Examining the role of alcohol and cannabis use patterns in bystander opportunity and behavior for sexual and relationship aggression.

OBJECTIVE: This study aimed to investigate the association between alcohol and cannabis use patterns and bystander intervention for sexual and relationship violence risk among college students who have used cannabis in the past year. The study tested two hypotheses: (1) reports of bystander opportunities will differ based on participants' alcohol and cannabis use patterns, and (2) among those who report bystander opportunities, reports of bystander behaviors will differ based on their alcohol and cannabis use patterns. METHOD: Participants were 870 students recruited from two large, minority-serving universities in the United States who reported past year cannabis use. Participants reported about their typical alcohol and cannabis use patterns and bystander opportunities and behaviors. Students were grouped for analysis based on their reported average substance use into four groups: alcohol and cannabis use on the same day, alcohol use only, cannabis use only, or no use. RESULTS: Students who reported alcohol and cannabis use on the same day, compared with those who reported alcohol use only, reported more bystander opportunities and behaviors in situations at risk for sexual and relationship violence. Compared with alcohol use only, students who reported only using cannabis or no use reported fewer bystander opportunities and behavior related to keeping others safe in party settings. CONCLUSIONS: Alcohol and cannabis use patterns are associated with bystander intervention, emphasizing the need to include knowledge about cannabis and co-use in bystander programming that aims to reduce sexual and relationship violence.

The association between alcohol use and sexual assault victimization among college students differs by gender identity and race.

PURPOSE: Alcohol use and sexual assault (SA) are common on college campuses. The purpose of this study is to examine if the association between alcohol use and SA differs by gender identity, sexual orientation, race, or ethnicity. METHODS: A total of 3,243 college students aged 18-25 at two large, minority-serving, public universities in the southwest and southeast United States completed an online survey about alcohol and sexual behaviors. Two negative binomial regressions were conducted to examine main effects and interaction effects. RESULTS: Almost half of the sample reported a SA victimization history. The main effects negative binomial regression indicated that more drinks per week, older age, identifying as a cisgender woman (vs. cisgender man), identifying as a gender minority (vs. cisgender man), and identifying as a sexual minority (vs. heterosexual) were associated with more severe SA victimization. Participants who identified as Latine (vs. non-Latine White) reported less severe SA. The negative binomial regression assessing interactions indicated that the association between alcohol use and SA severity was stronger among cisgender women and gender minority identities than cisgender men, and Black identities than non-Latine White identities. CONCLUSION: Findings suggests that alcohol use is an important factor for SA severity among all students, but that the association is stronger among some with marginalized identities. Given that perpetrators target people who hold some marginalized identities, prevention programming could address cisnormative, heteronormative, and White normative ideas about alcohol and sex to attain social justice and health equity.

An eHealth Prevention Program for Substance Use, Sexual Assault, and Sexual Risk Behaviors for Adolescents in Primary Care: Pilot Feasibility Randomized Controlled Trial of Teen Well Check.

BACKGROUND: Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. OBJECTIVE: Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. METHODS: Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. RESULTS: We recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). CONCLUSIONS: These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434.

Recreational marijuana legalization and marijuana and alcohol co-use among adolescents: Differential associations among racial and ethnic groups.

We examined associations of the 2016 legalization of recreational marijuana (RML) in California with marijuana and alcohol co-use among race/ethnic groups using successive cross-sections from 7th, 9th, and 11th graders (N = 3,319,329) in the 2010-11 to 2018-19 California Healthy Kids Surveys. Multilevel logistic regressions indicated a stronger positive association between RML and co-use among non-Hispanic/Latine White youth (OR = 1.21) relative to Hispanic/Latine (OR = 1.02) or Black youth (OR = 0.85). Among drinkers who had not consumed five or more drinks on any occasion in the past 30-days (non-heavy drinkers), the positive association between RML and co-use was stronger among American Indian/Alaska Native youth (OR = 2.19) compared to non-Hispanic/Latine Whites (OR = 1.56). For heavier drinkers it was stronger for Native Hawaiian/Pacific Islanders (OR = 1.47). Among marijuana users, there was a stronger inverse association between RML and co-use among Black youth (OR = 0.72) compared to non-Hispanic/Latine White youth (OR = 0.84). RML may increase the risk of co-use to a greater extent among non-Hispanic/Latine White youth than other race/ethnic groups in California, but broadly increases the risk among youth who engage in alcohol use or heavy drinking.

