Advancing Proficiencies for Health Professionals in the Treatment of Tobacco Use Among Marginalized Communities: Development of a Competency-Based Curriculum and Virtual Workshop.

BACKGROUND: Tobacco-related disparities are a leading contributor to health inequities among marginalized communities. Lack of support from health professionals is one of the most cited barriers to tobacco cessation reported by these communities. Improving the proficiencies with which health professionals incorporate social and cultural influences into therapeutic interactions has the potential to address this critical barrier. In general, training to improve these proficiencies has shown promise, but the specific proficiencies required for treating tobacco use among marginalized communities are unknown. This project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals with experience and training in the evidence-based treatment of tobacco use, and then pilot test the content delivered via an expert review of a virtual, self-paced workshop. METHODS: We used the Delphi Technique to systematically identify the specific competencies and corresponding knowledge and skill sets required to achieve these proficiencies. Educational content was developed to teach these competencies in a virtual workshop. The workshop was evaluated by 11 experts in the field by examining pre- and post-training changes in perceived knowledge, skill, and confidence levels and other quantitative and qualitative feedback. Repeated measures analysis of variance and paired sample t-tests were used to examine pre-post training differences. RESULTS: Six competencies and corresponding skill sets were identified. After exposure to the virtual workshop, the experts reported significant increases in the overall proficiency for each competency as well as increases in nearly all levels of knowledge, skill, and confidence within the competency skill sets. Qualitative and quantitative findings indicate that content was relevant to practice. CONCLUSIONS: These findings provide preliminary support for 6 competencies and skills sets needed to improve therapeutic interpersonal interactions that recognize the importance of social and cultural influences in the treatment of tobacco use.

Imaging Voltage Globally and in Isofrequency Lamina in Slices of Mouse Ventral Cochlear Nucleus.

The cochlear nuclei (CNs) receive sensory information from the ear and perform fundamental computations before relaying this information to higher processing centers. These computations are performed by distinct types of neurons interconnected in circuits dedicated to the specialized roles of the auditory system. In the present study, we explored the use of voltage imaging to investigate CN circuitry. We tested two approaches based on fundamentally different voltage sensing technologies. Using a voltage-sensitive dye we recorded glutamate receptor-independent signals arising predominantly from axons. The mean conduction velocity of these fibers of 0.27 m/s was rapid but in range with other unmyelinated axons. We then used a genetically-encoded hybrid voltage sensor (hVOS) to image voltage from a specific population of neurons. Probe expression was controlled using Cre recombinase linked to c-fos activation. This activity-induced gene enabled targeting of neurons that are activated when a mouse hears a pure 15-kHz tone. In CN slices from these animals auditory nerve fiber stimulation elicited a glutamate receptor-dependent depolarization in hVOS probe-labeled neurons. These cells resided within a band corresponding to an isofrequency lamina, and responded with a high degree of synchrony. In contrast to the axonal origin of voltage-sensitive dye signals, hVOS signals represent predominantly postsynaptic responses. The introduction of voltage imaging to the CN creates the opportunity to investigate auditory processing circuitry in populations of neurons targeted on the basis of their genetic identity and their roles in sensory processing.

Incorporating Intersectionality as a Framework for Equity-Minded Tobacco Control Research: A Call for Collective Action Toward a Paradigm Shift.

INTRODUCTION: To eliminate tobacco-related disparities, tobacco control research would benefit from a paradigm shift. Intersectionality, a framework pioneered by Kimberlé Crenshaw in late 1980s, has the potential to improve our understanding of why and how certain social groups are disproportionately harmed by commercial tobacco use, and improve our ability to address persistent tobacco-related health disparities. AIMS AND METHODS: In this commentary, we outline the rationale and recommendations for incorporating intersectionality into equity-minded tobacco control research. These recommendations arose from intersectionality webinars organized by the Health Disparities (now Health Equity) Network of the Society for Research on Nicotine & Tobacco (SRNT) in 2019 and 2020. RESULTS: Specifically, we propose that eliminating tobacco-related disparities through intersectionality-informed research requires a multilevel, multipronged approach. We summarize priority actions for the tobacco control research field to achieve health equity through the intersectionality framework including acknowledging that structural factors, racism and power dynamics shape lived experiences, integrating critical theoretical frameworks and intersectionality scholarship into research questions, and embracing collaborative community-based approaches at every level of the research process. CONCLUSIONS: Through these actions, our field can take concrete steps to fundamentally improve our approach to conducting research to achieve health equity. IMPLICATIONS: Intersectionality is a valuable tool to align our field with our pursuit of health equity. The recommendations aim to improve methods of equity-focused tobacco control, prompt ongoing dialogue on the utility of this tool, and shift paradigms in how the research process is conducted at every level among stakeholders, including researchers, journal editors and reviewers, funders, practitioners, and policy makers.

