Validation of the Wave 1 and Wave 2 Population Assessment of Tobacco and Health (PATH) Study Indicators of Tobacco Dependence Using Biomarkers of Nicotine Exposure Across Tobacco Products.

INTRODUCTION: This study examined the predictive relationships between biomarkers of nicotine exposure and 16-item self-reported level of tobacco dependence (TD) and subsequent tobacco use outcomes. AIMS AND METHODS: The Population Assessment of Tobacco and Health (PATH) Study surveyed adult current established tobacco users who provided urine biospecimens at Wave 1 (September 2013-December 2014) and completed the Wave 2 (October 2014-October 2015) interview (n = 6872). Mutually exclusive user groups at Wave 1 included: Cigarette Only, E-cigarette Only, Cigar Only, Hookah Only, Smokeless Tobacco Only, Cigarette Plus E-cigarette, multiple tobacco product users who smoked cigarettes, and multiple tobacco product users who did not smoke cigarettes. Total Nicotine Equivalents (TNE-2) and TD were measured at Wave 1. Approximate one-year outcomes included frequency/quantity used, quitting, and adding/switching to different tobacco products. RESULTS: For Cigarette Only smokers and multiple tobacco product users who smoked cigarettes, higher TD and TNE-2 were associated with: a tendency to smoke more, smoking more frequently over time, decreased likelihood of switching away from cigarettes, and decreased probability of quitting after one year. For other product user groups, Wave 1 TD and/or TNE-2 were less consistently related to changes in quantity and frequency of product use, or for adding or switching products, but higher TNE-2 was more consistently predictive of decreased probability of quitting. CONCLUSIONS: Self-reported TD and nicotine exposure assess common and independent aspects of dependence in relation to tobacco use behaviors for cigarette smokers. For other product user groups, nicotine exposure is a more consistent predictor of quitting than self-reported TD. IMPLICATIONS: This study suggests that smoking cigarettes leads to the most coherent pattern of associations consistent with a syndrome of TD. Because cigarettes continue to be prevalent and harmful, efforts to decrease their use may be accelerated via conventional means (eg, smoking cessation interventions and treatments), but also perhaps by decreasing their dependence potential. The implications for noncombustible tobacco products are less clear as the stability of tobacco use patterns that include products such as e-cigarettes continue to evolve. TD, nicotine exposure measures, and consumption could be used in studies that attempt to understand and predict product-specific tobacco use behavioral outcomes.

The association between problematic parental substance use and adolescent substance use in an ethnically diverse sample of 9th and 10th graders.

Adolescents of parents who use substances are at an increased risk for substance use themselves. Both parental monitoring and closeness have been shown to mediate the relationship between parents' and their adolescents' substance use. However, we know little about whether these relationships vary across different substances used by adolescents. Using structural equation modeling, we examined these associations within a racially and ethnically diverse sample of 9th and 10th graders (N = 927). Path analyses indicated that maternal closeness partially mediated the association between maternal problematic substance use and adolescent alcohol use. Parental monitoring partially mediated the relationship between paternal problematic substance use and adolescent alcohol, cigarette, marijuana, inhalant, and illicit prescription drug use. These results were consistent across gender and race/ethnicity. These findings suggest that parental interventions designed to increase closeness and monitoring may help to reduce adolescent substance use.

Risk of alcohol-impaired driving recidivism among first offenders and multiple offenders.

OBJECTIVES: We sought to determine the statewide impact of having prior alcohol-impaired driving violations of any type on the rate of first occurrence or recidivism among drivers with 0, 1, 2, or 3 or more prior violations in Maryland. METHODS: We analyzed more than 100 million driver records from 1973 to 2004 and classified all Maryland drivers into 4 groups: those with 0, 1, 2, or 3 or more prior violations. The violation rates for approximately 21 million drivers in these 4 groups were compared for the study period 1999 to 2004. RESULTS: On average, there were 3.4, 24.3, 35.9, and 50.8 violations per 1000 drivers a year among those with 0, 1, 2, or 3 or more priors, respectively. The relative risks for men compared with women among these groups of drivers were 3.8, 1.2, 1.0, and 1.0, respectively. CONCLUSIONS: The recidivism rate among first offenders more closely resembles that of second offenders than of nonoffenders. Men and women are at equal risk of recidivating once they have had a first violation documented. Any alcohol-impaired driving violation, not just convictions, is a marker for future recidivism.

Predictive validity of the adult tobacco dependence index: Findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study.

