the stress condition first. More importantly, SIA effects on CPT tolerance were abolished by opioid blockade. There were no significant SIA effects on heat pain responses. This study demonstrates that the endogenous opioid system may mediate effects of acute stress on pain perception, although this effect seems to be qualified by the type of evoked pain stimuli experienced.

Tobacco withdrawal increases junk food intake: The role of the endogenous opioid system.

BACKGROUND: The aims of this study were to 1) determine whether acute nicotine withdrawal increases the intake of junk food (high in salt, fat, and sugar) and 2) assess whether the endogenous opioid system is involved in junk food intake during nicotine withdrawal using naltrexone as a pharmacological probe. METHODS: Smokers were randomly assigned to 24-hr withdrawal from tobacco products (n = 42) or smoking ad libitum (n = 34). A non-smoking group (n = 29) was included. Participants completed two laboratory sessions where a placebo or 50 mg of naltrexone was administered. At the end of each session, participants were given a tray of snack items that differed in high to low energy density and dimensions of salty, sweet, and fat. Self-reported mood and withdrawal measures were collected immediately before the snacks were offered. Generalized linear and logistic models were used to assess the effects of acute smoking withdrawal, drug, and sex on the intake of snack items and self-reported measures. RESULTS: Choice and consumption of food items were impacted by smoking condition (withdrawal > ad lib smoking and non-smokers; p < .05), the opioid blockade (naltrexone < placebo; p < .05), and sex (male > female; p < .05). The effects were evidenced in high sweet and high fat foods. No differences were found in low sweet and fat foods. CONCLUSIONS: These findings extend earlier studies indicating impact of tobacco use on appetite, and identify the regulatory influence of the endogenous opioid system on appetite during nicotine withdrawal.

Early life adversity and appetite hormones: The effects of smoking status, nicotine withdrawal, and relapse on ghrelin and peptide YY during smoking cessation.

There is evidence suggesting that ghrelin and peptide YY (PYY) modulate stress responses and the rewarding effects of drugs, although no research has examined the impact of exposure to early life stress on these hormones in smokers nor during smoking cessation. This study examined the relationships between early life adversity (ELA) and circulating ghrelin and PYY during ad libitum smoking and early withdrawal in tobacco smokers (N = 98) who were interested in cessation. We also included a comparison group of nonsmokers (N = 36). We prospectively compared levels of hormones between smokers who were successful in quitting within a 2-week period, smokers who relapsed during that period, and nonsmokers. Results showed that ELA was positively associated with elevated ghrelin in nonsmokers. Among those reporting no ELA, successful quitters had higher ghrelin levels than nonsmokers during ad libitum smoking, while relapsers had higher ghrelin levels than nonsmokers during withdrawal. In addition, having no ELA was associated with a decline in ghrelin from the ad libitum to abstinence sessions in successful quitters; this withdrawal-related decline was not found in relapsers. Although effects of ELA, smoking group, and time on PYY were not significant, greater PYY was associated with reduced urges to smoke during withdrawal. These findings suggest the importance of considering changes in appetite-related hormones in individuals who are dependent on tobacco. This research provides additional indications for effects of ELA on appetite-stimulating hormones.

Blunted opioid regulation of the HPA stress response during nicotine withdrawal: therapeutic implications.

Endogenous opioids regulate pain, drug reward, and stress responses. We have previously shown reduced hypothalamic-pituitary-adrenal (HPA) responses to psychological stress and to opioid blockade among dependent smokers. In this study, we examined the extent to which biologically confirmed nicotine withdrawal alters endogenous opioid regulation of HPA axis functioning during rest and in response to acute stress. Smokers were randomly assigned to one of two conditions; 24 h withdrawal from all nicotine-containing products (n = 62) or smoking ad libitum (n = 44). A nonsmoking comparison group (n = 43) was also included. Participants (85 males and 64 females) completed two acute stress sessions during which a placebo or 50 mg of naltrexone (opioid antagonist) were administered using a double-blind design. Blood and saliva samples (assayed for cortisol and adrenocorticotropic hormone, i.e. ACTH) and mood measures were obtained during a resting absorption period, after acute stress (public speaking, mental arithmetic, and cold pressor tasks), and during an extended recovery period. Results indicated that opioid blockade (naltrexone) was associated with increased ACTH and cortisol responses to stress, and tobacco withdrawal was associated with blunted hormonal responses. A pattern of sex differences also emerged, with women exhibiting reduced ACTH responses to stress and higher ACTH and plasma cortisol responses to opioid blockade. These results indicated that compared to ad libitum smoking, nicotine withdrawal is associated with blunted opioid modulation of the HPA axis. Sex may modulate these effects. Blunted endogenous opioid regulation may underlie an incentive process that reinforces smoking behavior and may warrant therapeutic attention.

