Legalization and retail availability of recreational marijuana and adolescent use in schools.

Legalization of use and retail sales of recreational marijuana in U.S. states and the associated potential increase in access to marijuana and normalization of its use by adults could lead to increased use by adolescents. Studies have found that states with legal recreational marijuana have higher rates of adolescent use and frequency of use compared to states without legal use. We examined changes in student office discipline referrals (ODRs) for substance use offenses in Oregon middle and high schools before and after the legalization of recreational marijuana relative to comparison schools in other states. We found that rates of substance use related ODRs in middle schools increased by 0.14 per 100 students (30% of the mean) with legalization relative to comparison schools. This increase was moderated by the presence of a marijuana outlet within one mile of the school. We found no statistically discernible changes in high school ODRs. Marijuana use in adolescence has been linked to negative health and social consequences, including academic problems, mental health issues, and impaired driving. Potential adverse impact on adolescents and investments in school-based prevention programs could be important considerations for policymakers and public health officials when evaluating marijuana legalization.

Adolescent Developmental Pathways Among Depression, Conduct Problems, and Rejection: Integrative Data Analysis Across Three Samples.

OBJECTIVE: The current study investigated sex differences in longitudinal associations among youth depression, conduct problems, and peer rejection from ages 11 to 16. We hypothesized that girls would follow the irritable depression model, which posits that depression leads to conduct problems, and that peer rejection would mediate this relationship. We hypothesized that boys would follow the cumulative failure model, which suggests that conduct problems predict future depression, mediated by peer rejection. METHOD: We used integrative data analysis to combine three datasets, creating an aggregate sample of 2,322 adolescents, 58.4% of an ethnic minority group, and 51.3% boys. Using random-intercept cross-lagged panel modeling with data from ages 11-16, we conducted a nested model comparison. RESULTS: Results indicated that a model which allowed paths to differ by sex demonstrated better model fit than a constrained model. While depression, conduct problems, and peer rejection were relatively stable over time and had correlated random intercepts, there were few crossover paths between these domains for either sex. When the strengths of individual crossover pathways were compared based on sex, only the path from conduct problems at age 13 to depression at age 14 was significantly different, with this path being stronger for girls. CONCLUSIONS: These results suggest that stable, between-person effects largely drive relationships between depression, conduct problems, and peer rejection during adolescence, whereas there are few transactional, within-person pathways between these domains. This pattern of findings demonstrates the utility of random intercept cross-lagged panel modeling for disentangling between- and within-person effects.

Assessing the Pragmatic Effectiveness and Implementation of Click City®: Tobacco:A School-Based Prevention Program Targeting Youth Cigarette and E-cigarette Use.

INTRODUCTION: Given the rapid increase in the prevalence of e-cigarette use among youth, we updated Click City®: Tobacco, an existing, efficacious, online tobacco prevention program for 5th graders with a 6th-grade booster, to also target e-cigarette use. METHOD: To evaluate the effectiveness of the updated 5th-grade program within a "real world" setting, we conducted a pragmatic randomized trial with 5th grade students in 43 schools across Arizona and Oregon, assessing change in intentions and willingness to use e-cigarettes/cigarettes, from baseline to one-week post-intervention. Students in intervention schools (n = 1327) received the updated version of Click City®: Tobacco; students in control schools (n = 1346) received their usual tobacco prevention curriculum. RESULTS: Students in intervention schools significantly decreased their intentions and willingness to use e-cigarettes and cigarettes, compared to students in control schools. The intervention also significantly changed all targeted etiological mechanisms predictive of intentions and willingness. The intervention was more effective for at-risk students, as defined by student's previous tobacco use, current family use of tobacco, and/or high in sensation-seeking. The effects of the intervention on all outcomes were similar as a function of state, gender, ethnicity, and historical timing (prior to COVID-19 pandemic school closures vs. after schools re-opened). Close to 90% of the students in the intervention condition completed the entire program, supporting fidelity of implementation, and teachers reported satisfaction with the program. CONCLUSIONS: Findings suggest that Click City®: Tobacco is effective for all 5th grade students and can be delivered with fidelity across school settings. IMPLICATIONS: The results of a randomized pragmatic effectiveness trial showed that the updated Click City®: Tobacco program decreased intentions and willingness to both vape e-cigarettes and smoke cigarettes among 5th grade students, particularly for those at high risk. Program effectiveness and lack of differences due to factors such as state, gender, ethnicity, and historical timing has universal implications, suggesting that all students can benefit from this program. Click City®: Tobacco received high ratings of program satisfaction from teachers and was implemented with fidelity. Findings suggest that Click City®: Tobacco is effective and can be easily implemented in schools.