Menthol Cigarette Use Among Adults Who Smoke Cigarettes, 2008-2020: Rapid Growth and Widening Inequities in the United States.

INTRODUCTION: In April 2021, the U.S. Food and Drug Administration announced its intention to issue a product standard banning menthol as a characterizing flavor in cigarettes. Given the potential relevance of national estimates of menthol use to pending legislation, this study estimated the prevalence of menthol use among U.S. adults who smoke cigarettes in 2020 and investigated changes in menthol use from 2008 to 2019 by sociodemographics, mental health, and substance use. AIMS AND METHODS: Nationally representative annual, cross-sectional data from the National Survey on Drug Use and Health, which included participants ages 18 years and older residing in the United States from 2008 to 2019 and the 2020. Data were analyzed using logistic and linear regression models to estimate trends in menthol use among adults who smoke cigarettes by sociodemographic, mental health and substance use variables (total analytic sample 2008-2019 n = 128 327). RESULTS: In 2020, 43.4% of adults who smoked cigarettes in the past month used menthol. Menthol use was most common among black adults (80%) and over 50% of those Hispanic, female, young (ages 18-34 years), lesbian/gay, with serious psychological distress, and with cigar use used menthol. Menthol use increased among adults who used cigarettes from 2008 to 2019, overall, and grew more rapidly among adults ages 26-34 years, Hispanic, light cigarette use (1-5 per day), and those who smoked cigars. CONCLUSIONS: Menthol use has increased among U.S. adults who smoke cigarettes over the past decade. Enacting menthol bans could have a widespread public health impact, especially among younger and minoritized groups. IMPLICATIONS: Menthol cigarette use increased among individuals who smoke cigarettes from 2008 to 2019 in the United States. In 2020, over 40% of smokers used menthol, and menthol use was considerably higher among adult smokers from racial/ethnic minoritized groups, who were younger and who reported mental health problems. The U.S. Food and Drug Administration seeks to ban menthol as a characterizing flavor in cigarettes; our results suggest that such a ban is likely to have a wide-ranging impact on public health.

Mammalian octopus cells are direction selective to frequency sweeps by excitatory synaptic sequence detection.

Octopus cells are remarkable projection neurons of the mammalian cochlear nucleus, with extremely fast membranes and wide-frequency tuning. They are considered prime examples of coincidence detectors but are poorly characterized in vivo. We discover that octopus cells are selective to frequency sweep direction, a feature that is absent in their auditory nerve inputs. In vivo intracellular recordings reveal that direction selectivity does not derive from across-frequency coincidence detection but hinges on the amplitudes and activation sequence of auditory nerve inputs tuned to clusters of hot spot frequencies. A simple biophysical octopus cell model excited with real nerve spike trains recreates direction selectivity through interaction of intrinsic membrane conductances with the activation sequence of clustered excitatory inputs. We conclude that octopus cells are sequence detectors, sensitive to temporal patterns across cochlear frequency channels. The detection of sequences rather than coincidences is a much simpler but powerful operation to extract temporal information.

Local targets of T-stellate cells in the ventral cochlear nucleus.

