The NHLBI Study on Long-terM OUtcomes after the Multisystem Inflammatory Syndrome In Children (MUSIC): Design and Objectives.

BACKGROUND: The Long-terM OUtcomes after the Multisystem Inflammatory Syndrome In Children (MUSIC) study aims to characterize the frequency and time course of acute and long-term cardiac and non-cardiac sequelae in multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C), which are currently poorly understood. METHODS: This multicenter observational cohort study will enroll at least 600 patients <21 years old who meet the Centers for Disease Control and Prevention case definition of MIS-C across multiple North American centers over 2 years. The study will collect detailed hospital and follow-up data for up to 5 years, and optional genetic testing. Cardiac imaging at specific time points includes standardized echocardiographic assessment (all participants) and cardiac magnetic resonance imaging (CMR) in those with left ventricular ejection fraction (LVEF) <45% during the acute illness. The primary outcomes are the worst LVEF and the highest coronary artery z-score of the left anterior descending or right coronary artery. Other outcomes include occurrence and course of non-cardiac organ dysfunction, inflammation, and major medical events. Independent adjudication of cases will classify participants as definite, possible, or not MIS-C. Analysis of the outcomes will include descriptive statistics and regression analysis with stratification by definite or possible MIS-C. The MUSIC study will provide phenotypic data to support basic and translational research studies. CONCLUSION: The MUSIC study, with the largest cohort of MIS-C patients and the longest follow-up period to date, will make an important contribution to our understanding of the acute cardiac and non-cardiac manifestations of MIS-C and the long-term effects of this public health emergency.

Changes in Alcohol Use and Drinking Context due to the COVID-19 Pandemic: A Multimethod Study of College Student Drinkers.

BACKGROUND: In spring 2020, U.S. universities closed campuses to limit the transmission of COVID-19, resulting in an abrupt change in residence, reductions in social interaction, and in many cases, movement away from a heavy drinking culture. The present mixed-methods study explores COVID-19-related changes in college student drinking. We characterize concomitant changes in social and location drinking contexts and describe reasons attributed to changes in drinking. METHODS: We conducted two studies of the impact of the COVID-19 pandemic on drinking behavior, drinking context, and reasons for both increases and decreases in consumption among college students. Study 1 (qualitative) included 18 heavy-drinking college students (Mage  = 20.2; 56% female) who completed semi-structured interviews. Study 2 (quantitative) included 312 current and former college students who reported use of alcohol and cannabis (Mage  = 21.3; 62% female) and who completed an online survey. RESULTS: In both studies, COVID-19-related increases in drinking frequency were accompanied by decreases in quantity, heavy drinking, and drunkenness. Yet, in Study 2, although heavier drinkers reduced their drinking, among non-heavy drinkers several indices of consumption increased or remained stable . Both studies also provided evidence of reductions in social drinking with friends and roommates and at parties and increased drinking with family. Participants confirmed that their drinking decreased due to reduced social opportunities and/or settings, limited access to alcohol, and reasons related to health and self-discipline. Increases were attributed to greater opportunity (more time) and boredom and to a lesser extent, lower perceived risk of harm and to cope with distress. CONCLUSION: This study documents COVID-19-related changes in drinking among college student drinkers that were attributable to changes in context, particularly a shift away from heavy drinking with peers to lighter drinking with family. Given the continued threat of COVID-19, it is imperative for researchers, administrators, and parents to understand these trends as they may have lasting effects on college student drinking behaviors.

Trajectories of early alcohol use milestones: Interrelations among initiation and progression.