BACKGROUND AND AIMS: Building on published work1 establishing concurrent validity of a self-report tobacco dependence (TD) index among users of different tobacco products in Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study, the current study examines prospective relationships with tobacco use behaviors to establish predictive validity of the TD index. Hypotheses suggested high levels of W1 TD would be associated with persistent tobacco use at Wave 2 (W2). PARTICIPANTS: A U.S. nationally representative sample of 32,320 adult W1 and W2 interviews focused on 11,615 W1 adults who were current established tobacco users and completed the W2 interview. FINDINGS: Higher TD scores and greater changes in TD scores were associated with greater quantity and frequency of tobacco use at the W2 interview for Cigarette Only (n = 7068), Smokeless (smokeless or snus pouches) Only (n = 772), Cigarette plus E-Cigarette (n = 592), and Multiple Products (n = 1866) users, although not significantly so for E-Cigarette Only (n = 367), Cigar Only (traditional, cigarillo, or filtered) (n = 584), or Hookah Only (n = 366) users. Higher TD was associated with decreased odds of successful quitting for Cigarette and Multiple Product users. Higher TD was associated with increased odds of a quit attempt for those in the Hookah and Multiple Products user groups and was not associated with quit attempts or deceased odds of quit success among exclusive E-Cigarette, Cigar, Smokeless and Cigarette plus E-Cigarette users. CONCLUSION: Support for the predictive validity of the PATH Study measures of adult TD will enable regulatory investigations of TD across several tobacco products.

Relapse Contexts for Substance Abusing Adolescents with Comorbid Psychopathology.

The relationship of diagnosis, developmentally relevant factors (e.g., life stress, peer substance use) and mental health symptoms to contexts of a return to substance use were examined for 103 substance abusing adolescents with Axis I psychopathology (ages 12-17) following inpatient treatment. Proximal psychiatric symptoms and developmentally relevant factors, but not psychiatric diagnosis at treatment entry, predicted contexts in which youth returned to alcohol and drug use in the 6 months following treatment. The findings suggest that comorbid youth are similar to same-aged peers without comorbid psychopathology and adults with comorbid psychopathology in regard to contexts associated with a return to substance involvement.

Facilitating youth self-change through school-based intervention.

Early interventions for youth with high rates of alcohol use have often suffered from lack of willing participation due to negative stereotypes about treatment and the impression that alcohol interventions are not developmentally relevant for adolescents. This study evaluated the effectiveness of a school-based voluntary secondary intervention for alcohol use (Project Options). 1254 high school students (55% girls; M age = 15.9, SD = 1.2) with a history of lifetime drinking completed survey measures after the first year of Project Options in 3 schools. These results suggest that the intervention was successful in recruiting high-frequency drinkers into the intervention as well as facilitating attempts to cut down or quit alcohol use in this group of adolescents. This study provides preliminary support for a consumer-based approach to alcohol intervention and design and use of voluntary secondary interventions in a school-based population.

Impact of consent procedures on reported levels of adolescent alcohol use.

This study examined sample bias related to parental consent procedures in school-based survey research on alcohol-related behavior. Alcohol prevalence and severity of use estimates from a high school student survey using traditional-active parental consent (N = 1,429) were compared with estimates from 2 student surveys using alternative parental consent procedures (passive consent; N = 2,210 and N = 3,231). Traditional-active parental consent procedures resulted in underrepresentation of lifetime drinkers. Furthermore, traditional-active parental consent procedures resulted in lower levels of high-risk drinking, and this bias was most evident for Caucasians and both boys and girls. Findings accentuate the need for administrators, policymakers, and researchers to consider the impact consent procedure related bias may have on results and interpretation of findings from school-based substance use research.

Adolescent alcohol reduction and cessation expectancies.

OBJECTIVE: Although many youths reduce or stop drinking without formal treatment, little is known of cognitive mechanisms influencing such alcohol change efforts during adolescence. The present research examines alcohol cessation expectancies of adolescents in the context of a cognitive-behavioral de-escalation model of alcohol use. Grounded in Developmental Social Information Processing theory (Coie and Dodge, 1998) and empirical findings on adolescent self-change process, alcohol cessation expectancies are defined as anticipated consequences of ceasing or decreasing drinking. The present study is the first to develop a measure of adolescent alcohol cessation expectancies. METHOD: A 23-item measure was administered to 5,446 high school students (51% female) as part of a survey on alcohol and drug use. RESULTS: Using data for adolescents who reported any history of alcohol use (N = 3,098), exploratory and confirmatory factor analyses identified expectations of global changes and social effects. Expectancy factor structure was examined within drinking groups (light, moderate, heavy drinkers) and as a function of age and change goal (reduction and cessation). Predictive validity of the expectancy measure was examined for youth who reported efforts to decrease or stop drinking during the prior year. Our results suggest greater differentiation in cessation expectancies with increased alcohol experience. The findings also provide evidence that youth cessation expectancies uniquely predict alcohol change efforts over and above alcohol use and problems. CONCLUSIONS: Youths maintain several types of alcohol reduction/cessation expectancies predictive of behavioral change efforts. Articulation of this construct for youth contributes to an understanding of mechanisms involved in adolescent efforts to reduce or stop drinking.