T-stellate cells in the ventral cochlear nucleus (VCN) are known to have local axon collaterals that terminate in the vicinity of their dendrites and cell bodies within the same isofrequency lamina in parallel with the auditory nerve fibers that innervate them. Excitatory synaptic connections between stellate cells within an isofrequency lamina are hypothesized to be involved in the nitric oxide-mediated upregulation of T-stellate responses to their auditory input. This could serve as a mechanism of variable gain control in the enhancement of responses to vowel spectral peaks. Previous studies have provided indirect evidence for these possible synaptic interconnections between T-stellate cells, but unequivocal identification has yet to be established. Here, we used retrograde neuronal tracing with adeno-associated viral vector or biotinylated dextran amine injected into the inferior colliculus (IC) to detect the postsynaptic target of T-stellate cells within the VCN. We show that backfilled T-stellate cell axons make monosynapatic connections on the labeled cell bodies and dendrites of other labeled T-stellate cells within an isofrequency lamina. Electron microscopy revealed that T-stellate terminals can also make synapses on structures not retrogradely labeled from the IC. Glycine antibodies combined with the viral labeling indicated that these nonbackfilled structures that the labeled T-stellate terminals were synapsing on are most likely the cell bodies and dendrites of two size categories of glycinergic VCN cells, whose sizes and relative numbers indicated they are the D- and L-stellate cells. These cells are known to provide inhibitory inputs back onto T-stellate cells. Our data indicate that, in addition to their auditory nerve input, T-stellate cells provide a second modulatable excitatory input to both inhibitory and excitatory cells in a VCN isofrequency lamina and may play a significant role in acoustic information processing.

College students' patterns of electronic nicotine delivery system use and other substance use.

Objective: Electronic nicotine delivery system (ENDS) use on college campuses increased dramatically in recent years. Little is known about how ENDS use among college students relates to other substance use. Participants: Undergraduates (n = 3,917) at a mid-sized Midwestern public university in the United States. Methods: Cross-sectional survey data and latent class analysis of ENDS, cigarettes, alcohol, marijuana, and non-medical use of attention-deficit/hyperactivity disorder (ADHD) medication. Results: Over 95% of ENDS users fit into one of two classes comprising a minority of college students engaged in multiple and often problematic substance use behaviors. Only 4% of ENDS users were grouped into a class comprising 85% of the sample and characterized by either little/no substance use or moderate alcohol consumption. Conclusions: ENDS use in this sample was not indicative of general exploration with substances, nor was it indicative of isolated tobacco use, but rather more heavy and problematic substance use.

Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy I: ENDS Use Behavior During Pregnancy.

PURPOSE OF REVIEW: This review examines Electronic Nicotine Delivery Systems (ENDS) use behavior during pregnancy, including the prevalence of and transitions in use during pregnancy. RECENT FINDINGS: Twenty-two papers addressed the prevalence of and/or transitions in ENDS use during pregnancy. Findings show a complex landscape of ENDS use. A minority (0.4%-7.0%) of pregnant persons use ENDS; most commonly this occurs in the form of dual use (ENDS and combustible cigarettes (CC); 75%). Many pregnant persons report using ENDS because they perceive them to be a lower-risk alternative and/or potential cessation aide for CC smoking. However, while a subset of those who use ENDS do quit all tobacco product use during pregnancy, only a small proportion switch from exclusive CC smoking to exclusive ENDS use. SUMMARY: ENDS are a somewhat new addition to the tobacco product landscape. The perception of ENDS as a lower-risk alternative may contribute to ENDS use in pregnancy. There is insufficient evidence to support the notion that ENDS facilities the cessation of tobacco product use during pregnancy.

Glycinergic axonal inhibition subserves acute spatial sensitivity to sudden increases in sound intensity.

Locomotion generates adventitious sounds which enable detection and localization of predators and prey. Such sounds contain brisk changes or transients in amplitude. We investigated the hypothesis that ill-understood temporal specializations in binaural circuits subserve lateralization of such sound transients, based on different time of arrival at the ears (interaural time differences, ITDs). We find that Lateral Superior Olive (LSO) neurons show exquisite ITD-sensitivity, reflecting extreme precision and reliability of excitatory and inhibitory postsynaptic potentials, in contrast to Medial Superior Olive neurons, traditionally viewed as the ultimate ITD-detectors. In vivo, inhibition blocks LSO excitation over an extremely short window, which, in vitro, required synaptically evoked inhibition. Light and electron microscopy revealed inhibitory synapses on the axon initial segment as the structural basis of this observation. These results reveal a neural vetoing mechanism with extreme temporal and spatial precision and establish the LSO as the primary nucleus for binaural processing of sound transients.