How pubertal timing and self-regulation predict adolescent sexual activity in resource-poor environments.

Studies found support for a link between pubertal timing and self-regulation in low-resource environments. This link could potentially explain a link between pubertal timing and early risk behavior. This study builds on this body of research by examining the mediated effect of pubertal timing on sexual activity through self-regulation in 728 adolescents and their families in a group with poor resources and a group with adequate resources. Income-to-Needs (ITN) was measured at age 7.5 to establish two groups (low-ITN and Medium/High-ITN). Pubertal timing was measured at age 10.5, self-regulation was assessed at age 14 and operationalized with effortful control, and sexual activity was assessed at age 16. Structural equation modeling was employed to test the hypothesized model in both groups. The link between pubertal timing and sexual activity mediated by effortful control was only significant in the low-ITN group. Specifically, more advanced pubertal maturity was associated with lower levels of adolescents' effortful control, which in turn was associated with more sexual activity at age 16. Findings were partially replicated with a drug use index replacing sexual activity. This study shows a different operating link from pubertal timing to effortful control and subsequent risk behavior in resource-poor environments. Implications are discussed.

Disrupting Maternal Transmission of Depression: Using Integrative Data Analysis (IDA) to Examine Indirect Effects of the Family Check-Up (FCU) Across Three Randomized Trials.

Maternal depression is a well-established risk factor for the development of depression in offspring. As such, reducing maternal depression may be key to effective prevention efforts to reduce offspring's depression. Based on the broad risk represented by maternal depression, examining cross-over effects of parent-focused interventions on maternal depression is important. The present study examined improvements in maternal depression as a mediator of the long-term effects of the Family Check-Up (FCU) prevention program on youth depression across three randomized controlled trials. The FCU is a family-focused intervention originally designed to reduce youth problem behaviors, particularly conduct problems and substance use, but has also been found to have cross-over effects on other youth problem behaviors, including internalizing symptoms. We utilized integrative data analysis that allows for powerful tests of prevention effects across trials, specifically moderated nonlinear factor analysis, to integrate data across three trials: one trial initiated in early childhood and two in early adolescence. Using a latent growth modeling approach, we first examined direct effects of the FCU on changes in maternal depression. Then we examined the mediating effect of maternal depression on changes in both parent and youth reports of youth depression. A significant intervention effect on maternal depression was observed across the three trials, with the FCU predicting improvements in maternal depression. In turn, such improvements predicted a reduction in the growth in both parent and youth reports of youth depressive symptoms across 10 years post baseline. These results demonstrate the utility in addressing cross-over effects of family-focused interventions in reducing the long-term development of depression in youth through mediating pathways.

Long-term Effects of the Family Check-Up on Suicidality in Childhood and Adolescence: Integrative Data Analysis of Three Randomized Trials.

This study employed integrative data analysis techniques to examine the long-term effects of the family check-up (FCU) on changes in youth suicide risk using three randomized prevention trials, including one trial initiated in early childhood and two initiated in early adolescence. Data were harmonized across studies using moderated nonlinear factor analysis, and intervention effects were tested using an autoregressive latent trajectory model examining changes in suicide risk across long-term follow-up. Across trials, significant long-term effects of the FCU on reductions in suicide risk were observed, although differences between intervention and control group trajectories declined over time. No moderation of intervention effects was observed by youth gender or race/ethnicity or across samples. While results offer further support for the benefits of the FCU for suicide risk reduction, they also suggest that such effects may wane over time, underscoring the need for continued development of the FCU to enhance longer-term durability of effects on suicide-related behaviors.

