"Just another thing for me to stress off of": Responses to unintentional fentanyl use in a community-based study of people who use opioids.

The unintentional consumption of fentanyl is a serious health risk for people who use illicit drugs. In an ongoing community-based study regarding polysubstance use among people who use opioids, we found that 17 of 58 (29%) of participants who did not endorse fentanyl use in the past thirty days tested positive for fentanyl during point-of-care urinalysis (UA). This paper describes the reactions and experiences of participants who were informed they had consumed fentanyl unintentionally, as well as how the research team handled the unanticipated occurrence of discordant results. Consistent with other recent studies, we found that people learning of unintentional fentanyl use expressed strong concerns about accidental overdose. It was common for participants to reflect on recent substance use experiences that were atypical and might have involved fentanyl, as well as to examine sources of recent drug purchases. While not all participants were surprised that they had unintentionally consumed fentanyl, all felt that learning their positive results was important due to risk of overdose. Research and medical staff have an opportunity to promote awareness of possible contamination by sharing and discussing UA test results with people who use drugs in non-judgmental manner. In addition to the widely promoted harm reduction strategy of testing drugs with fentanyl test strips, self-administered point-of-care UA, particularly after an unexpected reaction to using a drug, could provide useful information for people buying and using illicit drugs.

Importance of Digital Communication in Adolescents' Development: Theoretical and Empirical Advancements in the Last Decade.

The past decade saw a sharp increase in the use of smartphones and digital communication platforms. This manuscript reviews advancements in the study of digital communication and adolescent development over the last decade. We highlight theoretical models that seek to explain the power of digital media in adolescents' lives. We then examine research conducted over the last decade on five aspects of digital media: (1) potential to contribute to adolescent development, (2) associations with mental health, (3) differential impact of active versus passive social media use, (4) cyberbullying, and (5) sexting. We conclude with a discussion of potential opportunities and challenges for studying the role of digital communication in adolescents' development during the coming decade.

Does Adolescent Digital Technology Use Detract from the Parent-Adolescent Relationship?

A population-representative sample of young adolescents (N = 2,104, mean age 12.4) reported on digital technology use and relationships in 2015. A subsample (N = 388) completed a 14-day ecological momentary assessment in 2016-2017 via mobile phone. Across the 2,104 adolescents, those who reported more social networking site engagement were more likely to live in families characterized by more family chaos and to report that their online experiences resulted in problems with their parents. However, when the subsample of adolescents was followed daily, there was little consistent evidence that adolescents' quantity of daily digital technology use detracted from the amount of time they spend interacting with close others (including parents) nor that adolescent daily technology use was associated with more negative or less positive parent-adolescent interactions.

Young Adolescents' Digital Technology Use, Perceived Impairments, and Well-Being in a Representative Sample.

OBJECTIVE: To examine the cross-sectional associations between young adolescents' access, use, and perceived impairments related to digital technologies and their academic, psychological, and physical well-being. STUDY DESIGN: There were 2104 adolescents (ages 10-15 years), representative of the North Carolina Public School population, who completed questionnaires in 2015. Administrative educational records were linked with parental consent. RESULTS: Nearly all young adolescents (95%) had Internet access, 67% owned a mobile phone, and 68% had a social media account. Mobile phone ownership was not associated with any indicators of well-being (math and reading test scores, school belonging, psychological distress, conduct problems, or physical health) after controlling for demographic factors. Having a social media account and frequency of social media use were only robustly associated with conduct problems (explaining ∼3% of the variation in conduct problems). Despite the lack of strong associations, 91% of adolescents reported at least 1 perceived technology-related impairment and 29% of adolescents reported online-to-offline spillover of negative experiences. Economically disadvantaged adolescents reported similar access, but greater online-to-offline spillover and stronger associations between social media account ownership and poor psychological well-being compared with their more affluent peers. CONCLUSIONS: At the population level, there was little evidence that digital technology access and use is negatively associated with young adolescents' well-being. Youth from economically disadvantaged families were equally likely to have access to digital technologies, but were more likely than their more affluent peers to report negative online experiences. Closing the digital divide requires prioritizing equity in experiences and opportunities, as well as in access.

