Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002-2019.

SIGNIFICANCE: Cannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The current study estimated the prevalence of cigarette dependence among US individuals who smoke cigarettes by cannabis use status, and investigated trends in cigarette dependence from 2002 to 2019 among cigarette smokers by cannabis use status and cigarette consumption (ie, cigarettes per day, CPD). METHODS: Data were drawn from the 2002-2019 annual National Survey on Drug Use and Health and included US individuals aged 12+ years who used cigarettes at least once in the past month (n=231 572). Logistic regression was used to estimate the prevalence of cigarette dependence, measured as time to first cigarette <30 min, by past-month cannabis use (no use, non-daily use, daily use), and to estimate trends in cigarette dependence from 2002 to 2019 overall and stratified by cannabis use and smoking level (light, 1-5 CPD; moderate, 6-15 CPD; heavy, 16+ CPD). RESULTS: Across all levels of cigarette use, cigarette dependence was significantly more common among individuals with daily cannabis use compared with those with non-daily or no cannabis use. From 2002 to 2019, cigarette dependence increased among cigarette smokers with non-daily cannabis use, and among light and moderate cigarette smokers with no cannabis use. CONCLUSIONS: US individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who use cigarettes and do not use cannabis at virtually all levels of cigarette consumption. Further, cigarette dependence is increasing in the USA both among those who use and do not use cannabis. Given the increase in cannabis use among those using cigarettes, efforts to elucidate the nature of the association between cannabis and cigarette dependence are needed.

Trends in U.S. Depression Prevalence From 2015 to 2020: The Widening Treatment Gap.

INTRODUCTION: Major depression is a common and potentially lethal condition. Early data suggest that the population-level burden of depression has been exacerbated by the COVID-19 pandemic. Prepandemic estimates of depression prevalence are required to quantify and comprehensively address the pandemic's impact on mental health in the U.S. METHODS: Data were drawn from the 2015-2020 National Survey on Drug Use and Health, a nationally representative study of U.S. individuals aged ≥12 years. The prevalence of past-year depression and help seeking for depression were estimated from 2015 to 2019, and time trends were tested with Poisson regression with robust SEs. Point estimates were calculated for 2020 and not included in statistical trend analyses because of differences in data collection procedures. RESULTS: In 2020, 9.2% (SE=0.31) of Americans aged ≥12 years experienced a past-year major depressive episode. Depression was more common among young adults aged 18-25 years (17.2%, SE=0.78), followed closely by adolescents aged 12-17 years (16.9%, SE=0.84). Depression increased most rapidly among adolescents and young adults and increased among nearly all sex, racial/ethnic, income, and education groups. Depression prevalence did not change among adults aged ≥35 years, and the prevalence of help seeking remained consistently low across the study period. CONCLUSIONS: From 2015 to 2019, there were widespread increases in depression without commensurate increases in treatment, and in 2020, past 12‒month depression was prevalent among nearly 1 in 10 Americans and almost 1 in 5 adolescents and young adults. Decisive action involving a multipronged public health campaign that includes evidence-based prevention and intervention to address this ongoing mental health crisis is urgently needed.

Estimating causal and time-varying effects of maternal smoking on youth smoking.

INTRODUCTION: Maternal smoking is a well-known risk factor for youth smoking, yet whether this relationship is causal remains unresolved. This study utilizes propensity score methods for causal inference to robustly account for shared risk factors between maternal and offspring smoking. METHODS: An 8-year longitudinal cohort of 900 adolescents in the Chicago area were followed starting from approximately age 15.6. The effects of maternal lifetime smoking (MLS) and prenatal tobacco exposure (PTE) (among participants reporting MLS) on offspring's past 30-day smoking, daily smoking status and smoking frequency were examined using logistic regression and Poisson regression after nearest-neighbor propensity matching. Age dependency of this relationship was then examined across the age range of 15-25 using time-varying effect modeling. RESULTS: Propensity matching yielded 438 and 132 pairs for MLS and PTE study samples, respectively. MLS demonstrated significant associations with past 30-day smoking (RR 1.09; 95% CI 1.04-1.14), daily smoking (RR 1.08; 95% CI 1.05-1.12), and smoking frequency of offspring (RR 1.32; 95% CI 1.15-1.52), with stable effects across age. Among participants reporting MLS, having PTE showed significant additional effects on daily smoking (RR 1.09; 95% CI 1.02-1.17) and age-dependency that showed significance during young adulthood but not adolescence. CONCLUSION: The relationship between maternal and offspring smoking was not fully accounted for by shared risk factors, suggesting possible causation with PTE having a delayed effect across age. Targeted prevention efforts should be made on maternal smoking-exposed adolescents to mitigate their risks of developing heavy smoking habits in adulthood.