BACKGROUND: Alcohol use shows age-graded patterning, with normative use progressing through characteristic milestones of escalating use or severity. Despite some knowledge about the timing of milestone attainment and sequencing across milestones, there is a gap in our understanding of the earliest stages of use. This study characterizes the timing, sequencing, and speed of progression through milestones beginning with the first sip of alcohol. METHODS: Sixth through eighth graders (N = 1023; 52% female; 76% White; M = 12.23 years old) completed web surveys through the end of high school. Participants reported on alcohol experiences including the first sip, full drink, consumption of 3+ drinks/occasion (heavy drinking), being drunk, and experiencing acute consequences, from which milestone age and speed of progression (duration) were calculated. Milestone prevalence, sequencing, and timing were characterized, and associations between age of attainment and speed of progression were examined. We also examined whether milestone timing and progression varied by sex and racial/ethnic group. RESULTS: Overall, milestones followed the expected ordering with the exception of heavy drinking (3+ drinks/occasion) and being drunk, which appear to index similar experiences. An earlier age of attainment was associated with an increased likelihood of attaining each of the milestones. In contrast, once a milestone was achieved, there was reduced risk of initiation of subsequent adjacent milestones for individuals with an earlier first sip and full drink, and earlier initiation was associated with a longer duration to subsequent milestones. Girls were more likely to attain all milestones than boys, but there was no sex difference in the age of attainment. In contrast, Hispanic youth reported earlier ages of initiation than White non-Hispanic youth, but the likelihood of attainment did not vary by race/ethnicity. Rapid progression was observed in females but did not vary by race/ethnicity. DISCUSSION: Risks associated with early drinking are complex, with little support for normative ordering of milestones beyond the first sip. Although early drinking is associated with an increased risk of subsequent drinking, it does not appear to place the drinker on an accelerated course to heavier use. A nuanced understanding of risks associated with milestone timing may inform intervention efforts.

Simultaneous Alcohol and Marijuana Use Among College Students: Patterns, Correlates, Norms, and Consequences.

BACKGROUND: Alcohol and marijuana users often engage in simultaneous alcohol and marijuana (SAM) use (i.e., using the 2 substances together so that their effects overlap), which can result in more negative consequences than using either substance alone. Nevertheless, little is known about SAM use among contemporary college students to aid in the development of preventive interventions. This study examined SAM use patterns, demographic correlates of SAM use, and normative influences on SAM use and related negative consequences among college students. METHODS: Students who had used alcohol and marijuana in the past year were recruited from 3 state universities in states with different laws regarding recreational marijuana use (N = 1,389). They completed an online survey, which assessed their own alcohol, marijuana, and SAM use and related consequences, their perceptions of the proportion of same-gender peers and close friends who engaged in SAM use, marijuana access, and demographic characteristics. RESULTS: About three-fourths of participants reported at least 1 occasion of SAM use in the past year with an average frequency of twice per month among SAM users. There were significant differences in SAM use prevalence and frequency by sociodemographic characteristics controlling for past-year alcohol and marijuana frequency. Students in a state with decriminalized recreational marijuana use reported higher frequency of past-year SAM use than students in states with legalized or criminalized use. There were significant demographic differences in perceived norms regarding SAM use among close friends and same-gender peers. SAM users endorsed significantly higher perceived peer and friend norms than nonusers. Also, higher perceived norms predicted more frequent SAM use and more negative consequences of use. CONCLUSIONS: Results indicate a need for prevention programs on college campuses that address SAM use. Interventions that use personalized normative feedback may be effective.

Exposure to Alcohol Content in Movies and Initiation of Early Drinking Milestones.

BACKGROUND: Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED). METHODS: Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use. RESULTS: Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation. CONCLUSIONS: Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking.

Sexual Minority Disparities in Substance Use Willingness Among Youth.