Evaluating the Use of Commercially Available Wearable Wristbands to Capture Adolescents' Daily Sleep Duration.

Commercially available wearable devices are marketed as a means of objectively capturing daily sleep easily and inexpensively outside of the laboratory. Two ecological momentary assessment studies-with 120 older adolescents (aged 18-19) and 395 younger adolescents (aged 10-16)-captured nightly self-reported and wearable (Jawbone) recorded sleep duration. Self-reported and wearable recorded daily sleep duration were moderately correlated (r ~ .50), associations which were stronger on weekdays and among young adolescent boys. Older adolescents self-reported sleep duration closely corresponded with estimates from the wearable device, but younger adolescents reported having an hour more of sleep, on average, compared to device estimates. Self-reported, but not wearable-recorded, sleep duration and quality were consistently associated with daily well-being measures. Suggestions for the integration of commercially available wearable devices into future daily research with adolescents are provided.

Concurrent and Subsequent Associations Between Daily Digital Technology Use and High-Risk Adolescents' Mental Health Symptoms.

Adolescents are spending an unprecedented amount of time using digital technologies (especially mobile technologies), and there are concerns that adolescents' constant connectivity is associated with poor mental health, particularly among at-risk adolescents. Participants included 151 adolescents at risk for mental health problems (Mage  = 13.1) who completed a baseline assessment, 30-day ecological momentary assessment, and 18 month follow-up assessment. Results from multilevel regression models showed that daily reports of both time spent using digital technologies and the number of text messages sent were associated with increased same-day attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) symptoms. Adolescents' reported digital technology usage and text messaging across the ecological momentary assessment (EMA) period was also associated with poorer self-regulation and increases in conduct problem symptoms between the baseline and follow-up assessments.

Understanding polysubstance use at the daily and event levels: protocol for a mixed-methods qualitative and ecological momentary assessment study in a community-based sample of people who use illicit drugs in Oakland, California, USA.

INTRODUCTION: Polysubstance use is extremely common among people who use illicit opioids in the USA. It is associated with poor substance use treatment outcomes, infectious disease risk and alarming rates of drug overdose. Nearly all extant literature examines polysubstance use over broad time frames, such as 30 days or 6 months. However, both substance use and overdose risk are episodic. To build a stronger understanding of polysubstance use and overdose risk, we need to expand the knowledge base to include daily-level and event-level data that examine how substances are used together, in which combinations and in which contexts. The study described in this protocol will use qualitative and ecological momentary assessment (EMA) methods to examine polysubstance use and overdose risk on a daily and event level. METHODS AND ANALYSIS: This is a mixed-methods observational study with three phases. The first phase is formative, consisting of qualitative interviews with people who use multiple substances (N=20), to inform the development of items for the EMA component. The second phase is EMA data collection with people who use multiple substances (N=120), three times daily for 28 days. The third phase consists of mixed-methods inquiries with a subset of participants (N=20), using participant-level EMA data and qualitative techniques to build a nuanced understanding of the motivations and contexts of polysubstance use in everyday life. Analytical induction methods will be used to interpret qualitative data. Hierarchical linear modelling methods will be used to analyse EMA data. ETHICS AND DISSEMINATION: This research has been reviewed and approved by the Institutional Review Board at RTI International (#MOD00001782 for EMA procedures and #MOD00001241 for qualitative procedures). Participants engage in an informed consent procedure for each component of the study. Data will be managed and shared per the National Institutes of Health extramural data sharing policy.

A Longitudinal Investigation of Observed Adolescent Text-Based Sexting and Adjustment.

Despite strong concerns that sexting poses risks for adolescents' well-being, previous research finds mixed results. Moreover, these studies rely heavily on self-report measures and cross-sectional designs. This study utilizes observational methods to examine longitudinal relations between text-based sexting and both negative and positive indicators of psychosocial adjustment. An ethnically diverse sample of 197 adolescents was provided smartphones that captured their text messages across high school, from 2008-2012. Two, two-day samples of text messages from grades 9-12 were content-coded (468,201 total observations). Sexting was defined as sending and receiving text-based statements about past, present, or hypothetical sexual behaviors occurring between dyadic texting partners. Each year, adolescents reported on negative (internalizing, externalizing, and social problems; borderline personality features) and positive (life satisfaction, group belongingness, and positive self-perceptions) indicators of their psychosocial adjustment. Using concurrent and longitudinal multilevel models, greater sexting at one time point than one's average (within-person) was only associated with lower levels of group belongingness within the same year. For girls only, text-based sexting more than others on average (between-person) was related to increased externalizing symptoms and borderline personality disorder features, as well as decreased life satisfaction, group belongingness, self-perceived social competence, and global self-worth. No within-person differences by gender emerged, nor did longitudinal associations. Future studies and intervention efforts should examine when and why higher sexting might be related to psychosocial problems among girls.

