ACTOR: a latent Dirichlet model to compare expressed isoform proportions to a reference panel.

The relative proportion of RNA isoforms expressed for a given gene has been associated with disease states in cancer, retinal diseases, and neurological disorders. Examination of relative isoform proportions can help determine biological mechanisms, but such analyses often require a per-gene investigation of splicing patterns. Leveraging large public data sets produced by genomic consortia as a reference, one can compare splicing patterns in a data set of interest with those of a reference panel in which samples are divided into distinct groups, such as tissue of origin, or disease status. We propose A latent Dirichlet model to Compare expressed isoform proportions TO a Reference panel (ACTOR), a latent Dirichlet model with Dirichlet Multinomial observations to compare expressed isoform proportions in a data set to an independent reference panel. We use a variational Bayes procedure to estimate posterior distributions for the group membership of one or more samples. Using the Genotype-Tissue Expression project as a reference data set, we evaluate ACTOR on simulated and real RNA-seq data sets to determine tissue-type classifications of genes. ACTOR is publicly available as an R package at https://github.com/mccabes292/actor.

Is age of onset and duration of stimulant therapy for ADHD associated with cocaine, methamphetamine, and prescription stimulant misuse?

BACKGROUND: To assess whether age of onset and duration of stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) are associated with cocaine, methamphetamine, and prescription stimulant misuse during adolescence. METHODS: Nationally representative samples of US 10th and 12th grade students (N = 150,395) from the Monitoring the Future study were surveyed via self-administered questionnaires from 16 annual surveys (2005-2020). RESULTS: An estimated 8.2% of youth received stimulant therapy for ADHD during their lifetime (n = 10,937). More than one in 10 of all youth reported past-year prescription stimulant misuse (10.4%)-past-year cocaine (4.4%) and methamphetamine (2.0%) use were less prevalent. Youth who initiated early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years) did not have significantly increased adjusted odds of cocaine or methamphetamine use relative to population controls (ie, non-ADHD and unmedicated ADHD youth). Youth who initiated late stimulant therapy for ADHD (≥10 years old) and for short duration (<1 year) had significantly higher odds of past-year cocaine or prescription stimulant misuse in adolescence than those initiating early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years). Youth who initiated late stimulant therapy for ADHD (≥10 years) for short duration (<1 year) had significantly higher odds of past-year cocaine, methamphetamine, and prescription stimulant misuse versus population controls during adolescence. No differences in past-year cocaine, methamphetamine, and prescription stimulant misuse were found between individuals who only used non-stimulant therapy for ADHD relative to youth who initiated early stimulant therapy (≤9 years old) and for long duration (≥6 years). CONCLUSIONS: An inverse relationship was found between years of stimulant therapy and illicit and prescription stimulant misuse. Adolescents with later initiation and/or shorter duration of stimulant treatment for ADHD should be monitored for potential illicit and prescription stimulant misuse.

Social Ecological Influences on Nicotine/Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults in the USA.

BACKGROUND AND PURPOSE: Our study examined individual-, interpersonal-, community-, and policy-level associations with nicotine/tobacco use among gender-varying and gender-stable U.S. individuals. METHODS: Data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (n = 33,197 U.S. adolescents and adults aged ≥14 years) and state-level gender minority policy data were used. Using multivariable logistic regression, the odds of past-30-day nicotine/tobacco use at W4 were estimated as a function of gender stability/variability, psychological distress, number of tobacco products used by family/friends, anti-tobacco marketing exposure, and change in gender minority-related policies from 2015 to 2017. RESULTS: Gender-varying individuals had higher odds of nicotine/tobacco use compared with gender-stable individuals (AOR range = 1.7-2.3, p < .01). In the overall sample, positive change in gender minority policy protections (tallied from medium to high) was associated with lower odds of any nicotine/tobacco, other tobacco, and poly-tobacco use (AOR = 0.8, p < .05) compared to states with no change in their negative policies. Anti-tobacco marketing exposure was associated with lower odds of any tobacco, cigarette, e-cigarette, and poly-tobacco use compared with those who had no anti-tobacco marketing exposure (AOR = 0.9, p < .05). Higher psychological distress (AOR range = 1.7-2.4, p < .001) and an increasing number of tobacco products used by family/friends (AOR range = 1.1-1.3, p < .001) were associated with increased odds of nicotine/tobacco use. CONCLUSIONS: Multilevel prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-varying and gender-stable individuals.