Feasibility, Utility, and Limitations of a Rapid Community Behavioral Diagnosis for Social Distancing During the 2020 Coronavirus Pandemic.

PURPOSE: To evaluate the feasibility, utility, and limitations of a rapid community behavioral diagnosis (RCBD) for social distancing behaviors to prevent coronavirus transmission during a global coronavirus pandemic. DESIGN: Using social media for recruitment, we partnered with a local community task force to administer a brief online survey. SETTING: Residential urban community. SAMPLE: Eighty-four community members, the majority of whom were white, female, college educated completed the survey. MEASURES: Theory of planned behavior constructs: behavioral intentions, attitudes, perceived norms, and perceived behavioral control for 3 social distancing behaviors: maintaining a 6-foot distance, avoiding places people congregate, and staying home as much as possible. ANALYSIS: Path analyses were conducted to understand significant determinants of intentions for each behavior to guide the development of locally tailored health promotion messages. RESULTS: The RCBD was implemented, and results were communicated to the community within 1 week. Intentions were high across the 3 behaviors but lowest for staying home as much as possible. Younger participants had lower intentions of maintaining a 6-foot distance than older participants. For each behavior, specific recommendations for health promotion messaging emerged based on how attitudes, norms, and perceived behavioral control related to intentions. CONCLUSION: In a situation where local community action is paramount for reducing coronavirus transmission, this RCBD process is feasible and useful for informing local health promotion.

Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy II: Perinatal Outcomes Following ENDS Use During Pregnancy.

Purpose of Review: This review examines the risk of adverse perinatal outcomes following electronic nicotine delivery system (ENDS) use during pregnancy, and considers whether there are sufficient data to support ENDS as a harm reduction approach during pregnancy. Recent Findings: Seven papers assessed perinatal outcomes following ENDS use during pregnancy. There was evidence that ENDS use was associated with increased risk for some adverse perinatal outcomes (e.g., small for gestational age). However, the repeated use of data sets, insufficient data (e.g., timing of ENDS use, type of ENDS products used), and limited samples size, contributed to mixed findings on the degree to which ENDS use (alone or in combination with combustible cigarettes (CC)) impacts the risk of adverse perinatal outcomes relative to CC smoking alone. Summary: The current data are still insufficient to support ENDS as a harm reduction approach, though findings do warrant concern and more detailed investigation of ENDS use during pregnancy. Future research directions, as well as implications for clinical recommendations and tobacco regulatory science are discussed.

Changes in excessive alcohol use among older women across the menopausal transition: a longitudinal analysis of the Study of Women's Health Across the Nation.

BACKGROUND: Recent data suggest that excessive alcohol use is increasing among women and older adults. Such trends are concerning, as women are more vulnerable to alcohol-related health consequences, and such health problems may be exacerbated with age. Furthermore, there are sex-specific factors that may influence alcohol consumption among women, including the hormonal changes associated with the menopausal transition and negative affect. The present study sought to investigate transitions in excessive drinking among women across the menopausal transition and included exploration of sex hormones (estradiol; testosterone) and depression. METHODS: The present study utilized publicly available data from the Study of Women Across the Nation (SWAN) and included 3302 women (42-52 years old at baseline), who completed 10 years of annual assessments. National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria were used as guidance when defining excessive drinking within the present dataset. At year 1, 170 women were identified as drinking excessively. Random-effect logistic regressions were used to examine transitions in excessive drinking. RESULTS: Women identified as excessive drinkers were more likely to transition to non-excessive drinking across all menopausal transition stages (ORs range = 3.71-5.11), while women were more likely to transition from non-excessive to excessive drinking during the early peri- and postmenopausal stages (OR = 1.52 and 1.98, respectively). Higher testosterone levels were associated with a decreased likelihood of transitioning to non-excessive drinking (OR = 0.59). Depression and estradiol levels were not related to transitions in drinking. CONCLUSIONS: The present study demonstrates that the menopausal transition marks a period of instability in alcohol use among women. Further research is warranted to understand factors related to transitioning in and out of excessive drinking.

