"I Like the Vibes it Gives": Adolescent Perspectives on Cannabis Billboards and Print Advertising in Nevada.

An influx of laws permitting recreational cannabis sales in the US has allowed for increased advertising. The purpose of this study was to describe how adolescents perceive outdoor and print cannabis advertising and to identify aspects of advertising that are appealing or eye-catching, focusing on five themes: price promotion, sex appeal, wellness, party, and text-only. We recruited adolescents ages 11-17 to participate in seven focus groups (44 participants) from 2019 to 2020. Participants viewed cannabis advertisements and responses were summarized using deductive thematic analysis. The party-themed advertisements were the most salient to participants, who desired to emulate the behaviors shown. Participants favored ads featuring young people and containing multiple colors. Participants disliked advertisements perceived to portray misleading or contradictory messages, such as the promotion of physical activity or use of sex appeal, and ads perceived to lack authenticity. Identification of youth appealing features can help inform cannabis advertising regulations.

Adverse childhood experiences, antenatal stressful life events, and marijuana use during pregnancy: A population-based study.

Cumulative exposure to adverse childhood experiences (ACEs) and antenatal stressful life events (ASLEs) are independently associated with marijuana use during pregnancy. However, research has not explored how both exposures may influence marijuana use jointly. Assessing the joint associations of ACEs and recent ASLEs on marijuana use can identify people who may benefit from early intervention. Data come from the Nevada Pregnancy Risk Assessment Monitoring System, 2017-2020 (N = 2483). We assessed eight measures of ACEs before age 18 and fourteen measures of ASLEs twelve months before giving birth. Generalized estimating equations estimated the direct and joint associations (additive and multiplicative interaction) of ACEs and ASLEs on marijuana use during pregnancy. 9.8% used marijuana during the most recent pregnancy. Compared to people who reported no ACEs, those reporting 1 ACE (adjusted prevalence ratio[aPR] = 1.96, 95% confidence interval [CI] = 1.30-2.94), 3 ACEs (aPR = 3.58, 95%CI = 2.69-4.77), and 4+ ACEs (aPR = 3.67, 95%CI = 2.36-5.72) were more likely to use marijuana. Compared to people reporting no ASLEs, those reporting 4+ ASLEs (aPR = 3.12, 95% CI = 1.64-5.92) were more likely to use marijuana. There was evidence of interaction for high ACE and ASLE exposure on an additive scale. ACEs and ASLEs were independently associated with marijuana use during pregnancy, and there was evidence of additive interaction. Screening for ACEs and ASLEs during pregnancy, referrals to appropriate behavioral health services, and trauma-informed approaches are important to address marijuana use during pregnancy.

Protective Environmental Factors and Opioid Use Among Sexual Minority Youth.

Objectives: Nonmedical use of prescription opioids (NMUPO) is a pressing public health concern and affects sexual minority youth (SMY) at greater rates than heterosexual youth. We investigated whether protective environmental factors-(1) Human Rights Campaign's state equality index (SEI) and (2) supportive school environments for LGBTQ youth, influenced NMUPO among SMY and non-SMY students. Methods: We combined data from the 2017-2019 Youth Risk Behavior Survey, 2016-2018 School Health Profiles, state-level socio-demographic and SEI data across 24 states (N=156,149). Generalized linear mixed models examined associations between (1) SEI and (2) supportive school environments for LGBTQ youth, with NMUPO, accounting for clustering at the school-and state-level. Results: Before adjustment, we found that youth in states with higher SEI were significantly less likely to engage in NMUPO compared to students in states with lower SEI, a relationship that became non-significant after adjustment. After adjusting for individual-and state-level indicators, SMY in states with supportive school environments for LGBTQ youth were less likely to engage in NMUPO. Conclusions: Supportive school environments for LGBTQ youth may play an important role in the health of SMY. Establishing more inclusive policies and supportive environments within schools may reduce NMUPO among SMY.

Associations between Circumstances Surrounding Overdose and Underlying Classes of Polysubstance Overdose Deaths.

BACKGROUND: The overdose crisis is worsening, with polysubstance overdose deaths involving psychostimulants increasing in the U.S. Substance-specific prevention and intervention activities may not be as effective for polysubstance use, so we sought to classify substances used among overdose decedents to identify unique factors related to these classes. METHODS: We used data from the Nevada State Unintentional Drug Overdose Reporting System, Jan 2019-Jun 2021, which comes from death certificates, coroner/medical examiner reports, and postmortem toxicology. Latent class analysis, multinomial logistic regression, and Chi-squared tests determined underlying drug use classes, differences in characteristics and circumstances surrounding overdose, and assessed relationships between circumstances and drug use classes. RESULTS: We identified four latent classes: (1) prescription drugs (19.1%), (2) predominately methamphetamine (31.4%), (3) multi-drug (28.9%), and (4) opioid and stimulant (20.6%). Compared to other classes, the prescription drug class had a higher percentage of female decedents, from rural counties, with mental health diagnoses, who died at home. The predominately methamphetamine class had a higher percentage of decedents experiencing homelessness. The multi-drug use class had higher percentage of younger and Hispanic decedents. Those in the opioid and stimulant class had higher odds of being recently released from an institutional setting, compared to the multi drug class. CONCLUSIONS: These underlying classes were associated with several characteristics and circumstances that can prove useful for prevention, treatment, and harm reduction agencies when designing programs and interventions to target specific groups of people at-risk for drug overdose.

