Associations Between Internalizing and Externalizing Symptoms on Subsequent Tobacco Product Initiation and Sustained Use as a Function of Sex Among Adolescents Ages 12-17.

OBJECTIVE: Previous studies have found positive associations between internalizing and externalizing symptoms and the initiation of tobacco use among adolescents. However, few studies have examined the relationship between these symptoms and sustained tobacco use patterns or how they may vary as a function of sex. The current study examined whether these symptoms predict initiation and sustained use of multiple tobacco products within a longitudinal cohort design. METHOD: Waves 1-3 of the Population Assessment of Tobacco and Health Study (2013-2016) were used to assess relationships between internalizing and externalizing symptoms, sex, and tobacco use categories (cigarettes, e-cigarettes, poly-tobacco use, other tobacco use) in 6,170 adolescents (M age = 13.42, SD = 1.10) who were tobacco naive at Wave 1. RESULTS: Internalizing and externalizing symptoms predicted initiation of several tobacco categories at the 2-year follow-up. Examining sustained use patterns revealed a more consistent relationship with externalizing symptoms across tobacco categories, whereas associations with internalizing symptoms were limited. Sex moderated the relationship between elevated internalizing symptoms and increased odds of subsequent e-cigarette and poly-tobacco initiation, with stronger relationships observed among females. In addition, the relationship between elevated externalizing symptoms and sustained other tobacco use was stronger in females as compared with males. CONCLUSIONS: Although both internalizing and externalizing symptoms predict tobacco initiation across several product categories, externalizing symptoms may reflect a more reliable signal of sustained tobacco use in adolescents. Mental health symptoms and subsequent tobacco use differed by sex, with females demonstrating stronger relationships for several products.

Resting Heart Rate Variability, Perceived Emotion Regulation, and Low-Risk Drug Use in College-Aged Adults: Gender as a Moderator.

Identification of individual differences in drug use is warranted, as a history of use is associated with future drug problems. Such drug use is thought to disrupt inhibitory and motivation networks involved in emotion regulation (ER). Higher resting heart rate variability (HRV), a biomarker of effective inhibitory abilities, is associated with less substance (e.g., alcohol, opioid) use. Higher HRV is associated with lower perceived ER difficulties, and this link is stronger in women relative to men. Evidence suggests women might engage in drug use primarily to reduce stress, and men primarily to induce feelings of elation. Research has yet to examine associations among individuals' difficulties in ER, resting HRV, and a recent history of drug use; the current study explored this, in addition to how these associations might differ as a function of gender. Young and healthy college students (N = 190; 88 women) completed a 5-min baseline to assess resting HRV, followed by the 36-item difficulties in ER Scale and 10-item Drug Abuse Screening Test. Higher difficulties in ER, but not resting HRV, were associated with a greater history of "low-risk" drug use in the full sample and moderation tests confirm this link was stronger in women. Moderated-mediation results confirmed an indirect association between resting HRV and drug use, mediated by self-reported difficulties among women only. A significant association between resting HRV and Difficulties in Emotion Regulation Scale (DERS) emerged only among women without a history of drug use. These results indicate that difficulties in ER are both associated with a low-risk history of drug use and underlie an indirect link between resting HRV and drug use history in women only. Among these women with a history of drug use relative to women without, there was no link between resting HRV and self-reported difficulties in ER, suggesting a disrupted inhibitory-motivational pathway. Additional work is needed to understand the psychophysiological correlates of a history of low-risk drug use in young men. These data are in line with research suggesting gender differences in the motivation to engage in recreational drug use and ER interventions might be important in women who engage in low-risk recreational drug use.

Tobacco Use Status as a Function of Transgender Identity: The Mediating Role of Psychological Distress.