Lesbian, Gay, Bisexual, Queer, Questioning and Transgender, Nonbinary, Genderqueer, and Gender Questioning Adult Alcohol Use Outcomes Associated with State Alcohol-Related Laws During the Coronavirus Pandemic in the United States.

Purpose: We assessed how COVID-19-related alcohol sales policies influenced alcohol use behaviors during the pandemic for U.S. adults of diverse sexual (lesbian, gay, bisexual, queer, questioning [LGBQ]) and gender identities (transgender, nonbinary, genderqueer, and gender questioning [T/NB/GQ]). Methods: Time-specific, state-level, restaurant, bar, and off-premise alcohol policy data were collected from the National Institute on Alcohol Abuse and Alcoholism-sponsored Alcohol Policy Information System and merged with the 2020 Behavioral Risk Factor Surveillance System survey data. Treatments included bar, restaurant, and delivery alcohol sales policies. Outcomes included past 30-day drinking frequency, quantity, and heavy episodic drinking (HED). We fitted negative binomial regression models for all outcomes, clustered standard errors by state and used sample weights. We also controlled for seasonality, state Alcohol Policy Scale scores, pre-/postpandemic time period, and included demographic control variables in our cross-sectional analyses. Results: The sample included 10,505 adults identifying as LGBQ and 809 as T/NB/GQ from 32 states. Restaurant and bar closures were associated with less alcohol use for LGBQ respondents. Outdoor-only policies at bars were also associated with significantly less quantity of use and HED for T/NB/GQ adults in the sample. Off-premise home delivery was associated with greater quantity of use for LGBQ respondents and less frequency for T/NB/GQ respondents. Conclusion: The COVID-19-related alcohol sales policy changes offer an opportunity to better understand alcohol policy and availability's influence on drinking behaviors among sexual and gender-diverse populations in the United States.

Associations among sexual assault, posttraumatic stress, drinking to cope with anxiety, and alcohol use based on gender identity and sexual orientation.

BACKGROUND: Sexual assault (SA) is experienced by a substantial proportion of emerging adult college students and is associated with elevated rates of posttraumatic stress disorder (PTSD) and alcohol use. This study examines the mediating role of posttraumatic stress symptoms (PTSS) in the associations among SA severity, drinking to cope with anxiety, and average weekly drinks while considering the moderating roles of gender identity and sexual orientation. METHODS: A total of 2160 college students who were diverse in gender (cisgender women, 64.4%; cisgender men, 30.6%, and transgender and gender diverse [TGD] individuals = 4.9%) and sexual orientation (heterosexual = 68.0%, LGBQ+ = 32.0%) completed measures of SA severity, PTSS, drinking to cope with anxiety motives, and average weekly drinks. RESULTS: The mediation model for the full sample indicated significant indirect effects of SA severity on drinking to cope with anxiety through PTSS, but not on average weekly drinks. Moderation analyses revealed differential relationships between the variables based on both gender identity and sexual orientation. For instance, the association between SA severity and PTSS was stronger for cisgender women and TGD individuals than cisgender men, and for LGBQ+ individuals than heterosexual individuals. While the association between PTSS and average weekly drinks was only significant for cisgender men, the association between PTSS and drinking to cope with anxiety was significant for both cisgender men and women but not TGD individuals. Furthermore, the association between SA severity and drinking to cope with anxiety was stronger for cisgender women than cisgender men. CONCLUSIONS: Findings from this study demonstrate sexual orientation and gender identity differences and similarities in the associations of SA severity, PTSS, drinking to cope with anxiety, and alcohol use. Results are discussed in relation to the self-medication hypothesis and tailoring interventions for diverse groups.

Changes in the Patterns and Characteristics of Youth ENDS Use over Time.