Prior work has shown that individuals whose gender identity changes over time (i.e., gender-varying) have higher risk for nicotine/tobacco use compared with individuals whose gender identity remains consistent over time (i.e., gender-stable). This study examined individual-, interpersonal-, community-, and policy-level associations with nicotine/tobacco use among gender-varying and gender-stable U.S. adolescents and adults. We analyzed data from Waves 2­4 (2014/15­2016/18) of the Population Assessment of Tobacco and Health study (n = 33,197 U.S. adolescents and adults aged 14 years and above) and state-level gender identity policy data from the Movement Advancement Project. Among the overall sample, we found that a positive change in state-level policy protections was associated with lower odds of any nicotine/tobacco, other tobacco, and poly-tobacco use compared with states that had no change in their negative policies. Exposure to anti-tobacco marketing was associated with lower odds of any tobacco, cigarette, e-cigarette, and poly-tobacco use compared with those who had no exposure to anti-tobacco marketing. Higher psychological distress and an increasing number of tobacco products used by close friends and family were associated with increased odds of nicotine/tobacco use. Multilevel prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-varying and gender-stable individuals.

How a "Something Else" Response Option for Sexual Identity Affects National Survey Estimates of Associations Between Sexual Identity, Reproductive Health, and Substance Use.

This randomized experiment tested whether the inclusion of a "something else" response option for a question about sexual identity in a national health survey would significantly moderate estimated differences between sexual identity subgroups in terms of various health outcomes, including substance use and reproductive health. We conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (NSFG; 2015-2019), where two large national half-samples were randomly assigned to receive one of two different versions of a question about sexual identity (a four-category version that included a "something else" response option or a three-category version omitting this option). We focused on national estimates of differences between subgroups defined by sexual identity. Multivariable models indicated that the estimated subgroup differences changed in a statistically significant fashion when using the four-category version of the sexual identity question for several measures, including 16% of male measures (household size, past-year cigarette use, and past-year illicit drug use) and 15% of female measures (wanting a/another child, ever had a sexually transmitted disease, and past-year marijuana use). The absence of a "something else" response option for questions about sexual identity in national health surveys may cause respondents to select options that do not accurately describe their identities, and this can have a significant effect on national estimates of differences between sexual identity subgroups in terms of selected health outcomes.

Associations of sexual identity change and identity-attraction discordance with symptomatic alcohol and other drug use.

PURPOSE: National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013-2019), and the associations with symptomatic alcohol and other drug use. METHODS: Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity-attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex. RESULTS: In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity-attraction discordance. CONCLUSION: These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period.

Family history of substance use disorder and likelihood of prescription drug misuse in adults 50 and older.

OBJECTIVE: Individuals who are family history positive (FHP) for substance use problems have increased risk for substance use, substance use disorders (SUDs), and psychopathology. Links between FHP status and prescription drug misuse (PDM) have not been well investigated; this study examined PDM in adults 50 and older by FHP status. METHODS: Data were from the US NESARC-III (n = 14,667). Participants reported their opioid PDM, tranquilizer/sedative PDM, SUD, psychopathology, and family history status (i.e. first- and second-degree relatives with alcohol/substance use problems). Prevalence rates were estimated by FHP status, and logistic regressions compared FHP and family history negative (FHN) groups. RESULTS: FHP status was associated with significantly higher rates of PDM (e.g. past-year opioid PDM, FHP: 3.8%, FHN: 1.5%) and SUD from PDM (e.g. past-year SUD, FHP: 1.2%, FHN: 0.2%); also, prevalence varied by family history density, with the highest rates in those with three or more relatives with substance use problems (e.g. past-year opioid PDM: 5.5%). Overall, 32.2% of FHP individuals with past-year PDM had past-year co-occurring SUD and psychopathology diagnoses, versus 11.0% of FHN individuals. CONCLUSION: FHP status could inform treatment decisions in adults 50 and older with conditions for which prescription opioids or tranquilizer/sedatives are indicated.

The Initiation and Developmental Course of Prescription Drug Misuse Among High School Athletes During the Transition Through Young Adulthood.