The Effect of Maternal Smoking on Offspring Smoking Is Unrelated to Heritable Personality Traits or Initial Subjective Experiences.

INTRODUCTION: Maternal smoking is a risk factor for offspring smoking. Lifetime maternal smoking vs. prenatal tobacco exposure (PTE) appears to act through different mechanisms. This study tested the hypothesis that maternal smoking measures' effects on offspring smoking could be attributable to hereditary mechanisms: personality traits (novelty-seeking, impulsivity, neuroticism, and self-esteem) and initial subjective smoking experiences (pleasurable, unpleasurable, and dizziness). METHODS: Data were drawn from the Social and Emotional Contexts of Adolescent Smoking Patterns study, an 8-year longitudinal study of 9th or 10th graders at baseline (≈age 15) who experiment with smoking (<100 lifetime cigarettes; N = 594) at baseline. The young adult smoking frequency at the 8-year follow-up (≈age 23) was examined as a function of baseline characteristics (heritable trait, maternal smoking, PTE, and sex) and baseline smoking frequency and nicotine dependence. Structural equation models determined whether the inclusion of each heritable trait among offspring confounded the effects of maternal smoking (PTE or maternal smoking) on offspring smoking and nicotine dependence. RESULTS: Impulsiveness was associated with intermediate adolescent smoking frequency (B = 0.135, SD = 0.043, p = .002) and nicotine dependence (B = 0.012, SD = 0.003, p < .001). Unpleasurable first experience (B = 0.886, SD = 0.374, p = .018) and dizziness (B = 0.629, SD = 0.293, p = .032) showed a trend with intermediate smoking frequency that was nonsignificant after correcting for multiple comparisons. These traits did not confound maternal smoking's effects. CONCLUSIONS: None of the heritable traits examined in this model explained the effect of maternal smoking measures on adolescence or young adulthood offspring smoking. Further research is needed to elucidate the mechanism by which PTE and maternal smoking are linked to offspring smoking. IMPLICATIONS: Prenatal tobacco exposure (PTE) and mother's lifetime smoking present separate and independent risks for offspring smoking; however, their mechanisms seem unrelated to heritable personality traits and initial subjective smoking experiences. These findings have implications for separate screening strategies tailored to different age groups, especially related to PTE's risk of smoking in young adulthood. Additionally, these findings add to the known risks of maternal smoking. Further research is needed to understand the mechanism underlying the risk posed by maternal lifetime smoking and PTE on offspring smoking behavior.

Alcohol Use Disorder Symptoms Rather than Alcohol Exposure Predict Experiences of Cannabis Use Disorder Symptoms among Adolescents and Young Adults.

Background: Alcohol and cannabis use are highly comorbid. Objective: We evaluate if alcohol use and/or alcohol use disorder symptoms predict experiences of cannabis use disorder symptoms among adolescents and young adults and whether the relationships differ based on frequency of cannabis use, recency of cannabis initiation and age. Method: Data were drawn from five annual surveys of the National Survey on Drug Use and Health (2014-2018) to include adolescents and young adults (age 12 to 21 years) who reported using cannabis and alcohol at least once in the past 30 days. Results: Number of alcohol use disorder symptoms, over and above alcohol quantity or frequency, was positively associated with each of the cannabis use disorder symptoms as well as the total number of cannabis use disorder symptoms endorsed. The association between alcohol and cannabis use disorder symptoms was stronger among those who were younger and those who initiated cannabis use within the past 2 years. Conclusions: Treatment should consider these and other cross-over effects of substance disorder symptoms when addressing risk for chronic and dependent use.