BACKGROUND: Disparities in substance use have been observed in sexual minority youth, but less is known about willingness to use substances, an important precursor to actual use. OBJECTIVE: The goal of this study was to examine willingness to use cigarettes, alcohol, and marijuana among sexual minority youth compared to their non-sexual minority counterparts using both cross-sectional and longitudinal data. METHODS: The present study drew on two waves (Times 1 and 2; 6 months apart) of data collected during high school as part of a prospective study of substance use initiation and progression in Rhode Island. At Time 1, participants (N = 443) ranged in age from 15 to 20 years (M age = 16.7 years, 26.6% sexual minority, 59.5% female, 72.0% White). Participants self-reported their sexual identity and attraction, lifetime use of alcohol, cigarettes and marijuana, and cigarette, alcohol, and marijuana use willingness (i.e., if offered by a best friend or group of friends). RESULTS: In cross-sectional multivariate regression models, sexual minority youth were more likely to report willingness to use cigarettes (p <.05) and marijuana (p <.01) compared to their non-sexual minority counterparts. Longitudinal multivariate regression models revealed that sexual minorities were only significantly more likely to report cigarette willingness at Time 2 compared to their non-sexual minority counterparts (p <.01). There were no significant differences in alcohol use willingness in multivariable cross-sectional or longitudinal models by sexual minority status. CONCLUSIONS: Sexual minority youth reported more willingness than non-sexual minority youth to use substances offered by peers; however, longitudinal analyses revealed that peers appear to play a role only in willingness to smoke cigarettes for these youth, and thus peer influence may be a contributing factor in explaining tobacco-related disparities among sexual minority youth. Given that stigma and peer groups may a particular risk factor for tobacco among sexual minority youth, our findings highlight the importance of prevention programs such as social marketing approaches that correct social norms, reduce stigma, and provide refusal-skills training to reduce tobacco-related disparities among sexual minorities.

Real-world simultaneous alcohol and cannabis use: An ecological study of situational motives and social and physical contexts.

OBJECTIVE: Given the adverse outcomes associated with simultaneous alcohol and marijuana (SAM) use, understanding factors that give rise to occasions of simultaneous use is critical. This study examines the relationships between situational motives and contexts and three situational outcomes: simultaneous alcohol and marijuana use (SAM) use versus cannabis-only use, number of cannabis uses, and subjective effects. METHOD: Past-month SAM users (n = 341; 52% female; 75% White; 10% Latinx/Hispanic; age 18-24) from three U.S. college campuses completed 8 weeks of surveys up to five times a day. Three-level generalized linear mixed-effects models tested the effects of situational motives and social and physical contexts on occasion type (SAM vs. cannabis-only), cannabis use, and subjective effects. RESULTS: Situational social and enhancement motives were related to greater odds of SAM relative to cannabis-only use; expansion motives were reported more often on cannabis-only occasions. Using with others and at friends' places, being with others consuming cannabis, and being with others who are intoxicated were more likely when combining alcohol with cannabis. Increased number of cannabis uses and subjective effects in a social context were evident only on cannabis-only occasions. Using alone and using at home were greater on cannabis-only occasions and were associated with lower cannabis use and subjective effects. CONCLUSIONS: The combination of alcohol and cannabis use occurs during social situations and when motivated by positive reinforcement but number of cannabis uses is not increased when consuming cannabis with alcohol in social situations. Characterizing the complex interplay of situational factors that contribute to risky use will inform interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Contextual influences on simultaneous alcohol and cannabis use in a predominately white sample of college students.

Objective: Simultaneous alcohol and cannabis (i.e., marijuana [SAM]) use is highly prevalent among young adults and college students and associated with a number of negative consequences compared to single substance use. The current study examined socio-contextual factors (e.g., physical, situational, social) associated with SAM use versus cannabis-only versus alcohol-only use. Method: Data were collected from college student SAM users (N = 313, 53% women, M age = 19.79; 74% White; 10% Hispanic/Latinx) who completed two bursts (28 days) of online repeated daily surveys (RDS). RDS were collected five times per day during both bursts (3 months apart). Results: Results suggested that odds of being at home were greater for cannabis-only use compared to SAM and SAM compared to alcohol-only use. Odds of being at a friend's place were greater for SAM compared to alcohol-only and cannabis-only use. Odds of being at a party were greater for SAM compared to alcohol-only use and odds of being at a bar or restaurant were greater for alcohol-only compared to SAM use. Results also suggested that odds of having more people in a location consistently were greater for SAM compared to cannabis-only use, and alcohol-only compared to cannabis-only use. Conclusion: Physical and social contexts (parties, friend's homes, and being around more people) are significantly associated with SAM use occasions. These findings are well-aligned with a social-ecological framework and suggest intervention and prevention efforts should take a comprehensive approach to reduce harms associated with SAM use. Future work is needed to examine these associations in diverse samples. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Individual and COVID-19-Specific Indicators of Compliance with Mask Use and Social Distancing: The Importance of Norms, Perceived Effectiveness, and State Response.