Associations Between Adolescents' Daily Digital Technology Use and Sleep.

PURPOSE: Although studies have found associations between greater digital technology use and poorer sleep health among adolescents, these studies typically rely on self-reported sleep and cross-sectional designs. This study applied an ecological momentary assessment design to examine how adolescents' daily digital technology use relates to self-reported sleep and wearable-recorded sleep duration. METHODS: A socioeconomically and ethnically diverse sample of 388 adolescents completed daily surveys of their digital technology use (i.e., messages sent, time for academics, time for leisure) and sleep for 2 weeks. Sleep duration was recorded through wearable devices among a subsample of 254 adolescents for an average of 3.4 days. RESULTS: Adolescents who reported spending more time using digital technology for nonacademic purposes than their peers reported both shorter self-reported sleep duration and later bedtime (between-person associations). Adolescents who sent more messages than their peers also had shorter sleep duration as recorded by wearable devices. In contrast, few associations were observed when comparisons were made within-individuals with adolescents used as their own controls. CONCLUSIONS: Consistent with prior research, adolescents who reported greater nonacademic daily digital technology use relative to their peers exhibited worse sleep outcomes as measured via self-reports and wearable devices. However, associations with sleep outcomes were weak and inconsistent when adolescents were used as their own controls. Future research should continue to explore between- and within-person associations between digital technology use and sleep to understand potential key differences.

"Ur a freakin goddess!": Examining Appearance Commentary on Instagram.

Frequent use of highly visual online platforms such as Instagram may be linked to greater body image concerns. One prominent feature of Instagram is the ability to receive feedback in the form of likes and comments. The goal of this cross-sectional study (conducted in laboratory and online) was to examine college students' receipt of appearance commentary on their most recent Instagram posts, and how this relates to their self-reported body image concerns. The Instagram commentary that 337 students (M age=20.39) received on their posts was observationally coded for positivity and negativity. Receiving positive appearance commentary was common and linked to greater appearance-related social media consciousness, and, weakly, to body surveillance. There were no associations with self-objectification, appearance-contingent self-worth, facial satisfaction, and body dissatisfaction. Negative appearance commentary was not associated with body image concerns. Photos depicting only the self were especially likely to elicit positive appearance commentary. Females received more positive appearance commentary compared to males, whereas males received more negative appearance commentary. Future research should examine long-term effects of receiving appearance comments via Instagram.

Daily Parent-Adolescent Digital Exchanges.

The present study tracked adolescents via mobile phones to describe how parents and their adolescent children are using digital technologies in daily life (i.e. facilitating warmth and behavioral control), and whether these uses are associated with the quality of offline parent-adolescent interactions and with adolescents' mental health. A sample of young adolescents (N = 388; mean age 13.37) completed a 14-day ecological momentary assessment in 2016- 2017, reporting on their daily digital contact and offline interactions with their parents and their mental health. Adolescents reported using texting and calling to communicate somewhat infrequently with their parents (i.e., on 29% of days), but days with more digital contacts (for both warmth and behavioral control) were also more likely to be characterized by more positive offline interactions with parents. Furthermore, adolescents struggling with mental health symptoms across the study period reported using texts/calls more frequently to seek out parent support, and parents were more likely to do text/call "check ins" on young people who were experiencing more behavioral problems. Results highlight the potential for digital communication devices to be used as tools in fostering parent-adolescent connection, support provision, and behavioral control in the digital era.

Associations between Self-Reports and Device-Reports of Social Networking Site Use: An Application of the Truth and Bias Model.

