Sexism and alcohol-related problems among women: The role of social anxiety and coping motivated drinking.

BACKGROUND AND OBJECTIVES: Experiencing sexism is related to more alcohol-related problems, presumably via drinking to cope with negative affect associated with experiencing sexism. Yet no known studies have directly tested whether the relation of sexism to alcohol problems occurs via relevant negative emotions and drinking to cope with negative emotions. Given that sexism is a type of negative evaluation, social anxiety may be one type of negative affect that plays a role in sexism's relation with drinking behaviors. METHOD: This study tested whether sexism was related to alcohol-related problems via the serial effects of social anxiety and coping-motivated alcohol use among 836 cis-female undergraduates who endorsed past-month alcohol use. RESULTS: Past-year experiences with sexism were positively correlated with coping and conformity-motivated alcohol use, alcohol problems (but not peak estimated blood alcohol content, eBAC), social anxiety, and depression. After statistically controlling for depression and peak eBAC, sexism was indirectly related to alcohol problems via the serial effects of social anxiety and drinking motives (coping, conformity). DISCUSSION AND CONCLUSIONS: Results highlight the important role of social anxiety and drinking to cope with negative emotions and to fit in with peers who drink in relation of sexism with alcohol-related problems. SCIENTIFIC SIGNIFICANCE: This is the first known study to find that experiences of sexism are related to alcohol problems via the serial effects of social anxiety and coping and conformity-motivated drinking. This is also the first known study to find that sexism is related to more conformity-motivated drinking.

Social Anxiety and Cannabis-Related Problems: The Serial Roles of Distress Tolerance and Cannabis Use Motives.

Background: Individuals with elevated social anxiety are vulnerable to experiencing negative consequences related to cannabis use. One transdiagnostic vulnerability factor that has received little attention in the social anxiety-cannabis problem relation is distress tolerance, which is associated with more cannabis use to manage negative affect broadly (i.e., coping motives) and cannabis-related problems. However, it is unknown whether distress tolerance is related to greater cannabis use to manage social anxiety specifically (i.e., social anxiety motives). Objectives: This study tested whether the relation between social anxiety and cannabis problems occurred via perceived distress tolerance among 309 (77.3% female) undergraduates who endorsed current (past three-month) cannabis use. Results: Social anxiety was negatively associated with distress tolerance and positively associated with cannabis problems, coping, and social anxiety motives. Social anxiety was indirectly (via distress tolerance) related to more cannabis problems and motives to cope with negative affect generally and to cope with social anxiety specifically. Social anxiety was indirectly related to more cannabis problems via the serial effects of distress tolerance and coping and social anxiety motives. Conclusions: Findings suggest that individuals with elevated social anxiety may be vulnerable to using cannabis to manage negative affect (generally and social anxiety specifically) due to low perceived ability to tolerate psychological distress, which may lead to more cannabis problems. Keywords: cannabis; marijuana; distress tolerance; social anxiety; motives; coping motives.

Cannabis and Nicotine Dual Use among Sexual Minority Individuals: Relations to Cannabis Use and Negative Affect.

Background: Sexual minority individuals report significantly more cannabis use and use-related problems than their heterosexual peers, and emerging data indicate sexual minority individuals who use cannabis are at greater risk for dual use of nicotine products (combustible smoking, e-cigarette use) than heterosexual individuals. Although cannabis-nicotine dual use is related to worse cannabis outcomes and negative affect, little work has identified factors related to dual use among sexual minority individuals or tested if sexual orientation-based discrimination (microaggressions, overt discrimination) is related to dual use. Objectives: The current study tested if cannabis-nicotine dual use is related to more frequent cannabis use, more cannabis-related problems, negative affect, and discrimination among sexual minority undergraduate students who endorsed current (past three-month) cannabis use (N = 328), 43.6% of whom endorsed dual nicotine use. Cannabis-nicotine dual use was related to more frequent cannabis use, more cannabis-related problems, more anxiety (but not depression), and more sexual orientation-based microaggressions and microaggressions-related negative affect (but not overt discrimination or non-sexual orientation-based daily stressors). Conclusions/Importance: Overall, this is the first known study to identify that sexual orientation-based discrimination is related to cannabis-nicotine dual use and that dual use is related to more frequent cannabis use, use-related problems, and negative affect (especially anxiety) among this underrepresented group.