Behavioral symptoms of eating disorders among adopted adolescents and young adults in the United States: Findings from the Add Health survey.

OBJECTIVE: More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating-disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals. METHOD: We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self-induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis. RESULTS: Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (ps < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (ps < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms. DISCUSSION: This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.

The Interpretation of Statistical Power after the Data have been Gathered.

Post-hoc power estimates (power calculated for hypothesis tests after performing them) are sometimes requested by reviewers in an attempt to promote more rigorous designs. However, they should never be requested or reported because they have been shown to be logically invalid and practically misleading. We review the problems associated with post-hoc power, particularly the fact that the resulting calculated power is a monotone function of the p-value and therefore contains no additional helpful information. We then discuss some situations that seem at first to call for post-hoc power analysis, such as attempts to decide on the practical implications of a null finding, or attempts to determine whether the sample size of a secondary data analysis is adequate for a proposed analysis, and consider possible approaches to achieving these goals. We make recommendations for practice in situations in which clear recommendations can be made, and point out other situations where further methodological research and discussion are required.

Among whom is cigarette smoking declining in the United States? The impact of cannabis use status, 2002-2015.

OBJECTIVES: To 1) estimate changes in the prevalence of daily and non-daily cigarette smoking among current (past 30-day) daily, non-daily, and non-cannabis users in the United States (U.S.) population; 2) examine time trends in current (past 30-day) cigarette smoking in daily, non-daily, and non-cannabis users ages 12+ from 2002 to 2015. METHODS: Data collected annually from the 2002 to 2015 National Survey on Drug Use and Health (NSDUH) were employed. Linear time trends of daily and non-daily cigarette smoking were assessed using logistic regression with year as the predictor. RESULTS: In 2015, the prevalence of current (past 30-day) cigarette smoking was highest among daily (54.57%), followed by non-daily (40.17%) and non-cannabis users (15.06%). The prevalence of non-daily cigarette smoking increased among daily cannabis users from 2002 to 2015, whereas non-daily cigarette smoking declined among non-daily cannabis users and non-cannabis users from 2002 to 2015. Daily cigarette smoking declined among both cannabis users and non-users; the most rapid decline was observed among daily cannabis users, followed by non-daily and then by non-cannabis users. However, the relative magnitude of the change in prevalence of daily cigarette smoking was similar across the three cannabis groups. CONCLUSIONS: Despite ongoing declines in cigarette smoking in the U.S., non-daily cigarette smoking is increasing among current cannabis users, a growing proportion of the U.S. POPULATION: Daily and non-daily cigarette smoking continue to decline among those who do not use cannabis. Efforts to further tobacco control should consider novel co-use-oriented intervention strategies and outreach for the increasing population of cannabis users.

The role of nicotinic receptor genes (CHRN) in the pathways of prenatal tobacco exposure on smoking behavior among young adult light smokers.

BACKGROUND: Prenatal tobacco exposure (PTE) is associated with more frequent smoking among young, light smokers. Little is known about how nicotinic acetylcholine receptor (CHRN) genes may contribute to this relationship. METHODS: Data were drawn from a longitudinal cohort of young light smokers of European ancestry (N = 511). Three single nucleotide polymorphisms (SNPs) among offspring, rs16969968 and rs6495308 in CHRNA5A3B4 and rs2304297 in CHRNB3A6, were analyzed with respect to whether they 1) predict PTE status; 2) confound the previously-reported effects of PTE on future smoking; 3) have effects on youth smoking frequency that are mediated through PTE; and 4) have effects that are moderated by PTE. RESULTS: rs2304297 and rs6495308 were associated with increased likelihood and severity of PTE, respectively. In a path analysis, rs16969968 directly predicted more frequent smoking in young adulthood (B = 1.50, p = .044); this association was independent of, and not mediated by, PTE. The risk of rs16969968 (IRR = 1.07, p = .015) and the protective effect of rs2304297 (IRR = 0.84, p < .001) on smoking frequency were not moderated by PTE. PTE moderated the effect of rs6495308, such that these alleles were protective against later smoking frequency only among non-exposed youth (IRR = 0.85, p < .001). CONCLUSIONS: The association between offspring CHRNB3A6 and PTE is a novel finding. The risk of rs16969968 on youth smoking is independent and unrelated to that of PTE among young, light smokers. PTE moderates the protective effect of rs6495308 on youth smoking frequency. However, PTE's pathway to youth smoking behavior was not explained by these genetic factors, leaving its mechanism(s) of action unclear.