Adverse childhood experiences and past 30-day cannabis use among middle and high school students: The protective influence of families and schools.

Exposure to adverse childhood experiences (ACEs) is a risk factor for adolescent cannabis use (CU). We explored whether family communication and school connectedness can offer direct protection (the compensatory model of resiliency) or moderating protection (the protective factors model of resiliency). Using cluster random sampling, a Youth Risk Behavior Survey (YRBS) was conducted with 5,341 middle school and 4,980 high school students in 2019. Generalized estimating equations were used to estimate whether family communication and school connectedness offered independent direct protection (multiple regression) or moderating protection (multiplicative interaction) in the relationship between ACEs and past 30-day CU. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) were calculated. There was a graded relationship between ACEs and past 30-day CU for all students that was particularly strong among middle school students: 1 ACE (APR = 2.37, 95% CI = 2.16, 2.62), 2 ACEs (APR = 2.89, 95% CI = 2.60, 3.23), 3 ACEs (APR = 5.30, 95% CI = 4.75, 5.90), 4 + ACEs (APR = 7.86, 95% CI = 7.13, 8.67). Results supported the compensatory model of resiliency with both family communication (middle school APR = 0.90, 95% CI = 0.88, 0.93; high school APR = 0.90, 95% CI = 0.87, 0.93) and school connectedness (middle school APR = 0.76, 95% CI = 0.72, 0.79; high school APR = 0.72, 95% CI = 0.68, 0.77) demonstrating a direct, independent protective relationship with past 30-day CU. There was no consistent evidence supporting the protective factors resiliency model.

Long-Term Improvements in Knowledge and Psychosocial Factors of a Teen Pregnancy Prevention Intervention Implemented in Group Homes.

PURPOSE: Youth in out-of-home care have higher rates of sexual risk behaviors and pregnancy than youth nationally. This study aimed to determine if Power Through Choices (PTC), a teen pregnancy prevention program developed for youth in out-of-home care, significantly improves knowledge and psychosocial outcomes regarding HIV and sexually transmitted infections (STIs), sexual activity and contraception methods, long term. METHODS: A cluster randomized controlled trial was conducted with 1,036 ethnically diverse youths (aged 13-18 years) recruited from 44 residential group homes in three states. Intervention participants received the 10-session PTC intervention; control participants received usual care. Participants were administered self-report surveys at baseline, after intervention, 6 and 12 months after the intervention. Survey items assessed knowledge, attitudes, self-efficacy, and behavioral intentions regarding HIV and STIs, sexual activity and contraception methods. Random intercept logistic regression analyses were used to assess differences between the intervention and control groups. RESULTS: Compared with youth in the control group, youth in the PTC intervention demonstrated significant improvements in knowledge about anatomy and fertility (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.03-1.11), HIV and STIs (AOR = 1.03, 95% CI = 1.002-1.07), and methods of protection (AOR = 1.06, 95% CI = 1.03-1.09), as well as self-efficacy regarding self-efficacy to communicate with a partner (AOR = 1.14, 95% CI = 1.04-1.26), plan for protected sex and avoid unprotected sex (AOR = 1.16, 95% CI = 1.04-1.28), and where to get methods of birth control (AOR = 1.13, 95% CI = 1.01-1.26) 12 months after the intervention. CONCLUSIONS: Findings suggest that the PTC intervention can have positive long-term knowledge and psychosocial effects regarding contraception methods on youth in out-of-home care.

Social Capital and Quality of Life Among People Living With HIV/AIDS in Southeast China.

A cross-sectional study was conducted with 261 people living with HIV (PLWH) in Southeast China. A social capital questionnaire was used to measure social capital dimensions (trust, social connection, and social participation). A Chinese version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) was used to assess Quality of Life (QoL); Physical Health Summary Scores (PHS) and Mental Health Summary Scores (MHS) were calculated. Multiple regression assessed whether social capital and its dimensions were associated with PHS and MHS. After controlling for sociodemographics and HIV-related factors, lower PHS scores were found among participants with low overall social capital (P < .01) and low trust (P < .001). Lower MHS scores were found among participants with low overall social capital (P < .001), low trust (P < .001) and low social connection (P < .01). Our findings identify potential intervention targets to improve QoL among PLWH in Southeast China, including the promotion of social capital.