Trends of major depressive episode among people with cannabis use: Findings from the National Survey on Drug Use and Health 2006–2015

Background: A dose-response association, suggesting that heavy cannabis users are more likely to report depressive disorders, has been hypothesized. However, evidence is not conclusive, and we aimed at testing the existence of a linear association between different levels of cannabis use and depressive disorders using large, representative, repeated surveys. Methods: We examined prevalence rates of different levels of past-year cannabis use and major depressive episode (MDE), separately for young people (12–17 years) and adults (18–64 years), using data between 2006 and 2015 from the National Survey on Drug Use and Health. Prevalence rates estimates with 95% confidence intervals were computed, and the association between past-year MDE and cannabis use was assessed. We then investigated whether time-period trends existed for MDE and, if so, whether these differed by cannabis use levels. Models included both time period, to evaluate trend changes in past-year MDE from 2006 to 2015, and time period by cannabis level interaction terms. Results: Cannabis users were more likely, using both single-year and pooled survey data, to have suffered from MDE in the past year. Multiple logistic regression models, after adjusting for time period, age, and gender, showed an association between MDE and cannabis use, regardless of its levels. However, a roughly dose-response relationship was detectable only for adults. Trends in past-year MDE prevalence rates among subjects with different levels of cannabis use did not differ from trends among nonusers. Women were more likely to report concurrent past-year MDE and cannabis use than men. Conclusions: Cannabis users have consistently higher prevalence rates of depressive disorders compared with nonusers, suggesting the need for integrated screening and treatment programs to tackle this comorbid condition.     

Trends in adolescent alcohol use in the Netherlands, 1992–2015: Differences across sociodemographic groups and links with strict parental rule-setting

BackgroundFrom an international perspective, studying trends in adolescent alcohol use in the Netherlands is an important case study. Whereas Dutch adolescents topped the international rankings of alcohol consumption in the beginning of this century, they are nowadays found more toward the bottom of these rankings. This study examines time trends in adolescent alcohol use between 1992 and 2015, and tests whether these trends differ according to gender, age group, and educational track. Moreover, it examines to what extent the strictness of parental rule-setting can explain the identified trends.MethodsUsing data from ten waves of two nationally representative studies with a repeated cross-sectional design, trends were examined for eight different alcohol measures. Interaction analyses were conducted to test for subgroup differences. All analyses were controlled for educational track, family structure, and ethnicity. For the period 2007–2015, trends in parental alcohol-specific rule-setting were included as a predictor of the trends in adolescent alcohol use.ResultsAdolescent alcohol use increased substantially between 1992 and 2003, and decreased sharply thereafter. Trends were stronger for 12- to 15-year olds, compared to the 16-year olds, and for adolescents attending higher educational tracks, compared to adolescents attending lower educational tracks. Overall, gender differences remained constant over time. Between 2007 and 2015, strict parental alcohol-specific rule-setting increased substantially, and this (partly) explained the strong decline in adolescent alcohol use during this period.ConclusionThis study shows clear time trend changes in alcohol use among Dutch adolescents. The phenomenal decrease in adolescent alcohol use since 2003 appears to be closely related to a radical change in parenting behaviours surrounding the alcohol use of their children. While national prevention programs may have encouraged stricter parenting behaviours, the decline in alcohol use should be interpreted in a broader context of internationally changing sociocultural norms regarding adolescent alcohol use.     

Abstention from Drug Use and Delinquency Increasing among Youth in the United States, 2002–2014

Background: Trends in abstaining from substance use and delinquency among adolescent's ages 12–17 in the United States was examined. Methods: Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic white, African American, and Hispanic respondents (n = 98,620) and spanning the years 2002–2014. Logistic regression was used to examine significance of trend year and correlates of low-risk and high-risk behavioral groups relative to abstaining. Results: Overall, the prevalence of abstaining was 47.56% between 2002 and 2014. Prevalence increased significantly among all adolescents from 44.85% in 2002 to 53.58% in 2014. Relative to abstainers nonabstaining youth were more likely to be male, and report lower household income, poorer grades, depression, and lower levels of parental affirmation and control. Conclusions: Findings indicate that there is a corresponding increase in abstaining mirroring the recent decreases found in adolescent drug use found in national surveys.     