Socioeconomic Disparities in Smoking Among U.S. Adults With Depression, 2005-2014.

INTRODUCTION: The purpose of this study is to estimate changes in the cigarette smoking prevalence among U.S. adults with and without depression from 2005 to 2014 by income and education level and overall. METHODS: This study examined data from adult respondents (aged ≥18 years) in the National Survey on Drug Use and Health, an annual cross-sectional study of U.S. individuals. Data from the years 2005 to 2014 were analyzed for a total analytic sample of n=378,733. The prevalence of past-month cigarette smoking was examined annually from 2005 to 2014 among adults with and without past-year major depression, overall and by income/education, using linear trend analyses. Data analysis occurred in 2017. RESULTS: The prevalence of smoking declined significantly from 2005 to 2014 among those with depression (37.62% to 34.01%; p<0.001) and without depression (23.99% to 19.87%; p<0.001). Yet, smoking remained nearly twice as common among those with depression during this period. Among adults with depression in the lowest income and education groups, the prevalence of smoking was more than double the prevalence of smoking among adults with depression in the highest income and education groups. CONCLUSIONS: Disparities in smoking prevalence are pronounced when depression and SES are considered simultaneously. Targeted public health and clinical efforts to reduce smoking among adult smokers of lower SES with depression are needed.

Nicotine dependence predicts cannabis use disorder symptoms among adolescents and young adults.

PURPOSE: We evaluate if cigarette smoking and/or nicotine dependence predicts cannabis use disorder symptoms among adolescent and young adult cannabis users and whether the relationships differ based on frequency of cannabis use. METHODS: Data were drawn from seven annual surveys of the NSDUH to include adolescents and young adults (age 12-21) who reported using cannabis at least once in the past 30 days (n = 21,928). Cannabis use frequency trends in the association between cigarette smoking, nicotine dependence and cannabis use disorder symptoms were assessed using Varying Coefficient Models (VCM's). RESULTS: Over half of current cannabis users also smoked cigarettes in the past 30 days (54.7% SE 0.48). Cigarette smoking in the past 30 days was associated with earlier onset of cannabis use, more frequent cannabis use and a larger number of cannabis use disorder symptoms compared to those who did not smoke cigarettes. After statistical control for socio-demographic characteristics and other substance use behaviors, nicotine dependence but not cigarette smoking quantity or frequency was positively and significantly associated with each of the cannabis use disorder symptoms as well as the total number of cannabis symptoms endorsed. Higher nicotine dependence scores were consistently associated with the cannabis use disorder symptoms across all levels of cannabis use from 1 day used (past month) to daily cannabis use, though the relationship was strongest among infrequent cannabis users. CONCLUSION: Prevention and treatment efforts should consider cigarette smoking comorbidity when addressing the increasing proportion of the US population that uses cannabis.

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.

Evaluating the mutual pathways among electronic cigarette use, conventional smoking and nicotine dependence.