The objective of this study was to examine the extent to which involvement in high-contact, semicontact, or noncontact sports during the 12th grade is associated with the initiation and developmental course of prescription drug misuse (PDM) between ages 17/18 years and 27/28 years. Data were collected from a national multicohort panel sample of US 12th-graders (cohorts 2006-2017; n = 4,772) from the Monitoring the Future Study who were followed for a decade, through age 27/28 years. Approximately 31% of high school seniors indicated PDM at baseline (age 17/18 years). While past-year PDM remained relatively stable between ages 17/18 years and 27/28 years, participation in both noncontact (adjusted odds ratio = 1.40, 95% confidence interval: 1.02, 1.91) and contact (adjusted odds ratio = 1.57, 95% confidence interval: 1.08, 2.28) sports in the 12th grade increased the odds of initiating prescription stimulant misuse during the 10 years following high school as compared with respondents who did not participate in these types of sports in the 12th grade. To our knowledge, this is the first national study to have assessed how sports participation during high school is associated with the initiation and developmental course of PDM from adolescence to young adulthood. These findings reinforce the need for PDM screening during adolescence, as nearly 1 in 3 high school seniors engage in PDM. Increased prescription stimulant misuse following high school warrants ongoing monitoring during young adulthood, especially among athletes.

Consistency and overfitting of multi-omics methods on experimental data.

Knowledge on the relationship between different biological modalities (RNA, chromatin, etc.) can help further our understanding of the processes through which biological components interact. The ready availability of multi-omics datasets has led to the development of numerous methods for identifying sources of common variation across biological modalities. However, evaluation of the performance of these methods, in terms of consistency, has been difficult because most methods are unsupervised. We present a comparison of sparse multiple canonical correlation analysis (Sparse mCCA), angle-based joint and individual variation explained (AJIVE) and multi-omics factor analysis (MOFA) using a cross-validation approach to assess overfitting and consistency. Both large and small-sample datasets were used to evaluate performance, and a permuted null dataset was used to identify overfitting through the application of our framework and approach. In the large-sample setting, we found that all methods demonstrated consistency and lack of overfitting; however, in the small-sample size setting, AJIVE provided the most stable results. We provide an R package so that our framework and approach can be applied to evaluate other methods and datasets.

A prospective randomized trial of standard versus multimedia-supplemented counseling in patients undergoing endometrial cancer staging surgery.

OBJECTIVES: A patient's understanding of surgery is often limited, especially in the setting of complex oncologic procedures. The use of supplemental materials can improve patients' knowledge of their procedure and satisfaction with decision making. We sought to determine if a multimedia-supplemented approach in patients undergoing robotic endometrial cancer staging improves satisfaction with preoperative counseling. Secondary objectives were patient comprehension, physician satisfaction, and visit length. METHODS: From 2018 to 2019, patients were randomized to standard physician education (SPE) or multimedia-based education (MBE), which included watching two novel videos followed by focused physician counseling. Basic demographic information was collected. Patient satisfaction was assessed using the Client Satisfaction Questionnaire-8 (CSQ-8, a validated satisfaction survey, scored 8-32) and a global satisfaction score (GGS, 10-point scale). Physician satisfaction was assessed using a GGS. Comprehension was assessed with a study-specific 9-question survey at three time points. t-tests and linear mixed models were used to compare groups. RESULTS: Of the 75 patients included in the analysis, the majority were white (70%), 50-70 years old (72%), and had at least some college education (74%). The MBE group reported higher satisfaction on the CSQ-8 (31.69 vs 30.69, p < 0.01) and global satisfaction score (9.95 vs 9.74, p = 0.04). There was no difference in comprehension scores over time (p = 0.84) or between groups (p = 0.23). Visit lengths were significantly longer in the MBE group (90.36 vs 80.46 min, p = 0.04). CONCLUSIONS: Patients had high satisfaction and comprehension with both SPE and MBE. Multimedia education may be implemented in preoperative counseling based on provider preference and consideration should be made for further study of satisfaction, both patient and physician, and visit length after the initial implementation period.

Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults Living in the United States.