Social Anxiety and Alcohol Use and Related Problems among Black Adults: Differential Roles of Motives by Sex.

Background: Black individuals who consume alcohol are at risk of experiencing alcohol-related problems. Psycho-sociocultural models of substance use posit that these individuals may continue to drink despite alcohol-related problems to cope with psychological distress. Emerging data indicate that social anxiety is one type of distress that may play an important role in drinking behavior among Black adults. Objectives: Yet despite evidence that drinking to cope varies as a function of sex among predominantly White samples, this is the first known study to test whether socially anxious Black women are similarly at risk for coping motivated drinking and its negative sequelae. Participants were 257 (75% female) Black undergraduates endorsing current alcohol use. Results: Among women and men, social anxiety was significantly related to more alcoholrelated problems and coping-depression and conformity motives. Among women (but not men), social anxiety was also significantly related to more coping-anxiety and greater typical drinking. Serial mediation analyses among women indicated that social anxiety was indirectly related to more alcohol problems via the serial effect of each of the relevant drinking motives (copinganxiety, coping-depression, conformity) and drinking frequency. Among men, social anxiety was indirectly related to alcohol problems via coping-depression and conformity motives. Conclusions/Importance: Findings highlight the importance of considering sex in research on psychosocial vulnerability factors associated with alcohol-related problems among Black adults.

False safety behavior use among Black adults.

Anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to anxiety in predominantly White samples are related to anxiety among Black individuals. Yet, given less mental health service utilization and greater experience of some life stressors, Black persons may be especially at risk for using false safety behaviors (FSB; designed to decrease anxiety in the short term, but are associated with more longer-term mental health problems). We tested whether non-Hispanic/Latin Black persons (n = 133) reported greater FSB use than non-Hispanic/Latin White participants (n = 844) as well as whether FSB use was related to more mental health problems among Black participants. Data were collected online among undergraduates. Black participants did endorse more frequent FSB use, especially FSB-Avoidance and FSB-Body Sensations. Results indicate that among Black participants, FSB use was related to more anxiety, depression, and suicidal thoughts and behaviors. FSB may be an important behavioral vulnerability factor related to anxiety and associated mental health problems among Black young adults.

Substance Misuse among a Diverse Psychiatric Inpatient Sample: Suicidal Thoughts and Behaviors and Motivation to Change.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Biopsychosocial Model Social Anxiety and Substance Use Revised.

PURPOSE OF REVIEW: To review data published in the past 5 years to evaluate the utility of our biopsychosocial model of social anxiety's relation to substance misuse to evaluate the model's utility and update it. RECENT FINDINGS: Data support the utility of our revised model-e.g., socially anxious persons report using substances to manage subjective anxiety, despite evidence that some substances may not have a direct effect on physiological responding. Other factors with promise include social influence, cognitive processes (e.g., post-event processing), and avoidance. Data highlight the importance of context as socially anxious persons use some substances more in some high-risk situations, despite lack of relation between social anxiety and use generally. Sociocultural factors remain understudied. This updated model is a theory- and data-driven model of the relations between social anxiety and substance misuse that can inform future work to improve substance-related outcomes among this especially vulnerable group.

Functional Impairment in Response to the COVID-19 Pandemic among Cannabis Users.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has contributed to over 2 million deaths and hospitalization of many individuals worldwide. Although preliminary evidence suggests that cannabis use has increased during the pandemic, there has been little research on the impact of cannabis use on COVID-related psychological outcomes. Cannabis use among college students is associated with problematic psychosocial outcomes; thus, it follows that cannabis users during the pandemic may experience more functional impairment problems with daily living as a result of increased psychological distress from the pandemic and difficulty with regulating that distress. METHODS: The current study tested whether cannabis use status was related to functional impairment in daily activities and whether this was due to difficulty with emotion regulation and COVID-related distress. The sample comprised of 727 (184 current cannabis users) young adults in Louisiana, a state that had some of the highest rates of COVID-19 deaths and infections in the U.S. RESULTS: Cannabis use was related to greater functional impairment in daily activities and this relation was mediated by the sequential effects of difficulty with emotion regulation and COVID-related distress. CONCLUSIONS: Results indicated that cannabis users during the COVID-19 pandemic are experiencing problematic psychosocial outcomes further highlighting the need for the development of interventions to help target COVID-related distress and improve psychosocial functioning during the pandemic.