BACKGROUND AND AIMS: The implications of the rapid rise in electronic cigarette (e-cigarette) use remain unknown. We examined mutual associations between e-cigarette use, conventional cigarette use and nicotine dependence over time to (1) test the association between e-cigarette use and later conventional smoking (both direct and via nicotine dependence), (2) test the converse associations and (3) determine the strongest pathways predicting each product's use. DESIGN: Data from four annual waves of a prospective cohort study were analyzed. Path analysis modeled the bidirectional, longitudinal relationships between past-month smoking frequency, past-month e-cigarette frequency and nicotine dependence. SETTING: Chicago area, Illinois, USA. PARTICIPANTS: A total of 1007 young adult smokers and non-smokers (ages 19-23 years). MEASUREMENTS: Frequency of (1) cigarettes and (2) e-cigarettes was the number of days in the past 30 on which the product was used. The Nicotine Dependence Syndrome Scale measured nicotine dependence to cigarettes. FINDINGS: E-cigarette use was not associated significantly with later conventional smoking, either directly (ß = 0.021, P = 0.081) or through nicotine dependence (ß = 0.005, P = 0.693). Conventional smoking was associated positively with later e-cigarette use, both directly (ß = 0.118, P < 0.001) and through nicotine dependence (ß = 0.139, P < 0.001). The strongest predictors of each product's use was prior use of the same product; this pathway was strong for conventional cigarettes (ß = 0.604, P < 0.001) but weak for e-cigarettes (ß = 0.120, P < 0.001). Nicotine dependence moderately strongly predicted later conventional smoking (ß = 0.169, P < 0.001), but was a weak predictor of later e-cigarette use (ß = 0.069, P = 0.039). CONCLUSIONS: Nicotine dependence is not a significant mechanism for e-cigarettes' purported effect on heavier future conventional smoking among young adults. Nicotine dependence may be a mechanism for increases in e-cigarette use among heavier conventional smokers, consistent with e-cigarettes as a smoking reduction tool. Overall, conventional smoking and, to a lesser extent, its resulting nicotine dependence, are the strongest drivers or signals of later cigarette and e-cigarette use.

Depression and marijuana use disorder symptoms among current marijuana users.

BACKGROUND: Depression is one of the most consistent risk factors implicated in both the course of escalating substance use behaviors and in the development of substance dependence symptoms, including those associated with marijuana use. In the present study, we evaluate if depression is associated with marijuana use disorder symptoms across the continuum of marijuana use frequency. METHODS: Data were drawn from six annual surveys of the National Survey of Drug Use and Health to include adults who reported using marijuana at least once in the past 30days (N=28,557). RESULTS: After statistical control for sociodemographic characteristics and substance use behaviors including marijuana use, alcohol use, smoking, and use of illicit substances other than marijuana, depression was positively and significantly associated with each of the marijuana use disorder symptoms as well as the symptom total score. Adult marijuana users with depression were consistently more likely to experience marijuana use disorder symptoms and a larger number of symptoms, with the magnitude and direction of the relationship generally consistent across all levels of marijuana use frequency from 1day used in the past month to daily marijuana use. CONCLUSIONS: Depression is a consistent risk factor for marijuana use disorder symptoms over and above exposure to marijuana suggesting that depressed individuals may represent an important subgroup in need of targeted substance use intervention.

Trends in Daily Cannabis Use Among Cigarette Smokers: United States, 2002-2014.

OBJECTIVES: To estimate changes in the prevalence of daily cannabis use among current, former, and never cigarette smokers from 2002 to 2014 in the United States. METHODS: The National Survey on Drug Use and Health is a nationally representative cross-sectional study conducted annually among persons aged 12 years and older in the United States. RESULTS: Daily cannabis use occurs nearly exclusively among nondaily and daily cigarette smokers compared with former and never smokers (8.03%, 9.01%, 2.79%, 1.05%, respectively). Daily cannabis use increased over the past decade among both nondaily (8.03% [2014] vs 2.85% [2002]; linear trend P < .001) and daily smokers (9.01% [2014]; 4.92% [2002]; linear trend P < .001). Daily cannabis use increased most rapidly among former cigarette smokers (2.79% [2014] vs 0.98% [2002]; linear trend P < .001). CONCLUSIONS: Daily cannabis use occurs predominantly among cigarette smokers in the United States. Daily cannabis use increased among current, former, and never smokers over the past decade, with particularly rapid increases among youth and female cigarette smokers. Future research is needed to monitor the observed increase in daily cannabis use, especially among youths and adults who smoke cigarettes.