Developmental Models of Depression, Externalizing Problems, and Self-regulatory Processes: Integrated Data Analysis Across Four Longitudinal Studies of Youth.

Integrative data analysis (IDA) was used to derive developmental models of depression, externalizing problems, and self-regulatory processes in three prevention trials of the Family Check-Up and one longitudinal, community-based study of girls over a 10-year span covering early to late adolescence (N = 4,773; 74.9% female, 41.7% white). We used moderated nonlinear factor analysis to create harmonized scores based on all available items for a given participant in the pooled dataset while accounting for potential differences in both the latent factor and the individual items as a function of observed covariates. We also conducted latent growth model analyses to examine developmental trajectories of risk. Results indicated a bidirectional relationship between depression and externalizing problems, with greater baseline externalizing problems and depression predicting growth in inhibitory control difficulties. Furthermore, initial level of inhibitory control difficulties was associated with growth in depression. We did not, however, find a relationship between early inhibitory control difficulties and growth in externalizing problems. This work illustrates the utility of IDA techniques to harmonize data across multiple studies to identify risk factors for the development of depression and externalizing problems that can be targeted by prevention efforts.

Complete home smoking ban survey analysis: an opportunity to improve health equity among sexual minority adults in California, USA.

BACKGROUND: Increasing the proportion of adults living in smoke-free homes is a US Healthy People 2020 objective. Complete home smoking bans are associated with higher odds of smoking cessation attempts and cessation duration. Sexual minority adults have disproportionality higher rates of smoking. This study investigates correlates of having a complete home smoking ban among sexual minority adults in California. METHODS: Secondary data analyses of the California Behavioral Risk Factor Surveillance System (CA BRFSS), 2014-2016. The CA BRFSS telephone survey of adults was conducted in English and Spanish and used random digit dial for landline and cell numbers. Weighted descriptives were stratified by sexual orientation and biological sex. Weighted bivariate and multivariable logistic regression analyses included only sexual minorities (i.e., lesbian, gay, bisexual) and were analyzed as a group and separately by biological sex to account for intragroup variances. The final weighted total of sexual minority adults (N = 359,236) included sexual minority adult females (N = 163,490) and sexual minority adult males (N = 195,746). RESULTS: Sexual minority adults in California had a lower prevalence of complete home smoking bans (Female 76.2%; Male 75.7%), higher prevalence of current cigarette smoking (Female 23.3%; Male 17.4%) and of e-cigarette use (Female 5.8%; Male 6.4%) than their straight counterparts. Sexual minorities that smoke everyday (Female Adjusted Odds Ratio (AOR) 0.26, 95% Confidence Interval (CI) 0.11-0.63; Male AOR 0.24, 95% CI 0.01-0.56) or some days (Female AOR 0.28, 95% CI 0.09-0.90) had lower adjusted odds of having a complete home smoking ban compared to those who never smoked. CONCLUSIONS: Smoking everyday was the only consistent predictor of not having a complete home smoking ban among sexual minority adults. Focused efforts to increase prevalence of complete home smoking bans should address smoking status to improve health equity among sexual minority adults.

Relational victimization and peer affiliate prosocial behaviors in African American adolescents: Moderating effects of gender and antisocial behavior.

INTRODUCTION: Experiencing relational victimization (e.g., peer exclusion, untrue rumors) during adolescence can have negative social-emotional consequences, including increased antisocial behavior and substance use. The negative impact of relational victimization may be lessened by spending time with supportive, prosocial peers. METHODS: This study examined the concurrent and predictive associations between relational victimization and peer affiliates' prosocial behaviors in 244 predominately African American adolescents (ages 13-14) living in U.S. urban neighborhoods. Questionnaires were collected every six months for two years. Overt victimization was controlled for in the analysis and the moderation of gender and antisocial behaviors were tested. RESULTS: Peer affiliates' prosocial behavior was stable across the two years. Relational victimization was not associated with peers' prosocial behavior at baseline or across time. Gender did not moderate the association between relational victimization and peers' prosocial behavior. Moderating effects were found for antisocial behavior; relational victimization was positively associated with peer affiliates' prosocial behavior but only for adolescents who were low on antisocial behavior at baseline. CONCLUSIONS: For African American youth, efforts to reduce relational aggression and increase peer support in prosocial activities prior to adolescence may be useful for preventing social-emotional problems.