Difficulties with emotion regulation and drinking during the COVID-19 pandemic among undergraduates: the serial mediation of COVID-related distress and drinking to cope with the pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has contributed to thousands of hospitalizations and deaths worldwide. Although alcohol use has increased in response to the pandemic, no known studies have identified transdiagnostic risk factors for greater drinking in response to COVID-related distress. Individuals with more difficulty with emotion regulation may drink more during the pandemic to manage pandemic-related distress. The current study tested whether difficulty with emotion regulation was related to greater estimated blood alcohol content (eBAC) during a typical week in the past month and if this was due to COVID-related distress and drinking to cope with the pandemic. The sample consisted of 347 past-month drinking undergraduates in Louisiana, a state with some of the U.S. highest rates of COVID-19 infections and related deaths. Difficulty with engaging in goal-directed behaviors was related to greater past-month eBAC and this relation was mediated by the sequential effects of COVID-related worry and drinking to cope with the pandemic. Results indicate that individuals with difficulty engaging in goal-directed behaviors are especially vulnerable to greater eBAC during the COVID-19 pandemic which may be due in part to their vulnerability to more COVID-related worry which may lead to more drinking to cope with the pandemic.

Sexual orientation-based microaggressions and cannabis use outcomes among sexual minority individuals: The impact of negative affect and coping-motivated cannabis use.

INTRODUCTION: Sexual minority individuals report significantly more cannabis use and problems than their heterosexual peers, possibly due to their frequent experiences with sexual orientation-based microaggressions. As a result, sexual minority individuals may turn to cannabis use to cope with the negative affect associated with these experiences. No known studies have tested this hypothesis; therefore, the current study tested if sexual orientation microaggressions are positively associated with negative affect (anxiety and depression), cannabis coping motives, and cannabis-related outcomes (frequency, problems); if coping motives are positively associated with cannabis-related outcomes; and if negative affect and cannabis use to cope with negative affect serially mediate the relation between sexual orientation microaggressions and cannabis-related outcomes. METHODS: Sexual minority undergraduate students who reported cannabis use in the past three months (N = 328; 71.3 % cis-female) completed an online survey. RESULTS: Microaggressions were significantly positively correlated with anxiety, depression, coping-motivated cannabis use, cannabis-related problems, non-sexual orientation-related stress, and overt sexual orientation-based discrimination. Additionally, after controlling for non-sexual orientation-related stress and overt sexual orientation-based discrimination, microaggressions were indirectly positively related to cannabis use frequency and problems via the sequential effects of negative affect and coping motives. This relation remained significant when examining negative affect specific to sexual orientation microaggressions and cannabis use to cope with this microaggressions-specific negative affect. CONCLUSIONS: Results highlight the adverse impact of sexual orientation microaggressions in terms of negative affect and negative cannabis-related outcomes.

Cannabis-related problems and social anxiety: The roles of sex and cannabis use motives updated.

Individuals with elevated social anxiety are particularly susceptible to cannabis problems, and sex differences in factors underlying this relation have been identified - e.g., among those with elevated social anxiety, men may use cannabis to cope with negative affect (NA) generally whereas women may use to cope with social anxiety specifically. This study examined the relations between social anxiety and cannabis-related behaviors by sex among 401 (75.3% female) undergraduates who endorsed past-month cannabis use. Among both sexes, social anxiety was related to more cannabis problems and coping (to decrease NA generally) and social anxiety (to manage NA in social situations) motives. Among men (not women), social anxiety was related to less frequent cannabis use and more conformity (to fit in with others) motives. Among women (not men), social anxiety was related to more enjoyment, experimentation, boredom alleviation, altered perceptions (to modulate perceptual experiences), and relatively low risk (perceived low risk) motives. The relation between social anxiety and cannabis problems occurred indirectly via coping motives for both sexes, and among men (not women) via conformity motives. Among women (not men), social anxiety was indirectly related to cannabis problems via enjoyment, experimentation, boredom, altered perceptions, and social anxiety motives. Findings suggest that among those with elevated social anxiety, men and women appear to use cannabis for different reasons, and that these reasons may play different roles in cannabis problem risk among men and women. Data highlight the importance of considering sex in efforts to understand the role of social anxiety in cannabis-related behaviors.