COVID-19 is a global pandemic that has resulted in widespread negative outcomes. Face masks and social distancing have been used to minimize its spread. Understanding who will engage in protective behaviors is crucial for continued response to the pandemic. We aimed to evaluate factors that are indicative of mask use and social distancing among current and former college students prior to vaccine access. Participants (N = 490; 67% female; 60% White) were current and former U.S. undergraduate college students. Perceived effectiveness and descriptive norms regarding COVID-19 safety measures, COVID-19-related news watching and seeking, state response timing to stay-at-home mandates, impulsivity-like traits, affect (mood), and demographic variables were assessed. Results found that greater perceived effectiveness indicated increased personal compliance within and across behaviors. Greater norms related to compliance within behaviors (e.g., indoor norms related to indoor compliance). Increased perceived stress, anxiety, and negative affect indicated greater compliance. More positive affect was associated with less compliance. Being non-White, compared to White (p < 0.001), and female, compared to male (p < 0.001), were associated with greater compliance. Overall, early implementation of stay-at-home orders, exposure to COVID-19-related news, and increased perceived effectiveness are crucial for health safety behavior compliance. Findings are important for informing response to health crises, including COVID-19.

Preliminary impact of the COVID-19 pandemic on smoking and vaping in college students.

We examined tobacco use changes in young adult college students in the context of the COVID-19 pandemic, focusing on smoking and vaping. First, we evaluated changes in tobacco use from pre to post campus closure focusing on smoking and electronic nicotine vaping frequency (days) and quantity (cigarettes/cartridges per day). Also, given the potential protective effects of pausing (temporarily or permanently discontinuing) smoking or vaping, we evaluated its predictors. We hypothesized that generalized anxiety and moving home would increase the odds of pausing. We also explored effects of COVID-related news exposure and seeking on tobacco use. We re-contacted young adults two years after they completed a study on alcohol and marijuana co-use. A subset (N = 83; 26.6% of the 312 respondents) were enrolled in college and reported use of cigarettes (n = 35) and/or e-cigarettes (n = 69) in the week prior to their campus closing (PC). Paired sample t-tests compared smoking and vaping frequency and quantity PC to past-week use since closing (SC). Multivariate logistic regression models were fit to examine predictors of pausing. Both smoking and vaping frequency decreased from PC to SC; however, decreased frequency did not correspond to reduced quantity. Twenty-four participants (28.9%) paused past-week use SC. Higher anxiety and moving home (versus living independently) were related to increased odds of pausing, whereas COVID-19 related news exposure and seeking were related to decreased odds of pausing. Characterizing COVID-19 related tobacco use change provides insights into how college students respond to novel health threats and informs potential interventions.

Changes in Alcohol Consumption Among College Students Due to COVID-19: Effects of Campus Closure and Residential Change.