AIM: The current study examined differences between individuals identifying as transgender and people identifying as cisgender in terms of (1) psychological distress (eg, anxiety, depression, and suicidal ideation), (2) rates of combustible and e-cigarette use, and (3) the potential for elevated psychological distress stemming from transgender identification to be associated with increased rates of smoking and vaping. METHOD: This was a secondary analysis of data from a study examining behavioral health, perceptions and behaviors associated with alcohol and other drug use, and mental health status at a large mid-western university. Differences in current use of cigarette and e-cigarette products were examined between self-identified transgender (n = 253) and cisgender (n = 18 371) respondents. RESULTS: Overall, 17.2% (n = 2727) of the sample endorsed past 30-day use of cigarettes or e-cigarettes. Results demonstrated a significant effect of gender identity, with individuals identifying as transgender reporting higher odds of using cigarettes or e-cigarettes (AOR = 2.82, 95% CI 1.26-6.31). Regression analyses revealed significant effects of transgender identity on symptoms of anxiety (b = 3.45, 95% CI = 1.64, 5.25, P < .001.); depression, (b = 4.14, 95% CI = 2.21, 6.07, P < .001); and suicidal ideation, (b = 2.51, 95% CI = 1.48, 3.55, P < .001.), respectively. Finally, we observed significant indirect effects of transgender identity on cigarette and e-cigarette product use via increased symptoms of depression (indirect effect = 0.13, 95% CI [0.07, 0.19], P < .05), and suicidal ideation (indirect effect = 0.22, 95% CI [0.15, 0.28], P < .05), but not symptoms of anxiety. DISCUSSION: This is the first study of our knowledge to examine the association between psychological symptoms and smoking and vaping products with transgender identity. The results of this study support previous findings that transgender individuals are at risk for elevated substance use and extend the literature by demonstrating this this risk is associated with elevated psychological distress.

Increases in Risky Drinking During the COVID-19 Pandemic Assessed via Longitudinal Cohort Design: Associations With Racial Tensions, Financial Distress, Psychological Distress and Virus-Related Fears.

BACKGROUND: The COVID-19 pandemic has created disruptions to daily life resulting in wide-spread unemployment and psychological distress. Recent studies have reported high rates of alcohol use during this time; however, longitudinal data remain scarce and factors associated with increases in high-risk drinking observed over time are unknown. AIMS: The current study examined changes in high-risk drinking patterns across four 7-day observation periods, prior to and following a university wide campus closure. Additionally, factors associated with changes in alcohol use patterns were examined including financial distress, psychological distress, impact of racial tensions and virus-related fears. METHOD: Students (N = 1001) in the Midwestern USA completed repeated assessments between March and June 2020. Each survey included a timeline follow-back measure of alcohol use. Pandemic-related distress spanning several factors was assessed at the final follow-up. RESULTS: Risky drinking patterns increased significantly over time. Overall, psychological distress and impact of racial tensions were associated with higher rates of risky drinking, whereas COVID-19-related fears were associated with lower rates. However, only financial-related distress was associated with an increase in risky drinking patterns over time. CONCLUSIONS: Increased risky drinking patterns observed in the current study may signal problems that are likely to persist even after the direct impact of the COVID-19 pandemic on daily life ends. Individuals experiencing financial distress may represent a particularly high-risk group. Interventions targeting the cross-section of job loss, financial stress and problematic alcohol use will be important to identify.

Effects of Negative Emotion on Abstinence Induced Change in Urge to Vape and Measures of Vaping Dependence.

INTRODUCTION: Negative emotion and craving to smoke are established factors driving the maintenance of combustible cigarette use and dependence. The current study aimed to examine whether these findings extend to e-cigarette use. Toward that aim, change in vaping urge following abstinence was examined as a function of negative emotion. Additionally, a mediation model which previously demonstrated relationships between negative emotion, craving, and combustible cigarette dependence was tested in e-cigarette users. METHOD: Daily e-cigarette users (N = 32, Mage = 21 years, SDage = 7 years; 78% white) completed a battery of psychological, behavioral, and smoking-related measures in a human laboratory setting. Using their personal devices, participants completed a 5-minute ad-libitum vaping session, a baseline measure of vaping urge, followed by a 2-hour observed abstinence period and a final assessment of vaping urge. RESULTS: Multivariate regression and two mediation models were utilized to examine factors associated with vaping dependence. The results of these models indicated that negative affect predicted vaping urge following observed abstinence. The relationship between negative affect and measures of vaping dependence and habit, respectively, were significantly mediated by changes in urge during the abstinence period. CONCLUSIONS: These preliminary results indicate that psychological constructs underlying vaping dependence are similar to those previously found to be associated with combustible cigarette dependence. Further research examining whether these constructs, namely negative affect and change in urge following abstinence, will be important variables to target for vaping cessation treatments is needed.

Interventions with potential to target executive function deficits in addiction: current state of the literature.

The inability to stop or reduce substance use despite motivation to do so is thought to result, in part, from self-control failure and can be understood within the framework of dual process models of addiction. These models view addictive behavior as the relative balance between automatic impulses and executive decision processes. This review focuses on treatments that aim to improve executive decision processes which often become dysregulated and ineffective in individuals with substance use disorders. It is posited that improving these executive function deficits should restore control over automatic impulses and drug seeking behavior.