School, Friends, and Substance Use: Gender Differences on the Influence of Attitudes Toward School and Close Friend Networks on Cannabis Involvement.

The school environment is extremely salient in young adolescents' lives. Adolescents who have unfavorable attitudes toward school and teachers are at elevated risk for dropping out of school and engaging in behavioral health risks. Peer network health-a summation of the positive and negative behaviors in which one's close friend group engages-may be one way by which attitudes toward school exert influence on youth substance use. Utilizing a sample of 248 primarily African-American young urban adolescents, we tested a moderated mediation model to determine if the indirect effect of attitude to school on cannabis involvement through peer network health was conditioned on gender. Attitude toward school measured at baseline was the predictor (X), peer network health measured at 6 months was the mediator (M), cannabis involvement (including use, offers to use, and refusals to use) measured at 24 months was the outcome (Y), and gender was the moderator (W). Results indicated that negative attitudes toward school were indirectly associated with increased cannabis involvement through peer network health. This relationship was not moderated by gender. Adolescents in our sample with negative attitudes toward school were more likely to receive more offers to use cannabis and to use cannabis more frequently through the perceived health behaviors of their close friends. Implications from these results point to opportunities to leverage the dynamic associations among school experiences, friends, and cannabis involvement, such as offers and use.

Enhancing Future Health Equity Plans: Insights from an Evaluation of Public Health Equity Resources in Oregon.

Health Equity Action Plans (HEAPs) are a recent strategy employed across health and human services to promote health equity. To inform the development of future HEAPs, as well as to build upon previous initiatives, we evaluated 52 health equity plans and resources from Oregon counties using five criteria: creation date, process orientation, racial equity lens, metrics, and community engagement. When developing future HEAPs, we recommend explicit commitments to collaborate with marginalized communities, to establish measurable goals and defined metrics for assessing progress, to include voices and perspectives of those affected by health inequities, and to detail community strengths, assets, and resources.

Preliminary Program Evaluation of Pocket PE 3-5™, A User-Friendly Digital Application for Teacher Skills Training and Physical Education Activities for Third- to Fifth-Grade Elementary Students.

BACKGROUND: In the United States, many classroom teachers also teach physical education (PE). However, there is a dearth of evidence- and standard-based PE programs designed to support classroom teachers to deliver PE effectively in schools. METHODS: The purpose of this study was to establish proof-of-concept for the Pocket PE 3-5 digital app in school settings with 10 third- to fifth-grade classroom teachers. We assessed fidelity of program implementation, measured via observations of PE quality. Students used wrist-worn heart rate monitors during Pocket PE 3-5 lessons to measure time spent in moderate to vigorous physical activity. Program feasibility was primarily assessed through teacher-reported surveys of usability, satisfaction, and acceptability and exit interviews. RESULTS: Mean PE observation scores were 18.6 (SD = 1.5) on a scale of 5 to 20. On average, students spent 56.7% (SD = 13.1%) of class time engaging in moderate to vigorous physical activity. Mean survey scores, reported on a 5-point scale, were 4.5 (SD = 0.6) for acceptability, 4.8 (SD = 0.4) for usability, and 4.7 (SD = 0.7) for satisfaction. Teachers liked how easy the app was to use but mentioned some technological challenges. CONCLUSIONS: This program evaluation study established the proof-of-concept for the Pocket PE 3-5 elementary school PE program.

A Longitudinal Study of E-Cigarette, Cigarette, and Marijuana Use Sequence in Youth.