Sexual orientation and cannabis outcomes among Black Individuals: The role of cannabis use motives.

Sexual minority individuals report greater cannabis use and cannabis use related problems relative to straight individuals. Although sociocultural models suggest that sexual minority individuals may be especially vulnerable to using cannabis for high-risk motives such as coping motives, little attention has been paid to the role of cannabis use motives among sexual minority relative to straight individuals. Thus, the current study examined the role of cannabis use motives and cannabis-related problems among Black sexual minority and straight individuals that reported current (past 3-month) cannabis use (N = 137, 28.5 % of whom identify as sexual minority). Sexual minority participants endorsed more frequent cannabis use, and social, coping, enhancement, and expansion motives than straight participants. Conformity motives were not significantly related to sexual minority status. Multiple mediation model with all relevant motives included as putative mediators indicated that sexual minority status was related to cannabis problems indirectly via the effects of coping and expansion motives. Alternative models strengthen confidence in the directionality of these effects, although future prospective research will be an important next step. Findings may help inform treatment efforts among sexual minority individuals to reduce risk of negative cannabis outcomes.

Group Cognitive Behavioral Therapy for Substance Use Disorders Among Psychiatric Inpatients in a Medically Underserved Area: An Intervention for Opioid Misuse.

OBJECTIVES: Opioid misuse is a serious public health concern, yet few people seek treatment for this condition. Hospitals may be one opportunity to identify those with opioid misuse and to teach them skills to help manage their opioid misuse upon discharge. We tested the relationship between opioid misuse status and motivation to change substance use among patients admitted with substance misuse to an inpatient psychiatric unit in a medically underserved area in Baton Rouge, Louisiana, who attended at least 1 group session of motivation enhancement therapy combined with cognitive behavioral therapy (MET-CBT) from January 29, 2020, through March 10, 2022. METHODS: Of the 419 patients in our sample, 86 (20.5%) appeared to misuse opioids (62.5% male; mean age, 35.0 y; 57.7% non-Hispanic/Latin White). At the beginning of each session, patients completed 2 measures of motivation-importance and confidence to change substance use-from 0 (not at all) to 10 (most). At the end of each session, patients rated perceived session helpfulness from 1 (extremely hindering) to 9 (extremely helpful). RESULTS: Opioid misuse was associated with greater importance (Cohen d = 0.12) and confidence (Cohen d = 0.13) to change substance use and with attending more MET-CBT sessions (Cohen d = 0.13). Patients with opioid misuse rated sessions as highly helpful (score of 8.3 of 9), and these ratings did not differ from patients who used other substances. CONCLUSIONS: Inpatient psychiatry hospitalizations may provide an opportunity to identify patients with opioid misuse and introduce these patients to MET-CBT to learn skills to manage opioid misuse upon discharge.

Development and initial psychometric properties of the Cannabidiol Outcome Expectancies Questionnaire (CBD-OEQ).

Cannabidiol (CBD), a nonpsychoactive cannabinoid, is used by many individuals to treat medical and mental health conditions, despite limited support for the efficacy of CBD for these conditions. Identification of CBD-related outcome expectancies (i.e., beliefs concerning the anticipated effects of CBD) could be useful in understanding the etiology and maintenance of CBD use and/or be useful in administration or clinical trial research. Although there are several measures of cannabis outcome expectancies, cannabis comprises several active compounds (e.g., tetrahydrocannabinol [THC], CBD). Thus, cannabis outcome expectancies may not reflect CBD-specific outcome expectancies. Yet, no known CBD-specific outcome expectancy measure exists. The present study used a three-phase, mixed-methods approach to develop and test the psychometric properties of the Cannabidiol Outcome Expectancy Questionnaire (CBD-OEQ). The CBD-OEQ assessed endorsement (i.e., how much an individual agrees/disagrees with an expected outcome) and desirability ratings (i.e., how desirable an expected outcome is). The initial item pool was administered to 600 adults who endorsed having heard of or using CBD products. Factor analyses supported a 60-item, six-factor structure. There was an initial support for internal consistency and convergent, discriminant, and incremental validity of the CBD-OEQ subscale scores in the present sample. Desirability ratings explained minimal additional variance in CBD variables for most subscales, but moderated the relationship between endorsement ratings and use behaviors for Global Negative Effects and No Effect subscales. The newly developed CBD-OEQ could be used as both a research and a clinical tool. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ethnic-racial identity and hazardous drinking among black drinkers: A test of the minority stress model.