Influences of Fasting on Stress Response and Withdrawal Symptoms in Habitual Khat Users.

BACKGROUND: Fasting changes mood and physiological states. Substance use, such as khat use, is prohibited during fasting during Ramadan, a traditional practice among Muslims. Habitual khat use is associated with increased negative affect and altered psychobiological stress responses. Effects of fasting on stress responses, mood, and withdrawal symptoms among khat users have not been examined. METHODS: In this study, 80 individuals completed an ambulatory monitoring period and a laboratory assessment session. Participants who completed the study while fasting during Ramadan were matched by gender and khat use status with participants who completed the study while not fasting. This resulted in 40 participants (12 females and 28 males; 25 khat users and 15 nonusers) in each fasting group. Cardiovascular (blood pressure and heart rate) and subjective measures were collected throughout the laboratory stress session. A mental arithmetic challenge was used to induce stress. In addition, self-reported mood and withdrawal measures were collected multiple times during the ambulatory assessment. RESULTS: Khat users reported greater negative affect than nonusers. Results from the ambulatory study indicated that withdrawal symptoms were lower during evening hours in the fasting group than in the no-fasting group. Stress-related changes in positive and negative affects were flattened in the fasting group relative to the no-fasting group. Khat users reported reduced blood pressure responses relative to nonusers. CONCLUSION: These preliminary results demonstrate that fasting is associated with reduced negative affect and withdrawal symptoms in khat users. Khat use was related to blunted blood pressure stress responses, but this was independent of fasting. Due to the small sample size, these results should be replicated with a large sample and comprehensive stress tasks.

Effects of tobacco addiction on links between early life adversities, sleep disturbance, and depression: A moderated mediation approach.

Despite the well-established relationship between early life adversities (ELA) and depression, the underlying mechanisms for this link remain less clear and need to be developed. The aim of this study was to advance our understanding of this link by testing the mediating role of sleep disturbances and the moderating role of tobacco use in this mediation. A total of 579 smokers and non-smokers were recruited in two US communities (Duluth and Minneapolis, MN). Simple and moderated mediation analyses were performed using the PROCESS macro for SPSS, with the number of ELA as an independent variable, depression symptoms assessed by the Patient Health Questionnaire-9 (PHQ-9) as a dependent variable, sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) as a mediator, and smoking status as a moderator variable. The study demonstrated that ELA and depressive symptoms were positively correlated; and sleep quality fully mediated this relationship. This mediation was moderated by tobacco use (index of moderated mediation = 0.10, 95%CI [0.03; 0.19]) and was more pronounced among smokers (b = 0.14, 95%CI [0.07; 0.23]) than non-smokers (b = 0.04, 95%CI [0.0002; 0.10]). Subsequent mediation analyses run separately for each component of the PSQI suggested that individuals who experienced ELA and who were smokers had greater delays in sleep onset and were more likely to sleep for a shorter duration, both of which predicted greater depressive symptoms. Sleep quality is therefore a promising ELA-related target for preventive and therapeutic interventions as well as for further research in depression and tobacco addiction.

Using novel mobile sensors to assess stress and smoking lapse.

Mobile sensors can now provide unobtrusive measurement of both stress and cigarette smoking behavior. We describe, here, the first field tests of two such methods, cStress and puffMarker, that were used to examine relationships between stress and smoking behavior and lapse from a sample of 76 smokers motivated to quit smoking. Participants wore a mobile sensors suite, called AutoSense, which collected continuous physiological data for 4 days (24-hours pre-quit and 72-hours post-quit) in the field. Algorithms were applied to the physiological data to create indices of stress (cStress) and first lapse smoking episodes (puffMarker). We used mixed effects interrupted autoregressive time series models to assess changes in heart rate (HR), cStress, and nicotine craving across the 4-day period. Self-report assessments using ecological momentary assessment (EMA) of mood, withdrawal symptoms, and smoking behavior were also used. Results indicated that HR and cStress, respectively, predicted smoking lapse. These results suggest that measures of traditional psychophysiology, such as HR, are not redundant with cStress; both provide important information. Results are consistent with existing literature and provide clear support for cStress and puffMarker in ambulatory clinical research. This research lays groundwork for sensor-based markers in developing and delivering sensor-triggered, just-in-time interventions that are sensitive to stress-related lapser risk factors.