Objective: There is evidence linking youth use of electronic (e-) cigarettes to subsequent cigarette and marijuana use, raising public health concerns. We examined the sequence of use of e-cigarettes, conventional cigarettes, and marijuana in a longitudinal sample of adolescents, to determine if use of e-cigarettes often preceded use of other substances. Methods: We collected self-reports from 1123 Oregon adolescents (52% female; 37% Hispanic) longitudinally from 8th to 11th grade (8 total surveys) regarding their lifetime (ever use) and current use (last 30 days) of e-cigarettes, cigarettes, and marijuana. If applicable, students also reported the delivery method of their current marijuana use. Results: Almost 10% of adolescents reported using e-cigarettes prior to use of cigarettes or marijuana, and the majority of these youth initiated use of marijuana, cigarettes, or both by 11th grade. More youth transitioned from e-cigarette use to marijuana use then from e-cigarettes to use of conventional cigarettes. Participants who were co-using e-cigarettes and marijuana in 11th grade had an increased likelihood of consuming marijuana via vaping, dabbing, and edibles, compared to those who were only using marijuana. Discussion: E-cigarettes were often the first substance used in this longitudinal sample, and more of these youth subsequently used marijuana compared to cigarettes. While research has focused on the progression from e-cigarettes to cigarettes in youth, these findings indicate that more attention should be focused on the subsequent initiation of marijuana.

Program Evaluation of Healthy Moves™: A Community-Based Trainer in Residence Professional Development Program to Support Generalist Teachers With Physical Education Instruction.

BACKGROUND: Elementary school teachers are often responsible for teaching physical education to their students, with little formal training in that instruction. This study evaluates a trainer in residence professional development program designed to improve physical education instructional attitudes and practices in elementary school generalist teachers. METHODS: Participants were 139 teachers and 3577 first to fifth grade students at 11 public elementary schools in Oregon. Program evaluation measures included pre- and postteacher surveys on teacher attitudes and practices toward teaching physical education for fidelity, postprogram lesson observations for sustainability, and teacher-reported program barriers to and facilitators of feasibility. A multivariate repeated-measures analysis of covariance test assessed changes in teacher attitudes and practices related to physical education instruction. RESULTS: There were main effects of time observed for teacher encouragement and enthusiasm and physical education teaching practices (F2,127 = 9.68, P < .001, ηp2=.132). Postprogram observations indicated sustained use of activity components and an average of 86% of physical education class time spent with students engaged in moderate to vigorous levels of physical activity. CONCLUSIONS: The trainer in residence community-based approach shows promise as an appropriate professional development strategy for generalist teachers responsible for physical education instruction. However, a longer duration, randomized control trial is needed to determine the efficacy of these programs in promoting student physical education outcomes.

Use of voter registration records to recruit a representative sample.

Research samples are not often compared to broader community samples to evaluate their representativeness, a critical factor in determining the generalizability of study findings. This study evaluated the use of voter-registration records for recruiting a representative sample of community-dwelling, older, and overweight participants for research on improving measures of diet and physical activity. County voter-registration records were used to identify individuals between 45 and 75 years of age and living in the two cities closest to the research lab. The data were collected from July, 2007 through November, 2008. Prospective participants were mailed an introductory letter and opt-out postcard, and received a follow-up recruitment phone call in which they underwent further screening if interested in participating. The representativeness of the final voter-recruited sample (N = 191) was evaluated by comparisons of demographic variables with Behavioral Risk Factor Surveillance System (BRFSS) data at the county and state levels. The voter-recruited sample was only partially comparable to that of the BRFSS sample, with expected differences in variables related to race/ethnicity, the proportion of women, employment status, and educational attainment. Voter-registration records are a relatively low-cost ($75 per participant) method of recruiting a community sample that avoids some biases of other recruitment methods, but may not achieve a fully representative sample.

Long-term cross-over effects of the family check-up prevention program on child and adolescent depression: Integrative data analysis of three randomized trials.