The Role of Nicotine Dependence in E-Cigarettes' Potential for Smoking Reduction.

Introduction: E-cigarettes (Electronic Nicotine Delivery Systems, or ENDS) are an increasingly popular tobacco product among youth. Some evidence suggests that e-cigarettes may be effective for harm reduction and smoking cessation, although these claims remain controversial. Little is known about how nicotine dependence may contribute to e-cigarettes' effectiveness in reducing or quitting conventional smoking. Methods: A cohort of young adults were surveyed over 4 years (approximately ages 19-23). Varying-coefficient models (VCMs) were used to examine the relationship between e-cigarette use and conventional smoking frequency, and how this relationship varies across users with different nicotine dependence levels. Results: Lifetime, but not recent, e-cigarette use was associated with less frequent concurrent smoking of conventional cigarettes among those with high levels of nicotine dependence. However, nondependent e-cigarette users smoked conventional cigarettes slightly more frequently than those who had never used e-cigarettes. Nearly half of ever e-cigarette users reported using them to quit smoking at the last measurement wave. For those who used e-cigarettes in a cessation attempt, the frequency of e-cigarette use was not associated with reductions in future conventional smoking frequency. Conclusions: These findings offer possible support that e-cigarettes may act as a smoking reduction method among highly nicotine-dependent young adult cigarette smokers. However, the opposite was found in non-dependent smokers, suggesting that e-cigarette use should be discouraged among novice tobacco users. Additionally, although a substantial proportion of young adults used e-cigarettes to help them quit smoking, these self-initiated quit attempts with e-cigarettes were not associated with future smoking reduction or cessation. Implications: This study offers potential support for e-cigarettes as a smoking reduction tool among highly nicotine-dependent young adult conventional smokers, although the extent and nature of this remains unclear. The use of e-cigarettes as a quit aid was not associated with reductions in conventional smoking, consistent with most other quit aids in this sample except for nicotine replacement therapy, which was only effective for the most dependent smokers. Notably, these findings highlight the necessity of accounting for smokers' nicotine dependence levels when examining tobacco use patterns.

Depression among current, former, and never smokers from 2005 to 2013: The hidden role of disparities in depression in the ongoing tobacco epidemic.

BACKGROUND: After declining sharply for many years, the prevalence of smoking has remained fairly stable over the past decade. One possible explanation is that there has been an increase in the prevalence of barriers to cessation, like depression, among remaining smokers. OBJECTIVES: To estimate changes in the prevalence of depression among current, former and never smokers in the United States (U.S.) population from 2005 to 2013 overall and by age, gender, and income. METHODS: Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons ages 12 and over (N=496,805). The prevalence of past 12-month depression was examined annually among current (past 12-month), former (not past 12-month), and lifetime non-smokers from 2005 to 2013. Data were re-analyzed stratified by age, gender, and household income, and adjusted for demographics. RESULTS: Depression appears to have significantly increased in the United States from 2005 to 2013 among current, former, and never smokers. Depression prevalence increased among current smokers overall, but the increase among former and never smokers was even more prominent. Striking temporal changes emerged by age, gender and income. Specifically, (1) depression increased significantly among current smokers aged 12-17 (from 16% to 22%, p-value=0.0002) and the prevalence was consistently more than twice as high as that of never smokers; (2) depression increased among male smokers (6.19%-7.82%, p-value=0.0099); (3) depression increased significantly among smokers in the highest income group (6.36% to 8.91%, p-value=0.0400). Throughout this period, the prevalence of depression among current smokers was consistently twice as high as among former and never smokers. DISCUSSION: Public health efforts aimed at decreasing the prevalence of smoking should take depression into account, a common and modifiable barrier whose treatment may help to increase successful smoking cessation. Future work is needed to disentangle the role of smoking and other factors that lead to increases in depression in the US population.