INTRODUCTION: This study examines the proportion of the United States adolescents and adults who are variable (ie, at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates. METHODS: We fit multivariable logistic regression models to data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n = 33 197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability over three waves with tobacco use at wave 4 (2016-2018). Differences in any past 30-day tobacco, cigarette, e-cigarette, other tobacco, and poly-tobacco use were assessed among cisgender-stable, transgender-stable, and gender-varying respondents. RESULTS: An estimated 1.0% of adolescents and adults were classified as gender-varying. Prevalence of any past 30-day tobacco use was higher among gender-varying individuals (42.7%) than among gender-stable individuals (transgender-stable, 37.8% and cisgender-stable, 26.7%). There were no significant differences in the odds of nicotine/tobacco use between the two gender-stable groups. However, gender-varying respondents had significant increased odds of any past 30-day tobacco use (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.3 to 3.0), cigarette use (AOR = 1.7, 95% CI = 1.1 to 2.5), e-cigarette use (AOR = 2.2, 95% CI = 1.4-3.5), other tobacco use (AOR = 2.2, 95% CI = 1.4 to 3.4), and poly-tobacco use (AOR = 2.0, 95% CI = 1.3 to 3.1) compared with cisgender-stable individuals. CONCLUSIONS: Gender-varying individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for tobacco-related health consequences. IMPLICATIONS: Despite increased knowledge about transgender health in recent years, there remains a paucity of research about gender-varying individuals. This study is the first to examine the proportion of gender-varying individuals in the United States using a longitudinal, nationally representative sample and to explore differences in nicotine/tobacco use among gender-varying and gender-stable individuals. Our findings suggest that gender-varying people have an increased risk for nicotine/tobacco use, placing them at higher risk for tobacco-related health consequences. This study increases knowledge about nicotine/tobacco use among this under-represented population in research and underscores the importance of developing an awareness of gender diversity.

Recent trends in prescription drug misuse in the United States by age, race/ethnicity, and sex.

BACKGROUND AND OBJECTIVES: To examine changes in United States past-year opioid, stimulant, and benzodiazepine prescription drug misuse (PDM) and poly-PDM by demographics. METHODS: Data were from the 2015-2019 National Survey on Drug Use and Health (N = 282,768), examining annualized PDM change by demographics. RESULTS: Opioid and poly-PDM significantly declined among those under 35 years, White, and multiracial residents. DISCUSSION AND CONCLUSIONS: Age and race/ethnicity are important moderators of recent PDM trends, warranting investigation of mechanisms. SCIENTIFIC SIGNIFICANCE: Results highlight ongoing PDM declines in younger groups but expand the literature by showing limited changes in adults 35 and older and non-opioid PDM.

Trajectories of prescription opioid and heroin use in adulthood.

BACKGROUND AND OBJECTIVES: Due to a reduction in the availability of prescription opioids in the United States, the potential transition from prescription opioids to heroin is a public health concern. We assessed trajectories of both nonmedical prescription opioid (NMPO) and heroin use from adolescence (age 18) to adulthood (age 50) and how these trajectories were associated with substance use disorder (SUD) in adulthood (age 35-50). METHODS: A national sample of 26,569 individuals from eleven cohorts of US high school seniors (1976-1986) who were followed until age 50 (2008-2018). The analysis focuses on respondents who engaged in past-year NMPO and heroin use. Outcomes included the endorsement of two or more SUD symptoms. RESULTS: Among NMPO users, 7.5% had used heroin by the age of 50. The latent profile analyses assessing individuals who reported both NMPO and heroin use during the 32-year study period found four unique trajectory groups: (1) "age 18 concurrent use" (81.2%); (2) "mid-30s NMPO-to-heroin use transition" (10.7%); (3) age 19/20 NMPO-to-heroin use transition, followed by 40s heroin-to-NMPO use transition (4.3%); and (4) "mid-20s NMPO-to-heroin use transition" (3.7%). Respondents in the "mid-30s NMPO-to-heroin use transition" trajectory group had the highest odds of indicating two or more SUD symptoms between ages 35-50. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: This is the first study to assess NMPO and heroin use trajectories among a national probability-based sample followed from age 18 to 50. The findings suggest that prescription opioid misuse is a risk factor in the development of SUDs and has a long-term impact.

An examination of how e-cigarette/cigarette use during adolescence is associated with future use during the third trimester of pregnancy.