Prevalence of marijuana use does not differentially increase among youth after states pass medical marijuana laws: Commentary on and reanalysis of US National Survey on Drug Use in Households data 2002–2011

There is considerable interest in the effects of medical marijuana laws (MML) on marijuana use in the USA, particularly among youth. The article by Stolzenberg et al. (2015) “The effect of medical cannabis laws on juvenile cannabis use” concludes that “implementation of medical cannabis laws increase juvenile cannabis use”. This result is opposite to the findings of other studies that analysed the same US National Survey on Drug Use in Households data as well as opposite to studies analysing other national data which show no increase or even a decrease in youth marijuana use after the passage of MML. We provide a replication of the Stolzenberg et al. results and demonstrate how the comparison they are making is actually driven by differences between states with and without MML rather than being driven by pre and post-MML changes within states. We show that Stolzenberg et al. do not properly control for the fact that states that pass MML during 2002–2011 tend to already have higher past-month marijuana use before passing the MML in the first place. We further show that when within-state changes are properly considered and pre-MML prevalence is properly controlled, there is no evidence of a differential increase in past-month marijuana use in youth that can be attributed to state MML.     

Associations between the levels of thyroid hormones and lipid/lipoprotein levels: Data from National Health and Nutrition Examination Survey 2007–2012

Data from National Health and Nutrition Examination Survey for the years 2007–2012 were used to investigate associations between thyroid hormones and lipid/lipoprotein levels for a representative sample of general US population aged ≥20 years. There were no statistically significant differences for adjusted high density lipoprotein levels among thyroid function groups, namely, subclinical hyperthyroid (SCHPR), clinical hyperthyroid (CHPR), euthyroid (EU), clinical hypothyroid (CHYP), and subclinical hypothyroid (SCHYP). For the general US population, positive associations for thyroid stimulating hormones (TSH) and negative associations for free thyroxine (FT4) levels were observed with total cholesterol (TC, p < 0.01), apolipoprotein B (APOB, p < 0.01), and triglycerides (TG, p < 0.01). A 10% increase in TC levels was associated with a 2% increase in TSH levels and 0.8% decrease in FT4 levels. Among EU subjects, TG levels were positively correlated with TSH (p < 0.01) and negatively correlated with FT4 (p < 0.01). For CHYP subjects, TG levels were negatively correlated with TSH (p < 0.01). For iodine deficient participants, low density lipoprotein levels (LDL) were lower for SCHPR when compared with EU or CHYP (p < 0.01). TC levels were usually lower for SCHPR than for EU, CHYP, and SCHYP but the differences were not necessarily statistically significant. For all participants and for iodine replete participants, TG levels for SCHPR were lower than for CHYP (p < 0.01). CHYP and SCHYP had higher levels of TG than other three thyroid function groups. APOB levels were lower for SCHPR than for EU and CHYP for all participants and for iodine replete participants (p < 0.01). There was a positive association between the four quartiles of thyroid stimulating hormones and TC, TG, and APOB. There was also an inverse association between the quartiles of free thyroxine levels and LDL, TC, TG, and APOB.     

Changes in the prevalence and correlates of cocaine use and cocaine use disorder in the United States, 2001–2002 and 2012–2013