Smoking Across the Menopausal Transition in a 10-Year Longitudinal Sample: The Role of Sex Hormones and Depressive Symptoms.

INTRODUCTION: Current cigarette smoking rates among older women remain problematic, especially given that this population experiences increased smoking-related health consequences. Despite these increased health concerns, little research to date has explored smoking patterns across the menopausal transition (pre-, early-peri-, late-peri-, and postmenopausal) or the effect of unique factors such as sex hormones and depression during this transition. METHODS: This study used 10 yearly waves of data from the Study of Women's Health Across the Nation, a longitudinal dataset. Data included 1397 women endorsing ever smoking regularly at baseline. Random-effects logistic regression models were used to examine smoking transitions. RESULTS: Although there were no associations between menopausal transition stage and smoking behavior, increased estradiol was associated with an increased likelihood of quitting regular smoking (eg, transitioning from regular smoking to non-regular or no smoking; odds ratio [OR] = 1.28), whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking (eg, transitioning from former or nonregular smoking to regular smoking OR = 2.56). Depression was associated with increased likelihood of continued smoking (OR = 0.97) and relapse (OR = 1.03). CONCLUSIONS: The results emphasize the need to develop interventions to target initiated or continued smoking among women across the menopausal transition and specifically highlight the importance of developing treatments that target depressive symptoms in this population. In addition, although singular hormone measures were associated with smoking behavior, there is a need for future study of dynamic changes in hormones, as well as the impact of progesterone on smoking behaviors across the menopausal transition. IMPLICATIONS: To date, no studies have examined smoking behaviors across the menopausal transition. In this study, although menopausal transition status was not significantly related to transitions in smoking behavior, important relationships between sex hormones and depression were observed. Increased estradiol was associated with an increased likelihood of quitting regular smoking, whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking behavior. Higher depression scores were related to continued smoking and relapse to regular smoking behavior. These results highlight the need to develop interventions to target smoking cessation among women across the menopausal transition.

Use of Mentholated Cigarettes and Likelihood of Smoking Cessation in the United States: A Meta-Analysis.

INTRODUCTION: Previous qualitative reviews have summarized evidence of an association between menthol cigarette use and likelihood of smoking cessation. The objective of this meta-analysis was to provide a quantitative summary of effect sizes, their variability, and factors related to the variability in effect size for the association between menthol use and likelihood of smoking cessation. METHODS: We systematically searched Medline, PsycINFO, and Embase for prospective and cross-sectional studies of the association between menthol use and smoking cessation. We analyzed data with random effects meta-analyses and meta-regression. RESULTS: Our review identified 22 reports from 19 studies of the association between menthol use and cessation. All identified study samples included only US smokers, with one exception that included both Canadian and US smokers. Our overall model did not demonstrate a significant association between menthol use and cessation; however, menthol users were significantly less likely to quit among blacks/African American smokers (odds ratio = 0.88). CONCLUSIONS: Among blacks/African Americans predominantly in the US menthol users have approximately 12% lower odds of smoking cessation compared to non-menthol users. This difference is likely the result of the tobacco industry's ongoing marketing influence on the black/African American Community, suggesting that a menthol ban may have a unique public health benefit for black/African American smokers by encouraging quitting behavior. IMPLICATIONS: This study adds a quantitative summary of the association between menthol cigarette use and smoking cessation in the United States. Findings of an association with lower likelihood of cessation among black/African American smokers, likely resulting from the tobacco industry's marketing influence, support the ban of menthol flavoring as part of a comprehensive tobacco control effort to increase cessation among black/African American smokers.

Cigarette smoking among those with mental disorders in the US population: 2012-2013 update.