Research on youth use of electronic nicotine delivery systems (ENDS) has explored the correlates of initiation and use; however, little is known about the factors that predict continued youth use of ENDS. We used an ecological momentary assessment (EMA) burst design to explore both daily variability within adolescents over a two-week observation period and variability over time two years later (2018 and 2020). The contribution of device characteristics, motivations for use, contextual factors, and community factors to daily use occasions were explored. Youth participants (n = 35) at the start of the study were past two-week nicotine vapers, 14 to 17 years old, who resided within 100 miles of Louisville, KY, and reported past two-week ENDS use. Close to a quarter of participants ceased all tobacco use two years later, suggesting that some youth, despite prior regular vaping habits, may have only been experimenting with ENDS. The regular continued use of ENDS was predicted by trying to quit using cigarettes, appealing flavors, and being in locations where cigarette use was prohibited. Except for flavors, these factors did not affect ENDS use in year one. These findings suggest that tobacco policy might target ENDS use by prohibiting all tobacco use, including ENDS, in locations where smoking is already banned.

Associations of California's Tobacco 21 Minimum Sales Age Law with Tobacco Use Among Sexual Minority Adolescents: A Trends Analysis.

INTRODUCTION: In 2016, California enacted a law (T21) prohibiting tobacco product sales to individuals under 21 years of age. Given tobacco use disparities among sexual minority (SM) youth, this study investigated whether California's T21 law was differentially associated with changes in tobacco use for SM and non-SM adolescents. AIMS AND METHODS: Secondary analyses of California Healthy Kids Survey data from 2013-2014 to 2018-2019 for 7th, 9th, and 11th graders (N = 2 229 401). RESULTS: Multilevel mixed-effects logistic regression analyses showed that SM students were more likely than non-SM students to report past-30-day and lifetime cigarette (odds ratio (OR) = 2.47; OR = 2.37), e-cigarette (OR = 1.21; OR = 1.10), smokeless tobacco use (OR = 1.95; OR = 1.56), and use of any tobacco product (OR = 1.94; OR = 1.61). Among SM youth, T21 was associated with significant reductions in lifetime e-cigarette use (OR = 0.66), and lifetime use of any tobacco products (OR = 0.75). These decreases generally were greater than or equivalent to those observed for non-SM youth. For 30-day e-cigarette and any tobacco use, SM youth showed no significant increases, whereas non-SM youth showed significant increases (OR = 1.06; OR = 1.11) following T21. T21 was associated with smaller increases in lifetime cigarette use (OR = 1.34), and larger increases for past-30-day and lifetime smokeless tobacco use (OR = 1.34; OR = 1.28) among SM students, to those observed for non-SM students. CONCLUSIONS: California's T21 policy may help reduce tobacco use disparities among SM students who are more at risk for tobacco use than their non-SM peers. IMPLICATIONS: Research on associations of T21 laws with tobacco use among sexual minority (SM) adolescents is lacking. The potential for unintended consequences of T21 for these adolescents raises concerns about increased health disparities. Importantly, our study generally found California's T21 was associated with reductions in tobacco use among SM students that were equivalent to or greater than those for non-SM students. Future research should investigate whether T21 laws and similar policies have differential effects for other marginalized groups and, if so, identify mechanisms that can be targeted in prevention efforts.

California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups.

OBJECTIVE: A California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents' use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups. METHODS: Secondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010-11 to 2017-2018. RESULTS: Multilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups. CONCLUSIONS: Our findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.

Recreational Marijuana Legalization and Co-use With Alcohol Among Adolescents.