Black Americans who consume alcohol experience negative alcohol-related outcomes, indicating a need to identify psycho-sociocultural factors that may play a role in drinking and related problems to inform prevention and treatment. Although lower levels of ethnic-racial identity (ERI) are related to negative drinking outcomes, this is the first known test of whether psychological distress and drinking to cope with distress play a role in these relations. Participants were 155 Black current drinking undergraduates at a racially/ethnically diverse university. ERI was significantly, negatively correlated with drinking frequency, drinking problems, coping motivated drinking, depression, and social anxiety. ERI was unrelated to drinking quantity. ERI was indirectly related to drinking and related problems via the sequential effects of depression and coping motivated drinking, but not via depression or coping motives alone. ERI was indirectly related to drinking via the sequential effects of social anxiety and coping motivated drinking, and indirectly related to drinking problems via social anxiety but not via coping motives alone. In line with minority stress-based models, ERI is related to less negative drinking outcomes (less frequent drinking, fewer problems) via less psychological distress (depression, social anxiety) and less coping motivated drinking. Also, social anxiety was robustly related to drinking frequency and problems among Black drinkers, a group that has been underrepresented in the social anxiety-drinking literature. This finding indicates that anxiety about social situations may play an especially important role in drinking behaviors in this group.

Do financial incentives increase mental health treatment engagement? A meta-analysis.

OBJECTIVE: Engagement in mental health treatment is low, which can lead to poor outcomes. We evaluated the efficacy of offering patients financial incentives to increase their mental health treatment engagement, also referred to as contingency management. METHOD: We meta-analyzed studies offering financial incentives for mental health treatment engagement, including increasing treatment attendance, medication adherence, and treatment goal completion. Analyses were run within a multilevel framework. All study designs were included, and sensitivity analyses were run including only randomized and high-quality studies. RESULTS: About 80% of interventions incentivized treatment for substance use disorders. Financial incentives significantly increased treatment attendance (Hedges' g = 0.49, [0.33, 0.64], k = 30, I2 = 83.14), medication adherence (Hedges' g = 0.95, [0.47, 1.44], k = 6, I2 = 87.73), and treatment goal completion (Hedges' g = 0.61, [0.22, 0.99], k = 5, I2 = 60.55), including completing homework, signing treatment plans, and reducing problematic behavior. CONCLUSIONS: Financial incentives increase treatment engagement with medium to large effect sizes. We provide strong evidence for their effectiveness in increasing substance use treatment engagement and preliminary evidence for their effectiveness in increasing treatment engagement for other mental health disorders. Future research should prioritize testing the efficacy of incentivizing treatment engagement for mental health disorders aside from substance use. Research must also identify ways to incentivize treatment engagement that improve functioning and long-term outcomes and address ethical and systemic barriers to implementing these interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Integrated cognitive-behavioral therapy for comorbid cannabis use and anxiety disorders: The impact of severity of cannabis use.