Avoiding DWI Among Bar-room Drinkers: Strategies and Predictors.

We examined the prevalence and predictors of 11strategies to avoid driving when feeling intoxicated among 561 bar-room patrons in two medium-sized Maryland communities. Logistic regression analyses identified demographic, behavioral, and attitudinal predictors of avoidance strategies and interactions among predictors. Overall, 89% reported one or more DWI avoidance actions in the past year, and 38% reported driving intoxicated during that time. Average frequencies of avoidance behavior and intoxicated driving increased significantly as drinking level increased. However, the higher the drinking level, the smaller the ratio of avoidance actions to DWI experiences, highlighting the vulnerability of heavy drinkers who had driven intoxicated.Using a sober driver or one who allegedly drank less than the respondent were the most popular and frequent strategies, but paying for a cab, walking, and using a bus or free cab were relatively unpopular. Higher drinking levels predicted significantly higher odds of using avoidance approaches, as did intoxicated driving. Confidence in driving safely when intoxicated was positively related to drinking level and intoxicated driving, but it tended to predict lower odds of avoidance actions. Similarly, marital status, age, gender, and location influenced the odds of avoidance behaviors. Interventions should be strategically tailored to exploit or counter drinker predilections among avoidance options.

Adolescent self-selection of service formats: implications for secondary interventions targeting alcohol use.

A novel motivational enhancement based secondary alcohol intervention has been shown to increase quit attempts for youth with heavier alcohol use histories (Brown et al., 2005). In the present study, we examined rates of self-selection into the three formats of this alcohol intervention: group, individual, and website; and examined differences between intervention participants and the general school population and across the three formats. Over four years, students at four schools were surveyed (n=6000) and were provided the opportunity to participate in Project Options (PO). Youth who were selected into PO (n=1147) were younger and more likely to identify as African American or Multiple/Other ethnicity than the school populations. More teens in PO reported lifetime alcohol use (65% vs. 60%); however, the school population reported more current (past 30 day) drinking. Boys were more likely to utilize the group format and minority youth were more likely to select the individual format. Findings highlight the utility of multiple intervention formats to engage youth in early intervention for alcohol problems.

Strategies for reduction and cessation of alcohol use: adolescent preferences.

BACKGROUND: Although the majority of youth and adults resolve alcohol problems without formal treatment, we know little about the strategies used by youth in their efforts to decrease alcohol use. Recent studies have begun to address change efforts that adolescents report being helpful in cutting down or stopping alcohol use. The current study seeks to improve our understanding of adolescent change processes in alcohol use by examining the perceptions of high school students. METHODS: As part of a secondary alcohol intervention study of high school students (ages 12-18; 51% male), 1069 participants completed an anonymous supplemental questionnaire on change strategies for cutting down and stopping alcohol use. Based on content analysis of youth-generated responses, a classification system consisting of nine broad categories was developed (e.g., informal-interpersonal supports, formal aids, alternative activities). Participant responses were independently coded by two raters trained to criterion. Cases with full agreement (n = 934; 96%) were used for data analyses of methods for cutting down drinking, stopping drinking, and strategies recommended for a friend. RESULTS: The five most frequently youth-generated change strategies to alter drinking were environmental exposure management (e.g., avoid drinking situations, 19%); informal interpersonal supports (e.g., talk to a friend, 18%); formal aids (e.g., peer support group, counselor, 17%); behavioral self-management (e.g., limit consumption, 14%); and alternative activities (e.g., recreation, sports, 10%). Whereas informal interpersonal supports were consistently endorsed for all change situations, behavioral self-management strategies were viewed as more useful for reduction of drinking and formal aids more critical for cessation efforts. Some differences were observed in youth-generated strategies for changing their own drinking compared with efforts to help friends, with environmental changes (e.g., reducing exposure to risk situations and people, formal aids) more often considered when changing youth's own behavior, and strategies reflecting a need for personal change (e.g., education) recommended to others. CONCLUSIONS: Our findings support theoretical conceptualizations of alcohol and drug problem resolution that accommodates multiple pathways to recovery. The normative information about specific change strategies generated by youth may further aid in the design of interventions more acceptable for adolescents.