Influences of the Menstrual Phase on Cortisol Response to Stress in Nicotine Dependent Women: A Preliminary Examination.

INTRODUCTION: Evidence indicates that menstrual cycle phase plays a role in smoking withdrawal symptoms and craving. Stress increases these symptoms. Whether the stress regulatory mechanism is associated with menstrual phase and withdrawal symptoms is not well understood. METHODS: Thirty-seven female smokers and 16 female nonsmokers were asked to complete a laboratory session. In each group, approximately half of the participants were tested when they were in the follicular phase and the other half was tested in the luteal phase. The session included resting baseline, stress, and recovery periods. Saliva samples for the measurement of cortisol and subjective measures of craving and withdrawal symptoms were collected at the end of each period. RESULTS: A series of repeated measures analysis of covariance found a significant smoking group × menstrual phase × sampling time interaction in cortisol levels (p < .05). Follow-up analyses indicated a reduced cortisol stress response in the luteal group relative to the follicular group in smokers (p < .02). This difference was not found in nonsmokers. CONCLUSIONS: Menstrual cycle phase is related to hormonal stress response and smoking withdrawal symptomatology. IMPLICATIONS: We show influences of the menstrual cycle phase on stress response among smokers. This is demonstrated by a reduced cortisol response to stress in the luteal group relative to the follicular group among smokers. This menstrual phase difference was not found in nonsmokers.

Impact of early life adversity on the stress biobehavioral response during nicotine withdrawal.

Exposure to early life adversity (ELA) is associated with increased subsequent risk for addiction and relapse. We examined changes in psychobiological responses to stress in dependent smokers and nonsmoking controls and evaluated how history of early adversity may exacerbate acute changes during nicotine withdrawal and acute stress. Smokers were randomly assigned to one of two conditions; 24 h withdrawal (66 smokers) from smoking and all nicotine-containing products or smoking ad libitum (46 smokers) prior to an acute laboratory stress induction session; and 44 nonsmokers provided normal referencing. The laboratory session included a baseline rest, stress and recovery periods. Plasma and saliva samples for the measurement stress hormones and cardiovascular and self-report mood measures were collected multiple times during the session. Multivariate analysis confirmed that all groups showed stress-related increases in negative mood, cardiovascular measures and stress hormones, particularly smokers in the withdrawal condition. Individuals with high ELA showed greater adrenocorticotropic hormone (ACTH), but lower plasma and salivary cortisol levels, than those with low ELA. Cortisol differences were abolished during tobacco withdrawal. These findings demonstrate that ELA moderates the effects of withdrawal on stress-related biobehavioral changes.

Development of the Khat Knowledge, Attitudes and Perception Scale.

INTRODUCTION AND AIMS: Khat (Catha edulis) is a stimulant plant widely used in East Africa and the Arabian Peninsula. Tobacco is often co-used with khat and its use has expanded to other parts of the world. Chronic khat use is associated with negative health consequences. There is a lack of research to develop a tool to assess attitudes toward khat use. This study aimed to develop a brief tool to assess attitude and perception related to khat (i.e. the Khat Knowledge, Attitudes and Perception Scale). DESIGN AND METHODS: Four-hundred and three participants in Yemen (151 concurrent users of khat and tobacco, 141 khat-only users and 92 non-users of khat and tobacco) were asked about knowledge and attitudes related to khat. A principle component analysis with Promax rotation, Scree-plot and Cronbach's α coefficients was performed to examine psychometric properties of the Khat Knowledge, Attitudes and Perception Scale. RESULTS: Principle component analysis revealed five factors: negative beliefs, positive beliefs, idleness, weight control and family issues. Internal consistency of items in negative beliefs, positive beliefs, idleness, weight control and family issues were 0.88, 0.62, 0.62, 0.72 and 0.53, respectively. Greater negative beliefs was inversely correlated with positive beliefs but positively associated with idleness, weight control and family issues. Concurrent users and khat-only users had lower scores on negative beliefs than non-users. Concurrent users had higher scores on positive beliefs than khat-only and non-users. DISCUSSION AND CONCLUSIONS: These results provide initial support of the usefulness of the Khat Knowledge, Attitudes and Perception Scale.

Anger, anxiety, and depressive affect as predictors of stress-induced cortisol production in khat and tobacco users.