OBJECTIVE: It is well established that college students increase their drinking when they leave home. This study examined changes in drinking as a result of campus closure due to coronavirus disease 2019 (COVID-19), focusing on the influence of living situation. METHOD: A sample of 312 college students (mean age = 21.2 years; 62% female; 67% White) responded to an online survey regarding their drinking behavior before and after university closures because of COVID-19. Those participants who lived with peers pre-closure and moved home to live with parents post-closure were compared with those who remained living with peers or remained living with parents in terms of changes in frequency and quantity of drinking. RESULTS: A comparison of pre- to post-closure drinking indicated significant decreases in the typical number of drinks per week (from 11.5 to 9.9) and maximum drinks per day (from 4.9 to 3.3) and a slight increase in typical drinking days per week (from 3 to 3.2). Patterns of change significantly varied across groups. Those who moved from peers to parents showed significantly greater reductions in drinking days (from 3.1 to 2.7), number of drinks per week (from 13.9 to 8.5), and maximum drinks in one day (from 5.4 to 2.9) than those who remained living with peers or with parents. In contrast, the latter two groups significantly increased their frequency (from 3.0 to 3.7 days and 2.0 to 3.3 days, respectively). CONCLUSIONS: Participants reduced their quantity of drinking during the COVID-19 pandemic. Returning to live with parents during emerging adulthood may be protective for heavy drinking.

Adolescent recanting of alcohol use: A longitudinal investigation of time-varying intra-individual predictors.

BACKGROUND: Recanting - denying previous reports of lifetime substance use - occurs frequently in longitudinal investigations of adolescent substance use. While research has focused on how individual differences contribute to recanting, intra-individual factors associated with recanting over time remain understudied. METHODS: Adolescents (n = 1023) were assessed six times between 2009 - 2015. The sample included participants who reported ever-sipping alcohol in at least one assessment who maintained or recanted ever-sipping at the subsequent assessment (n = 543, 53.1% of full sample; 54.5% female; 84.9% white; 89.5% non-Hispanic). The majority (58.6%) of the sample recanted ever-sipping. We fit linear mixed models to investigate whether prospective changes in perceived peer drinking, peer approval, alcohol expectancies, and fear of reprisal predicted recanting. To explore whether mechanisms of recanting differed for delayed (i.e., two assessments or later) recanting, we refit the models in a subset of data excluding immediate (i.e., subsequent assessment) recanters. RESULTS: Prospective increases in perceived peer drinking (OR = 0.65), peer approval of drinking (OR = 0.82), and positive and negative alcohol expectancies (OR = 0.96; 0.98, respectively) predicted lower odds of recanting. Similar effects were observed among only delayed recanters. CONCLUSION: Time-varying, intra-individual factors uniquely predicted recanting over time. Although most recanting occurs immediately following the initial report of ever-sipping, the observed effects were consistent between delayed recanters and the sample as a whole. Considering the systematic patterns evident in recanting, researchers should consider using computer-assisted or other research methods that minimize or verify recanting when it occurs while also informing missing data models.

Contextual influences on early drinking: Characteristics of drinking and nondrinking days.

Research characterizing the adolescent drinking context is limited, often relies on samples of current drinkers reporting on recent/last or typical drinking experiences, and provides little information about the context of very early use. The present study uses repeated monthly assessments to describe the context of drinking days and matched nondrinking days to determine the unique risk associated with different drinking-related characteristics. Additionally, we used latent class analysis to empirically identify key configurations of drinking-related characteristics and both family- and nonfamily-related environmental characteristics (social context, physical location, source of alcohol). Data included 688 days (344 drinking days, 344 nondrinking days) from 164 middle-school students enrolled in a prospective study on drinking initiation and progression (62% female; 26% non-White, 11% Hispanic). Results supported 4 patterns: (a) heavier drinking occurring in a peer context, lighter drinking occurring in (b) a family context or (c) a peer context, and (d) drinking alcohol obtained at home without permission. Latent classes varied as a function of gender, age, peer norms, and parenting behaviors as well as alcohol type and perceived alcohol availability. Findings indicated that highly endorsed contexts were not necessarily the riskiest ones, and simply targeting an oft-reported source of alcohol, physical location, or social context may not be an effective strategy for reducing underage drinking. Additionally, although greater monitoring and anticipated parent reaction to drinking are typically protective against adolescent drinking, we found they were associated with parent-sanctioned drinking, suggesting the role of parenting practices must be considered in the context of drinking pattern. (PsycINFO Database Record