INTRODUCTION: Little is known about the possible impacts of recreational marijuana legalization on alcohol and marijuana co-use among underage youth. This study examines the association between recreational marijuana legalization in California in 2016 and alcohol and marijuana co-use among adolescents. Additional analyses investigate the associations between recreational marijuana legalization and co-use among past 30-day drinkers and marijuana users and the frequency of alcohol and marijuana use among co-users. METHODS: This study used annual cross-sectional data from 7th, 9th, and 11th graders (N=3,319,329) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Measures included past 30-day alcohol and marijuana use and student demographic characteristics, survey year, pre-post recreational marijuana legalization, and urbanicity. Multilevel regression analyses were conducted in 2021. RESULTS: Recreational marijuana legalization was associated with greater odds of past 30-day alcohol and marijuana co-use in the total sample (OR=1.06, 95% CI=1.05, 1.07). Recreational marijuana legalization was more strongly associated with co-use among adolescents who reported past 30-day alcohol use (OR=1.58, 95% CI=1.52, 1.62) and heavy drinking (OR=1.25, 95% CI=1.21, 1.29) but was inversely related to co-use among past 30-day marijuana users (OR=0.76, 95% CI=0.74, 0.78). Among past 30-day co-users, there was a positive association with the frequency of marijuana use (ß=0.36, SE=0.07). CONCLUSIONS: Recreational marijuana legalization may increase the risk of alcohol and marijuana co-use among adolescents. Greater restrictions on the numbers of alcohol and marijuana retail outlets and hours of operation and advertising and higher taxes on alcohol and marijuana products may help reduce the availability of these substances to adolescents.

Relationships Between Social Host Policies, Youth Drinking Contexts, and Age.

OBJECTIVE: We examined associations of city-level policies and enforcement operations (i.e., social host laws and party patrol operations) with youth drinking, heavy drinking, and drinking-related problems in private and public drinking contexts. We also examined whether these associations were modified by age. METHOD: We surveyed 580 youth (ages 16-20 years; 53% male) living in 24 midsized California cities. We used mixed-effects negative binomial and logistic regression to calculate the frequency of youth drinking and heavy drinking and odds of drinking-related problems in each context (own home, friend's home, restaurant, bar, music venue, and outdoors). RESULTS: There were positive associations between more comprehensive city-level social host policies and frequency of youth drinking and heavy drinking at music venues, and youth heavy drinking and drinking-related problems at restaurants. Younger youth who lived in cities with more comprehensive social host laws drank heavily less frequently in their own home than younger youth living in cities with less comprehensive social host laws. Youth ages 17 or under who lived in cities with more party patrol enforcement had higher odds of problems related to drinking outdoors in the past 12 months than those in cities with fewer party patrol operations. CONCLUSIONS: City-level alcohol policies and enforcement targeting underage drinking may have differential effects depending on youth drinking contexts and age. Comprehensive social host policies, which aim to decrease drinking in private contexts, may displace or increase youth drinking in other contexts, such as restaurants and music venues. Comprehensive social host policies and party patrol operations may be more influential for younger youth drinking in their own home or outdoors.

#PuertoRicoSeLevanta: A Closer Look at the Language Used on the First-Year Anniversary of Hurricane Maria.

In September of 2017, Puerto Rico was hit by Hurricane María. Reactions to the hurricane were widely discussed on the social media site Twitter. The principal aim of the study was to examine the psychological processes of tweets one-year after Hurricane Maria and compare patterns of psychological processes within tweets originating from Puerto Rico relative to tweets originating from the continental United States and other countries. Also, researchers aim to geo-map the origin of tweets, as well as psychological processes exhibit in tweets world-wide. Researchers collected tweets (N = 1191) using #María, #PRSeLevanta, and #PuertoRico between September 20, 2018 to September 25, 2018. Linguistic Inquiry and Word Count software application was used to conduct a quantitative linguistic analysis of the sample of tweets, which classified the language utilized in the tweets across affective, social, psychological, and cognitive dimensions. A one-way between-groups multivariate analysis of variance investigated whether the affective, social, psychological and cognitive dimensions of the language utilized in the tweet varied as a function of where the tweet originated. Tweets varied in psychosocial dimensions as a function of where they originated, such that tweets originating from Puerto Rico used more language classified as positive emotion, cognitive processes, and referencing money in comparison to tweets originating elsewhere. These findings demonstrate how the particular use of words after a traumatic event can provide rich information about psychological processes and health outcomes experienced by individuals in the aftermath of disaster.