OBJECTIVE: The present study examined prevention effects of the family check-up (FCU) prevention program on longitudinal changes in youth depression, using harmonized data collected across three prevention trials, including one trial initiated in early childhood and two initiated in early adolescence (total N = 2,322). METHOD: Data from parent and youth reports of youth depression were harmonized using Moderated Nonlinear Factor Analysis (MNLFA), which provides a robust means to examine differential item functioning (DIF) across subgroups of participants (e.g., age groups, ethnic groups), and creates scale scores based on all available items while accounting for individual differences. Long-term intervention effects were tested using a multi-informant growth model examining changes in depression from baseline to up to 14-year postbaseline. RESULTS: Across trials, significant long-term effects of the FCU on reductions in depression were observed, although effects were found to wane after approximately 10 years. CONCLUSION: FCU effects on depression across trials were attained with a relatively brief parenting program designed to reduce behavior problems and improve relational functioning that emphasized parental motivation to change while supporting positive parenting strategies. Implications of these results are discussed, along with directions for future work in this area. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A public health framework for the regulation of marketing.

Cross-sectional, longitudinal, and experimental studies have found a link between youth exposure to cigarette marketing and youth initiation of smoking. These decisive research findings led to regulations of cigarette marketing to youth-including no television or radio ads, prohibitions on the use of cartoons, bans on transit and billboard advertisements, and disallowing tobacco brand sponsorships of sporting events or concerts. Similar products that may cause more harm than benefits include alcohol, electronic cigarettes, and opioids. We review the evidence linking problematic use of these products with exposure to marketing and discuss standards for assessing the potential harmfulness of marketing. We next address how public health agencies might apply regulatory principles to these harmful products similar to those applied to cigarette advertising, in the advancement of public health.

Associations between marijuana use and anxious mood lability during adolescence.

OBJECTIVE: To date, research investigating the association between adolescent marijuana use and anxiety is mixed, given differences in how anxiety is measured and the age ranges studied. The research is further limited as many relevant studies have small sample sizes. This investigation examines the association between marijuana use (use in the past 30 days) and anxious mood lability (rapid fluctuation in emotional states) during early adolescence (average age 14.4, spring of 8th grade) through midadolescence (10th grade). METHODS: Participating adolescents (N = 466; 52.8% female) were from rural and suburban communities and 38% were Hispanic/Latino. Ecological Momentary Assessment (EMA) was used to measure adolescents' anxious mood in real time; the EMAs were collected within 30 days of the adolescent report of their marijuana use. RESULTS: Multilevel models with measurement waves (7 time points) nested in individuals showed that anxious mood lability was significantly higher for adolescents reporting recent marijuana use compared to those reporting no recent marijuana use. Although females were higher than males in anxious mood lability, the association between anxious mood lability and recent marijuana use did not differ by gender. Post hoc analysis showed that the associations between anxious mood lability and recent marijuana use did not differ between assessments conducted pre and post legalization of adult recreational marijuana use. CONCLUSIONS: The association between recent marijuana use and anxious mood lability for youth is important for understanding the developmental processes of cannabis use and anxious mood disorders in adolescence and young adulthood.

Friend Selection and Influence Effects for First Heavy Drinking Episode in Adolescence.

OBJECTIVE: Heavy alcohol consumption has both immediate and longer-term risks for adolescents. Using a dynamic network modeling approach, this study investigated the role of adult supervision and affiliation with heavy drinking friends in predicting the risk of a first heavy drinking episode in a community sample of adolescents. METHOD: Two cohorts of ninth grade youth (n = 1,220, 48% male) from seven communities were surveyed three times over the course of the school year (fall, winter, and spring), each time assessing their friendship networks, whether they had ever experienced a heavy drinking episode, frequency of heavy drinking over the past month, and the amount of unsupervised time spent with each of their friends over the past month. RESULTS: Participants were more likely to form friendships with classmates with similar recent heavy drinking behavior, but similarity on adult supervision of time spent with friends had no effect on friendship selection. A negative interaction was observed between these two similarity effects, implying that they were antisynergistic. Risk for a first heavy drinking episode was greater for youth with friends who had experienced such an episode already. This effect was no stronger if these friends had more such episodes in the previous 30 days but was marginally stronger if the friends reported less adult supervision. CONCLUSIONS: Heavy drinking-related friendships increase the risk of a first heavy drinking episode. Adult supervision of time spent with friends may reduce this risk. Results support interventions that target the spread of heavy drinking through adolescent social ecosystems, in addition to targeting the most at-risk individuals.