Marijuana use disorder symptoms among recent onset marijuana users.

BACKGROUND: With recreational marijuana having recently been legalized in a growing number of U.S. states, as well as the increasing support for its legalization among substantial segments of the American public, an understanding of the development of symptoms associated with marijuana use disorders will assist in guiding both education and policy. METHODS: This study examined the prevalence of marijuana use disorder symptoms among a nationally representative sample of recent onset marijuana users ages 12-21 drawn from the National Survey of Drug Use and Health (N=9697). RESULTS: The most frequently reported marijuana use symptoms were "tolerance", and "time occupied acquiring, using or recovering from the effects of marijuana". Logistic regression analyses indicated an expected positive association between marijuana use frequency and each marijuana use disorder symptom. In many cases the positive trend was quadratic or cubic, with greater increases between rates among low and moderate frequency marijuana users (i.e. 1-10days per month) than among those using at a higher frequency (i.e. >10days per month). Relationships between marijuana use frequency and marijuana use symptoms were largely consistent according to age, gender and ethnicity. CONCLUSIONS: Recognizing symptoms of marijuana use disorders among adolescents and young adults using marijuana infrequently may assist in early identification and intervention for those at risk for problem use.

Nicotine Dependence and Alcohol Problems from Adolescence to Young Adulthood.

BACKGROUND: Despite the highly replicated relationship between symptoms associated with both alcohol and nicotine, little is known about this association across time and exposure to both drinking and smoking. In the present study, we evaluate if problems associated with alcohol use are related to emerging nicotine dependence symptoms and whether this relationship varies from adolescence to young adulthood, after accounting for both alcohol and nicotine exposure. METHODS: The sample was drawn from the Social and Emotional Contexts of Adolescent Smoking Patterns Study which measured smoking, nicotine dependence, alcohol use and alcohol related problems over 6 assessment waves spanning 6 years. Analyses were based on repeated assessment of 864 participants reporting some smoking and drinking 30 days prior to individual assessment waves. Mixed-effects regression models were estimated to examine potential time, smoking and/or alcohol varying effects in the association between alcohol problems and nicotine dependence. FINDINGS: Inter-individual differences in mean levels of alcohol problems and within subject changes in alcohol problems from adolescence to young adulthood were each significantly associated with nicotine dependence symptoms over and above levels of smoking and drinking behaviour. This association was consistent across both time and increasing levels of smoking and drinking. CONCLUSIONS: Alcohol related problems are a consistent risk factor for nicotine dependence over and above measures of drinking and smoking and this association can be demonstrated from the earliest experiences with smoking in adolescents, through the establishment of more regular smoking patterns across the transition to young adulthood. These findings add to accumulating evidence suggesting that smoking and drinking may be related through a mechanism that cannot be wholly accounted for by exposure to either substance.

The Causal Effect of Student Mobility on Standardized Test Performance: A Case Study with Possible Implications for Accountability Mandates within the Elementary and Secondary Education Act.

This paper presents a limited case study examining the causal inference of student mobility on standardized test performance, within one middle-class high school in suburban Connecticut. Administrative data were used from a district public high school enrolling 319 10th graders in 2010. Propensity score methods were used to estimate the causal effect of student mobility on Math, Science, Reading, and Writing portions of the Connecticut Academic Performance Test (CAPT), after matching mobile vs. stable students on gender, race/ethnicity, eligibility for free/reduced lunches, and special education status. Analyses showed that mobility was associated with lower performance in the CAPT Writing exam. Follow-up analyses revealed that this trend was only significant among those who were ineligible for free/reduced lunches, but not among eligible students. Additionally, mobile students who were ineligible for free/reduced lunches had lower performance in the CAPT Science exam according to some analyses. Large numbers of students transferring into a school district may adversely affect standardized test performance. This is especially relevant for policies that affect student mobility in schools, given the accountability measures in the No Child Left Behind that are currently being re-considered in the recent Every Student Succeeds Act.