Background: Adolescent e-cigarette use has increased, as has e-cigarette use during pregnancy, yet little is known about how these types of tobacco/nicotine (cigarettes/e-cigarettes) use during adolescence are associated with tobacco/nicotine use during the third trimester of pregnancy among young adults. Methods: National longitudinal data (2013-2018) from the Population Assessment of Tobacco and Health (PATH) study were used. Young adults ages 18-20 who indicated past-year pregnancy made up the analytic sample (N = 246). Logistic regression was used to evaluate the association between history of past 30-day use of cigarettes/e-cigarettes during adolescence (i.e., 14-17) and later use during the third trimester of pregnancy among young women (i.e., 18-20). Results: Within the sample of young women who indicated a pregnancy during the past year, 18.9% indicated smoking cigarettes and 4.2% indicated using e-cigarettes during their last trimester. Cigarette smoking in adolescence (wave 1 or 2) was associated with cigarette use during the last trimester (aOR = 4.76, 95% CI = 1.36, 16.6); however, e-cigarette use during adolescence was not associated with either cigarette or e-cigarette use during the third trimester of pregnancy. Conclusions: Tobacco/nicotine prevention in early adolescence has implications for preventing tobacco/nicotine-related harms during pregnancy among young adults. Intervention programs and clinicians informed about various types of tobacco/nicotine are needed to address tobacco/nicotine cessation among adolescents to prevent consequences of tobacco/nicotine use during pregnancy.

Trends in binge drinking, marijuana use, illicit drug use, and polysubstance use by sexual identity in the United States (2006-2017).

Background: National studies often examine associations between sexual identity and substance use at a single point in time and neglect to examine whether these associations change over time. The present study examines U.S. trends in the past-year prevalence of binge drinking, marijuana use, illicit drug use, and polysubstance use across sexual identity subgroups (gay, lesbian, bisexual and heterosexual). Methods: The data come from four independent, cross-sectional samples measured by the National Survey of Family Growth (2006-2010, 2011-2013, 2013-2015, and 2015-2017). Based on the consistency in the sampling procedures used over time, merging the four data sets was possible. The target population is men and women 15-44 years of age. Results: Lesbian women had the sharpest decline in past-year binge drinking over time, followed by heterosexual women. The prevalence of binge drinking for bisexual women did not change significantly over time and was higher in 2015-2017 than for any sexual identity subgroup. In contrast, there were no significant differences in the prevalence of binge drinking among men by sexual identity subgroup. Past-year abstinence from substance use was consistently lower among lesbian women, gay men, and bisexual women relative to other sexual identity subgroups. Polysubstance use was consistently more prevalent among bisexual women (e.g., 32.3% in 2015-2017) as compared to other sexual identity subgroups. Conclusion: This is the first study to examine U.S. national trends in alcohol, marijuana, illicit drug, and polysubstance use across sexual identity subgroups, and demonstrates that sexual identity subgroup differences were robust with relatively few changes in trends over time. The consistently high rates of binge drinking and polysubstance use among bisexual women deserve much closer attention based on the related health consequences.

Is it all in the family? Sexual identity differences in DSM-5 alcohol and other drug use disorders and associations with alcohol and other drug misuse history among parents, offspring, and other relatives.

Background: The objectives of this study were to: (1) estimate the prevalence of family history of alcohol and other drug (AOD) misuse (positive family history [FH+]) in first- and second-degree relatives across sexual identity subgroups (i.e., lesbian, gay, bisexual, heterosexual); (2) compare AOD misuse among offspring of sexual minority and heterosexual parents; and (3) examine the relationships between FH+ and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol use disorder (AUD) and other drug use disorder (ODUD) across sexual identity subgroups. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309 non-institutionalized U.S. adults aged ≥ 18 years). Data collection occurred in households using structured diagnostic face-to-face interviews during 2012-2013. Results: The presence of FH+ in first- and second-degree relatives was most prevalent among bisexual women relative to all other sexual orientation subgroups. Multivariable regression analyses indicated that the odds of AUD and ODUD were higher among FH+ adults relative to negative family history (FH-) adults. Lesbian and bisexual women had higher odds of AUD compared to heterosexual women, controlling for any FH+; this sexual identity difference was not found for men. There were no significant differences in ODUD between heterosexual FH- men and gay FH- men. We found differences in AOD misuse among offspring of bisexual parents, but not gay or lesbian parents compared to heterosexual parents. Conclusions: Health professionals should consider the higher likelihood of a family history of AOD misuse among sexual minorities, especially bisexual women, when treating these individuals. The lack of differences in AOD misuse among offspring of gay or lesbian parents relative to heterosexual parents warrants attention for legal, policy, and clinical decisions.