Cannabis use disorder (CUD) is the most common illicit substance use disorder and individuals with CUD have high rates of comorbid anxiety disorders. Comorbidity between CUD and anxiety disorders is of public health relevance given that although motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for CUD, outcomes are worse for patients with elevated anxiety. Integrated cannabis and anxiety reduction treatment (ICART) was developed based on translational research; it integrates a transdiagnostic CBT for anxiety disorders with MET/cognitive behavior therapy (MET-CBT) for CUD, with outcomes comparable to MET-CBT alone. The current study tested whether ICART is more efficacious than MET-CBT alone for patients with more severe baseline cannabis use and use-related problems. Individuals seeking treatment for CUD (56.4% male, Mage = 23.2, 63.3% non-Hispanic White) with at least one comorbid anxiety disorder were randomly assigned to ICART (n = 27) or MET-CBT (n = 28). Baseline severity of cannabis use and use-related problems moderated the relation between condition and posttreatment outcomes, such that among patients with the greatest baseline cannabis use, ICART was associated with less posttreatment cannabis use than MET-CBT alone. Further, among those with the greatest number of cannabis-related problems, patients in ICART reported fewer posttreatment problems than those in the MET-CBT alone condition. These data suggest that for dually diagnosed patients with more severe cannabis use, ICART may be more efficacious than a gold-standard psychosocial CUD treatment, MET-CBT. MET-CBT may be more efficacious for those with less baseline cannabis use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Social anxiety and risky Marijuana use: The role of underutilization of protective behavioral strategies.

Social anxiety is a common mental health problem that increases the risk of experiencing cannabis-related problems. In fact, social anxiety more than quadruples the risk of developing cannabis use disorder, yet it is inconsistently related to more cannabis use. Inconsistent findings may be due to lack of attention to protective behavioral strategies (PBS) among socially anxious cannabis users. PBS are cognitive-behavioral strategies to reduce cannabis use and related problems. Yet socially anxious persons may be less likely to use PBS for a variety of reasons (e.g., fear of negative evaluation for engaging in behaviors to reduce use), leading to heavier or more frequent use and related problems. The current study examined the mediating role of PBS in the relationships of social anxiety with past-month cannabis use and related problems among current (past-month) cannabis users (N = 102). Social anxiety was significantly positively related to past-month cannabis problems, but not directly related to cannabis use. Social anxiety was significantly negatively related to PBS. Social anxiety was indirectly (via PBS) related to more frequent use, greater peak use, and more cannabis problems. Serial mediation analyses indicated that social anxiety was indirectly related to more cannabis problems via the serial effects of PBS and cannabis use variables. Findings suggest that socially anxious persons may be vulnerable to heavier cannabis use and more cannabis problems due to PBS underutilization. Treatment implications are discussed.

Cannabis use and electronic cigarette use: The role of dual use on use frequency and related problems.

Despite high rates of use of both cannabis and electronic nicotine delivery systems (ENDS), little is known about the role of cannabis use among ENDS users and of ENDS use among cannabis users. This study tested whether dual use was related to more frequent use, use-related problems, and negative affect. Among cannabis users (n=315), ENDS was associated with more frequent cannabis use, cannabis-related problems, anxiety, and depression. Among ENDS users (n=156), cannabis was associated with more frequent ENDS use, ENDS-related problems, and anxiety. Overall, ENDS use is common among cannabis users and cannabis use is common among ENDS users. Further, use of both of these substances is related to more use, use-related problems, and negative affect, especially anxiety.

E-cigarettes use prior to smoking combustible cigarettes among dual users: The roles of social anxiety and E-cigarette outcome expectancies.

E-cigarette use is prevalent, and rates of use continue to increase. Although e-cigarettes are often used to help combustible users quit or reduce smoking, some use e-cigarettes in the absence of combustible cigarettes, increasing risk for smoking combustible cigarettes. Yet, little research has examined individual vulnerability factors implicated in transitioning from exclusive e-cigarettes use to dual use of combustible cigarettes. Social anxiety may be one such factor given it is related to a variety of negative smoking-related outcomes. Thus, the current study tested whether social anxiety was related to using e-cigarettes before smoking combustibles among 226 current undergraduate dual users (use both e-cigarettes and combustible cigarettes). Most dual users reported initiating with e-cigarettes (67%). Those who initiated with e-cigarettes reported statistically significantly greater negative reinforcement (d = 0.59) and weight control expectancies (d = 0.37) and greater social anxiety (d = 0.37) than those who initiated with combustibles. Social anxiety was indirectly related to e-cigarette initiation via negative and weight control expectancies. Findings add to a growing literature that dual users initiated with e-cigarettes and extend understanding of this phenomenon by identifying that socially anxious persons may be especially vulnerable to doing so, at least partially due to expectations regarding e-cigarette's ability to manage negative affect and/or weight.