Recreational Marijuana Legalization and Use Among California Adolescents: Findings From a Statewide Survey.

OBJECTIVE: The legalization of recreational marijuana use and retail sales raises concerns about possible effects on marijuana use among adolescents. We evaluated the effects of recreational marijuana legalization (RML) in California in November 2016 on use among adolescents and investigated subgroup differences in these effects. METHOD: We analyzed data from successive cross-sectional samples of 7th, 9th, and 11th grade students (N = 3,330,912) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Participants reported grade, sex, ethnicity, race, and lifetime and past-30-day marijuana use. RESULTS: Multilevel analyses showed that RML was associated with increases in the likelihood of lifetime (odds ratio = 1.18, 95% CI [1.15, 1.21], p < .01) and past-30-day marijuana use (odds ratio = 1.23, 95% CI [1.20, 1.26], p < .01) relative to previous downward trends. RML was more strongly associated with increases in prevalence of marijuana use among 7th versus 9th and 11th graders, females versus males, non-Hispanic versus Hispanic youth, and White versus African American, American Indian/Native Alaskan, and multiracial youth. Overall, RML was not significantly associated with frequency of past-30-day use among users, although stronger positive associations between RML and frequency of use were found for 11th graders, Asian Americans, and African Americans. The association was weaker for females. CONCLUSIONS: RML in California was associated with an increase in adolescent marijuana use in 2017-2018 and 2018-2019. Demographic subgroup differences in these associations were observed. Evidence-based prevention programs and greater local control on retail marijuana sales may help to reduce marijuana availability and use among adolescents.

Retail Availability of Recreational Marijuana and Alcohol in Oregon Counties and Co-Use of Alcohol and Marijuana and Related Beliefs among Adolescents.

Objective: We investigated whether recreational marijuana legalization (RML) in Oregon in 2015 and recreational marijuana and alcohol retail outlet density levels in Oregon counties were associated with increased alcohol and marijuana co-use and beliefs supportive of alcohol and marijuana use among adolescents. Method: We conducted secondary analyses of biennial data collected from 11th graders who participated in the Student Wellness Survey (SWS) in 36 Oregon counties from 2010 to 2018 (N = 71,870). Multi-level logistic regression analyses assessed changes in past-30-day co-use of alcohol and marijuana, and alcohol- and marijuana-related beliefs after RML in counties with low, medium, and high densities of licensed recreational marijuana and alcohol retail outlets. We used post-RML 2016 and 2018 SWS data to examine whether beliefs accounted for any relationship of recreational marijuana and alcohol outlet density with alcohol and marijuana co-use. Results: We found a significant post-RML increase in past-30-day alcohol and marijuana co-use in 2016 in counties with the highest density of recreational marijuana and alcohol retail outlets. There were significant post-RML increases in perceived risk and parent approval of alcohol and marijuana use. Analyses with 2016 and 2018 SWS data indicated that the relationship between level of recreational marijuana and alcohol retail outlet density and past-30-day alcohol and marijuana co-use was accounted for beliefs about marijuana and alcohol availability, approval by parents, and risk. Conclusion: RML and greater retail availability of recreational marijuana and alcohol were positively associated with alcohol and marijuana co-use among adolescents, and with beliefs favorable to alcohol and marijuana use.

#4645Boricuas: Twitter reactions to the estimates of deaths by Hurricane María in Puerto Rico.

This study explores the sentiment expressed by Twitter users after the Harvard University report was released, reporting a death estimate of 4,645 Puerto Ricans following Hurricane María. Researchers utilized the NVivo addition NCapture to collect Twitter data including the hashtag #4645Boricuas. Thematic content analyses explored emergent themes within the hashtag. Geographic information systems (GIS) documented the location of Tweets and differences across geographical locations among Twitter users. The themes that emerged in #4645Boricuas included: disaster phases, media, psychological processes, and politics. GIS documented that Tweets from Puerto Rico were more likely to discuss themes of psychological processes, politics, and resilience compared with disaster phases or media. The present data highlights how individuals engage with Twitter to cope following the trauma of natural disasters.