BACKGROUND: Recent nationally representative estimates from the USA suggest the prevalence of cigarette smoking continues to be much higher among those with mental disorders compared with those without; however, prevalence estimates for current cigarette use by specific diagnoses are outdated. METHODS: We analysed data from the National Epidemiologic Survey on Alcohol and Related Conditions III (2012-2013). We estimated the prevalence of lifetime and past-year smoking, lifetime and past-year daily smoking, and lifetime smoking cessation among ever smokers (ie, the quit ratio) among those with common mood, anxiety and substance use disorders in comparison to those without these disorders. RESULTS: Across disorders, smoking prevalence was higher and the quit ratio was lower among those with common mental disorders compared with those without, with twofold to sixfold relativedifferences in the odds of the magnitude. CONCLUSIONS: Despite tobacco control advances since 2000 and resulting declines in smoking prevalence, smoking remains extraordinarily more common among those with mood, anxiety and substance use disorders, with highest rates among those with bipolar and substance use disorders.

Evaluation of medial division of the medial geniculate (MGM) and posterior intralaminar nucleus (PIN) inputs to the rat auditory cortex, amygdala, and striatum.

The medial division of the medial geniculate (MGM) and the posterior intralaminar nucleus (PIN) are association nuclei of the auditory thalamus. We made tracer injections in these nuclei to evaluate/compare their presynaptic terminal and postsynaptic target features in auditory cortex, amygdala and striatum, at the light and electron microscopic levels. Cortical labeling was concentrated in Layer 1 but in other layers distribution was location-dependent. In cortical areas designated dorsal, primary and ventral (AuD, Au1, AuV) terminals deep to Layer 1 were concentrated in infragranular layers and sparser in the supragranular and middle layers. In ectorhinal cortex (Ect), distributions below Layer 1 changed with concentrations in supragranular and middle layers. In temporal association cortex (TeA) terminal distributions below Layer 1 was intermediate between AuV/1/D and Ect. In amygdala and striatum, terminal concentrations were higher in striatum but not as dense as in cortical Layer 1. Ultrastructurally, presynaptic terminal size was similar in amygdala, striatum or cortex and in all cortical layers. Postsynaptically MGM/PIN terminals everywhere synapsed on spines or small distal dendrites but as a population the postsynaptic structures in cortex were larger than those in the striatum. In addition, primary cortical targets of terminals were larger in primary cortex than in area Ect. Thus, although postsynaptic size may play some role in changes in synaptic influence between areas it appears that terminal size is not a variable used for that purpose. In auditory cortex, cortical subdivision-dependent changes in the terminal distribution between cortical layers may also play a role.

Impact of a Community-level Intervention on HIV Stigma, Homophobia and HIV Testing in New York City: Results from Project CHHANGE.

Background: HIV stigma and homophobia are barriers to access to HIV prevention and treatment services. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a multicomponent intervention designed to reduce community-level HIV stigma and homophobia via workshops, space-based events and bus shelter ads delivered to community-based organizations and neighborhood residents in a high HIV prevalence, primarily African-American, Black and/or Afro-Caribbean, neighborhood in New York City (NYC). Methods: Serial cross-sectional, street intercept surveys among residents of the invention neighborhood and matched control neighborhood were conducted before and after the intervention. Propensity score matching and generalized estimating equation regression models assessed the impact of CHHANGE on HIV stigma and homophobia. HIV testing service utilization data were assessed and multivariable models of self-reported HIV testing among post-intervention street survey respondents were built. Results: We did not find a significant treatment effect on HIV stigma and homophobia among residents of the intervention neighborhood as compared with control community residents. However, HIV testing increased by 350% at the testing site in the intervention community after the intervention implementation. Further, lower HIV stigma, attending an HIV stigma workshop and having friends or family living with HIV were independently associated with past six-month HIV testing among post-intervention respondents in both neighborhoods. Conclusions: CHHANGE was feasible and acceptable to community residents. Evaluating community-level interventions is challenging. Our triangulated approach yielded somewhat conflicting results, which may be due to design limitations. Further research is needed to understand whether and how CHHANGE affected HIV testing.