People are generally poor reporters of time spent using digital technology. Advancing smartphone features, such as the iOS Screen Time application, allow researchers to obtain more objective measurements of digital technology use. Truth and Bias models were used to test how self-reported social networking site use aligns with device-reported use as recorded by the iOS Screen Time app (N=1585). This study explored use across four major platforms (Facebook, Instagram, Twitter, Snapchat) and examined how individual differences moderate biases in reports. Participants overestimated their use for all platforms at comparable levels. Moderation by individual differences was not consistent. These findings add to the growing call from researchers to utilize assessments other than self-reports in measuring digital technology use.

Frequency of Text Messaging and Adolescents' Mental Health Symptoms Across 4 Years of High School.

PURPOSE: The aim of the study was to examine the concurrent and longitudinal associations between adolescents' text messaging frequency and mental health symptoms across 4 years of high school. METHODS: A total of 203 adolescents (aged 14-18 years) consented and were provided smartphones across 4 years of high school. Using billing records, daily frequencies of text messaging were created for each year. Adolescents reported on their mental health symptoms (internalizing, externalizing, social problems, and inattention) each summer. RESULTS: Multilevel analyses tested the between- and within-person associations between texting and mental health symptoms. Between-person analyses revealed an association only between externalizing symptoms and texting. Girls who texted more (vs. less) frequently reported more externalizing and inattention symptoms, whereas there were no significant associations for boys. There were no significant within-person concurrent associations between texting and symptoms. Autoregressive latent cross-lagged model with structured residuals testing the longitudinal, bidirectional associations also did not find significant relations across 4 years of adolescence. CONCLUSIONS: Across analyses, few robust associations emerged. Adolescent girls who text messaged more frequently reported greater externalizing and inattention symptoms. Contrasting the popular narrative that smartphones cause depression, this study did not find any consistent within-person or longitudinal associations between texting and mental health symptoms across adolescence. Research on the content, rather than quantity, of texts and device use is necessary to understand the potential effects on development.

Exploring text messaging as a platform for peer socialization of social aggression.

This study examined whether adolescents' social aggression is socialized through exposure to peers' socially aggressive text messaging. Using data on the socially aggressive content of text messages that 221 participants (Mage = 15.02 years; 46.7% female) sent to and received from peers, and teacher ratings of participants' in-person social aggression, this study found that exposure to peers' socially aggressive texting about out-dyad peers predicted positive changes in adolescents' text-based and in-person social aggression. Gender differences were examined, and results were mixed. In ninth grade, girls sent more socially aggressive text messages than boys; however, by 10th grade, these differences disappeared. Gender differences in adolescents' in-person social aggression and their exposure to peers' socially aggressive texting were nonsignificant at both time points. There was no evidence of gender differences in the links between exposure to peers' socially aggressive texting and adolescents' socially aggressive texting. However, marginal differences were found in the associations between exposure to peers' socially aggressive texting and adolescents' in-person social aggression. Results suggest that texting provides an additional platform for peer socialization of adolescents' social aggression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Seven Fears and the Science of How Mobile Technologies May Be Influencing Adolescents in the Digital Age.

Close to 90% of U.S. adolescents now own or have access to a mobile phone, and they are using them frequently. Adolescents send and receive an average of over 60 text messages per day from their devices, and over 90% of adolescents now access the Internet from a mobile device at least occasionally. Many adults are asking how this constant connectivity is influencing adolescents' development. In this article, we examine seven commonly voiced fears about the influence of mobile technologies on adolescents' safety (e.g., cyberbullying and online solicitation), social development (e.g., peer relationships, parent-child relationships, and identity development), cognitive performance, and sleep. Three sets of findings emerge. First, with some notable exceptions (e.g., sleep disruption and new tools for bullying), most online behaviors and threats to well-being are mirrored in the offline world, such that offline factors predict negative online experiences and effects. Second, the effects of mobile technologies are not uniform, in that benefits appear to be conferred for some adolescents (e.g., skill building among shy adolescents), whereas risk is exacerbated among others (e.g., worsening existing mental health problems). Third, experimental and quasi-experimental studies that go beyond a reliance on self-reported information are required to understand how, for whom, and under what conditions adolescents' interactions with mobile technologies influence their still developing social relationships, brains, and bodies.