INTRODUCTION: Glucocorticoid activity is disrupted in substance users including khat chewers who also use tobacco. Anger, dysphoria, and anxiety can mediate this relationship. The aim of this study was to contrast emotion dysregulation and substance use variables as predictors of post-stress cortisol output. MATERIALS AND METHODS: Comparable numbers of males (n = 90) and females (n = 85) including controls, khat only, and concurrent khat and tobacco users participated in a stress study. Depressive affect, anxiety, anger, substance use patterns, and saliva samples were collected following a standardized laboratory stress manipulation. RESULTS: Regression analysis showed that high depression and low anxiety was associated with high post-stress cortisol, but only in co-users of tobacco and khat. Males, but not females, showed a significant association between co-use of khat and tobacco and cortisol, which appears to be mediated by frequency of use. The link between anxiety and post-stress cortisol in the co-users remained significant after controlling for nicotine dependence and substance use frequency. CONCLUSION: Anxiety predicted the neuroendocrine consequences of concurrent use of tobacco and khat above and beyond sex, nicotine dependence, anger, and substance use frequency. Sex differences, however, are related to differences in nicotine dependence.

Smokers report lower intake of key nutrients than nonsmokers, yet both fall short of meeting recommended intakes.

Smoking is a major risk factor in the development of preventable disease which may be due to a poorer diet and the reduced nutrient intake of smokers. Our objective was to compare and evaluate the reported intake of current smokers with that of nonsmokers among participants of a study evaluating stress and smoking. We hypothesized (1) that overall energy and nutrient intake would be reduced in smokers compared with nonsmokers and (2) that smokers would have increased noncompliance with Dietary Reference Intakes (DRIs). Men and women (smokers n=138, nonsmokers n=46) completed a 3-day diet record at baseline. Mean energy and nutrient intakes were stratified by smoking status and compared with DRI levels. The mean body mass index was 28.3±0.5kg/m2 for smokers and 27.2±1.0kg/m2 for nonsmokers. Compared with nonsmokers, the smokers reported lower intakes of energy, total polyunsaturated fatty acids, linolenic acid, docosahexaenoic acid, total sugars, calcium, iron, magnesium, phosphorus, potassium, vitamin C, riboflavin, niacin, pantothenic acid, vitamin B6, folate, vitamin A, and vitamin E. Smokers reported reduced compliance with the DRIs for iron, phosphorus, vitamin C, riboflavin, and folate compared with nonsmokers. Unlike other evaluations of smokers vs nonsmokers, we observed no difference in body weight between groups. Smokers and nonsmokers alike reported dietary intakes lower than the DRIs for many nutrients. However, the reported nutrient intake of the smokers was substantially lower than nonsmokers for key nutrients, and they were more likely to not comply with the DRIs for essential nutrients, placing them at increased risk of chronic disease.

Khat Use is Associated with Tobacco, Alcohol, and Illicit Drug Use: A Cross-Sectional Examination in the United States.

No study has systematically examined khat (Catha edulis) use and its linkages with other substance use in the United States. This study provides novel findings related to the associations of khat with other substance use among immigrants in metropolitan areas of Minnesota where large East African communities reside. Using a convenience sampling, a total of 261 individuals completed a brief face-to-face interview during which demographic information and substance use were assessed. The proportion of lifetime and current use were 30% and 6.6% for khat, 35% and 18% for tobacco, 35% and 21% for alcohol, and 13% and 10% for other illicit drugs. Self-report history of khat use was associated with tobacco, alcohol, and other drug use. Tobacco use was related to alcohol and use of other drugs. The results suggest that a history of khat use is useful in identifying individuals who are vulnerable to substance-use-related problems. The findings indicate the need for more research on khat in the U.S.

Level of khat dependence, use patterns, and psychosocial correlates in Yemen: a cross-sectional investigation.

Chronic khat use is associated with negative health consequences. However, no study has fully characterized individuals who are khat dependent. This paper examines socio-demographic and psychosocial correlates of adult khat dependence. A total of 270 khat users (129 women) in Yemen completed face-to-face interviews and provided demographic information and data on patterns of khat use, subjective mood, and sleep quality. The Severity of Dependence Scale-Khat (SDS-khat) was used to assess level of khat dependence. A series of analysis of variance was conducted. Khat users, on average, used khat for 5.2 hours a day (SD = 2.3) for 5.7 days a week (SD = 2.0). Individuals who screened positive for khat dependence reported longer duration of khat sessions per day, higher frequency of khat use per week, greater levels of negative mood and sleep disturbances, and were more likely to endorse physical symptoms after khat use (P < 0.05). Future research should elucidate mechanisms responsible for khat dependence symptomatology.