Young adults' expectations for healthcare following institutional betrayal.

Healthcare-related institutional betrayal has been used to examine how patients' previous negative healthcare experiences influence their current provider-level trust and future interactions with the healthcare system. However, healthcare-related institutional betrayal has rarely been considered among emerging independent users of the healthcare system: college students. Moreover, it is unknown whether healthcare-related institutional betrayal is associated with future healthcare expectations among this population. Using a trauma-informed framework, this study examined the relations among self-reported experiences of healthcare-related institutional betrayal, trust in healthcare providers, and subsequent expectations for healthcare among college students (n = 967). Analyses considered whether greater past healthcare-related institutional betrayal during one's worst healthcare experience predicts i) lower current trust in healthcare providers and ii) greater negative expectations for future healthcare above and beyond trauma symptoms and the perceived severity of participants' worst healthcare experiences. Sixty-nine percent of participants endorsed having experienced at least one act of institutional betrayal, the most common being the institution not taking proactive steps to prevent unpleasant healthcare experiences (28.5%). As predicted theoretically, greater experiences of institutional betrayal accounted for 16% of the variance in current trust in healthcare providers, even after accounting for trauma symptoms and the severity of the worst healthcare experience. Greater endorsement of institutional betrayal experiences were also significantly associated with negative expectations for future healthcare. Given the youthfulness of the sample, it is noteworthy that 41.4% of participants endorsed at least one negative expectation for future healthcare. Future research should examine how negative expectations are related to healthcare avoidance behaviors.

Nicotine and Tobacco Product Use and Dependence Symptoms Among US Adolescents and Adults: Differences by Age, Sex, and Sexual Identity.

INTRODUCTION: Sexual minorities are at increased risk for tobacco use; however, there is heterogeneity in this risk by sociodemographic factors. AIMS AND METHODS: This study sought to understand if vulnerability to tobacco use among US sexual minorities varies by age group. For this study we used data from wave 4 of the Population Assessment of Tobacco and Health adolescent and adult surveys (n = 37 959), a nationally representative survey. We examined five nicotine/tobacco use outcomes by sex and sexual identity across four age groups. The five outcomes included past 30-day e-cigarette use, past 30-day cigarette use, past 30-day other tobacco use, the number of tobacco products used, and nicotine dependence symptoms. RESULTS: For males, sexual identity differences were greatest in middle adulthood, particularly for bisexual males; adjusted odds ratios and adjusted incident rate ratios ranged from 2.08 to 5.59 in middle adulthood compared to 0.83-1.62 in adolescence. For females, sexual identity differences were persistent from adolescence through middle adulthood. We found significant differences most consistently for nicotine dependence symptoms when comparing gay/lesbian and bisexual females across multiple age groups; adjusted incident rate ratios ranged from 1.90 in middle adulthood to 3.26 in adolescence. CONCLUSIONS: Risk among sexual minorities varied considerably across age groups and by nicotine/tobacco product and severity of symptoms. Our findings underscore the importance of looking beyond single tobacco products when examining nicotine/tobacco differences related to sexual identity and in examining differences by age group. Our results demonstrating age-varying risk among sexual minorities have important implications for tobacco prevention and cessation efforts. IMPLICATIONS: This study identifies important age variation in sexual minority differences in tobacco use, particularly among males. This study also shows that many sexual minorities not only have higher risk for tobacco and nicotine product use but also use significantly more tobacco products and have higher nicotine dependence symptom scores. These results have important implications for implementation of nicotine and tobacco prevention and cessation strategies for sexual minority adolescents and adults.

Discrimination, Sexual Orientation Discrimination, and Severity of Tobacco Use Disorder in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III.