Principal cells of the brainstem's interaural sound level detector are temporal differentiators rather than integrators.

The brainstem's lateral superior olive (LSO) is thought to be crucial for localizing high-frequency sounds by coding interaural sound level differences (ILD). Its neurons weigh contralateral inhibition against ipsilateral excitation, making their firing rate a function of the azimuthal position of a sound source. Since the very first in vivo recordings, LSO principal neurons have been reported to give sustained and temporally integrating 'chopper' responses to sustained sounds. Neurons with transient responses were observed but largely ignored and even considered a sign of pathology. Using the Mongolian gerbil as a model system, we have obtained the first in vivo patch clamp recordings from labeled LSO neurons and find that principal LSO neurons, the most numerous projection neurons of this nucleus, only respond at sound onset and show fast membrane features suggesting an importance for timing. These results provide a new framework to interpret previously puzzling features of this circuit.

Intersection of stress and gender in association with transitions in past year DSM-5 substance use disorder diagnoses in the United States.

BACKGROUND: Stress contributes to the development and maintenance of substance use disorders (SUD), with some research suggesting that the impact of stress on SUD is greater in women. However, this has yet to be evaluated in a national dataset, across major substances of abuse. METHODS: Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n=36,309) we evaluated relationships among past year stressful life events (0 or 1 vs. 2+ events, range 0-16) and gender, and their association with transitions (new vs. absent cases; ongoing vs. remitted cases) in Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) alcohol use disorder (AUD), tobacco use disorder (TUD), cannabis use disorder (CUD), and nonmedical prescription opioid use disorder (OUD) diagnoses. RESULTS: Having 2 or more stressful life events in the past year increased the odds of having a new AUD, TUD, CUD, and OUD (OR=3.14, 2.15, 5.52, and 3.06, respectively) or ongoing AUD, TUD, and CUD (OR=2.39, 2.62, and 2.95, respectively) compared to 0 or 1 stressful life event. A stress by gender interaction for new vs. absent AUD demonstrated that having 2 or more stressful life events was associated with increased odds of new AUD in men (OR=2.51) and even greater odds of new AUD in women (OR=3.94). CONCLUSIONS: Results highlight that stress is a robust factor in both men and women with new or ongoing substance use disorders, and that effective treatments for substance use should consider the role of stress in addiction etiology and maintenance. There was little evidence for gender differences in the role of stress on transitions in substance use disorders, except for the onset of alcohol use disorders. Given that rates of alcohol use disorders are increasing in women; the impact of stress needs to be considered.

Integrative Data Analysis of Gender and Ethnic Measurement Invariance in Nicotine Dependence Symptoms.

Little research has evaluated whether conflicting evidence for gender and racial/ethnic differences in nicotine dependence (ND) may be attributed to differences in psychometric properties of ND symptoms, particularly for young Hispanic smokers. Inadequate racial/ethnic diversity and limited smoking exposure variability has hampered research in young smokers. We used integrative data analysis (IDA) to pool DSM-IV ND symptom data for current smokers aged 12-25 (N = 20,328) from three nationally representative surveys (1999, 2000 National Surveys on Drug Use and Health (NSDUH) and Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Moderated nonlinear factor analysis (MNLFA) tested symptom measurement invariance in the pooled sample containing greater ethnic and smoking exposure variability. There was study noninvariance for most symptoms. NESARC participants were more likely to report tolerance, using larger amounts or for longer periods, inability to cut down/quit, and more time spent smoking at higher levels of ND severity, but reported emotional/physical health problems at lower ND severity. Four symptoms showed gender or race/ethnicity noninvariance, but observed differences were small. An ND severity factor score adjusting for symptom noninvariance related to study membership, gender, and race/ethnicity did not differ substantively from traditional DSM-IV diagnosis and number of endorsed symptoms in estimated gender and race/ethnicity differences in ND. Results were consistent with studies finding minimal gender and racial/ethnic differences in ND, and suggest that symptom noninvariance is not a major contributor to observed differences. Results support IDA as a potentially promising approach for testing novel ND hypotheses not possible in independent studies.