INTRODUCTION: Tobacco use is more prevalent among sexual minority populations relative to heterosexual populations. Discrimination is a known risk factor for tobacco use. However, the relationship between exposure to different forms of discrimination, such as racial or ethnic discrimination and sexual orientation discrimination, and tobacco use disorder (TUD) severity has not been examined. AIMS AND METHODS: Using data from the 2012-2013 National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36 309 US adults), we conducted multivariable logistic regression analyses to examine the associations among racial or ethnic discrimination, sexual orientation discrimination, and TUD severity for lesbian or gay-, bisexual-, and heterosexual-identified adults. Consistent with the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), past-year moderate-to-severe TUD was defined as the presence of ≥4 DSM-5 TUD symptoms. RESULTS: Higher levels of lifetime racial or ethnic discrimination were associated with significantly greater odds of past-year moderate-to-severe TUD among sexual minorities (adjusted odds ratio [AOR] = 1.03, 95% confidence interval [CI] = 1.01-1.05) and heterosexuals (AOR = 1.04, 95% CI = 1.03-1.05). Stressful life events, mood disorder, and anxiety disorder had significant associations with moderate-to-severe TUD among sexual minorities (AOR range: 1.86-5.22, p < .005) and heterosexuals (AOR range: 1.71-3.53, p < .005). Among sexual minorities, higher levels of racial or ethnic and/or sexual orientation discrimination were associated with greater odds of any TUD (AOR = 1.02, 95% CI = 1.01-1.03). CONCLUSIONS: Sexual minorities and heterosexuals who experience higher levels of racial or ethnic discrimination are at heightened risk of having moderate-to-severe TUD. Exposure to higher levels of discrimination also increases the risk of having any TUD among sexual minority adults. Health providers and tobacco cessation professionals should be cognizant of the minority stressors experienced by their clients and their potential impact on TUD severity. IMPLICATIONS: This study is the first to show how experiences of racial or ethnic and sexual orientation discrimination are associated with DSM-5 TUD severity among sexual minority and heterosexual populations. Individuals exposed to multiple minority stressors may have increased vulnerability for developing TUD and related adverse health consequences. Our study underscores the importance of considering racial or ethnic discrimination and the multiple minority statuses that individuals may hold. Eliminating all forms of discrimination and developing interventions that are sensitive to the role that discrimination plays in TUD severity may attenuate the tobacco use disparities between sexual minority and heterosexual adults.

The latent class structure of substance use in US adults 50 years and older.

OBJECTIVE: Substance use rates have increased in adults 50 years and older, and substance use in this population is associated with significant consequences. Given that little is known about their underlying substance use patterns, the objective was to identify latent classes of adults 50 years and older by past-year substance use, past-month substance use, and past-year substance use disorder (SUD) diagnosis. METHODS: The National Survey on Drug Use and Health is an annual nationwide cross-sectional U.S. survey. Participants were 35,229 civilian, non-institutionalized U.S. residents, 50 years and older. Past-year and past-month alcohol, tobacco, marijuana, heroin, cocaine, methamphetamine use, and opioid, stimulant, and tranquilizer/sedative prescription drug misuse (PDM) were captured, as was past-year DSM-IV SUD from these substances. Correlates included mental health, physical health, and healthcare utilization variables. RESULTS: Latent class analysis indicated four past-year or past-month substance use subgroups (Alcohol-Only, Alcohol-Tobacco-Marijuana, Cocaine-Polydrug, PDM-Polydrug), with SUD prevalence rising from 3.2% to 17.3%, 68.8%, and 78.5% by past-year subgroup; similarly, rates of past-year suicidal ideation increased from 2.1%, to 4.8%, 12.0%, and 20.4% by past-year subgroup. For SUD, there were three subgroups (Low Nicotine Dependence [ND], High Alcohol Use Disorder, Multiple SUDs). Over 90% of adults were in a low-risk subgroup (i.e., Alcohol-Only and Low ND), but members of Cocaine-Polydrug, PDM-Polydrug, or Multiple SUDs latent classes had high rates of mental and physical health concerns. CONCLUSIONS: Most adults 50 and older have lower risk profiles, but those engaged in PDM or cocaine use are heavily substance-involved and need screening and likely multi-disciplinary intervention.

Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older.

OBJECTIVE: To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older. METHODS: Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion. RESULTS: Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM. CONCLUSIONS: US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.