To present nationally representative data on changes in the prevalences of 12-month cocaine use, cocaine use disorder (CocUD) and 12-month CocUD among 12-month cocaine users between 2001 and 2002 and 2012–2013. Data were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012–2013 NESARC-III. Between 2001 and 2002 and 2012–2013, prevalences of 12-month cocaine use and DSM-IV CocUD significantly increased and 12-month CocUD among 12-month users significantly decreased. Increases in risk of cocaine use were seen across nearly all sociodemographic subgroups while increases in CocUD were observed among women, those in the oldest age group, Whites, individuals with the lowest incomes and highest education, and those residing in urban areas. Prevalence of CocUD among users significantly declined overall and among men, individuals aged 30–44 years old, the never-married, respondents with incomes between $20,000 and $34,000, and those residing in the Midwest. Increases in coca cultivation in Colombia in recent years together with increases in the purity of cocaine entering the U.S. portend more significant increases in the rates of cocaine use and CocUD in the U.S. along with increases in cocaine-related morbidity and mortality. The results of this study support the continued monitoring of cocaine use and CocUD in the U.S., especially in view of the narrowing of the gender gap and shifts in race-ethnic, age and socioeconomic differentials seen between 2001 and 2002 and 2012–2013.     

Usual Alcohol Consumption and Risks for Nonfatal Fall Injuries in the United States: Results From the 2004–2013 National Health Interview Survey

Background: Acute alcohol consumption is known to be a risk factor for fall injuries. Objective: The study sought to determine whether usual alcohol consumption increases the risk for nonfatal fall injuries. Method: Data from 289,187 sample adults in the 2004–2013 U.S. National Health Interview Surveys were analyzed. Of these, 3,368 (～1%) reported a total of 3,579 fall-injury episodes requiring medical consultation in the past 3 months. Latent class analysis based on four contextual indicators identified four ecological subtypes of fall injury within two age groups (18–49 and 50+). Five drinking patterns (i.e., lifetime abstainer, former drinker, low-risk drinker, increased-risk drinker, and highest-risk drinker) were categorized according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) low-risk drinking guidelines. Controlling for potential confounders, negative binomial regression estimated the adjusted rates of any type and subtypes of fall injury, by gender, for each drinking pattern relative to lifetime abstainer. Results: Compared with lifetime abstainers, the adjusted rate of any fall injury for adults ages 18–49 was significantly higher among highest-risk drinkers (men: incidence rate ratio [IRR] = 2.59, 95% confidence interval [CI] [1.60, 4.20]; women: IRR = 1.90, 95% CI [1.24, 2.91]) and increased-risk drinkers (men: IRR = 1.94, 95% CI [1.25, 3.00]; women: IRR = 1.51, 95% CI [1.11, 2.07]). Furthermore, highest-risk drinkers had higher adjusted rates of either leisure- or sports-related fall injuries than lifetime abstainers. Conclusions: Alcohol consumption exceeding NIAAA's low-risk drinking guidelines is associated with elevated rates of nonfatal fall injuries. Findings underscore the importance of adhering to these recommendations.     

Experience of harm from others’ drinking and support for stricter alcohol policies: Analysis of the Australian National Drug Strategy Household Survey

BackgroundPrevious research indicates that those who have experienced alcohol-related harm from others are more likely to support stricter alcohol control policies. This study investigates the association between types of harm experienced because of others’ drinking and support for stricter alcohol control policies.MethodsData from 20,570 Australians aged 18 and over who completed the 2013 National Drug Strategy Household Survey was used. Questions about experience of alcohol-related harm from others – being put in fear and abuse (verbal or physical) – were asked. Support for stricter alcohol control policies was quantified by a mean policy support score across 18 alcohol policy questions.ResultsTwenty seven percent of respondents reported harm from someone’s drinking. Respondents who were put in fear had a higher level of support for stricter alcohol control policies than respondents who were not harmed (p < 0.001), regardless of whether they were abused or not. Conversely, respondents who experienced abuse but were not put in fear did not significantly differ in their support for stricter policies from those who experienced no harm.ConclusionIt is the apprehension of harm (i.e. having been put in fear), and not the experience of harm itself (i.e. abuse), which is related to people’s support for stricter alcohol policies. These findings suggest that perceiving others’ intoxication as dangerous to oneself may motivate support for stricter alcohol policies.     

Does consideration of future consequences moderate the relationship between aggression and alcohol use in adolescents? Results from the United Kingdom

Background: An increasing body of literature suggests that those who give greater consideration to the future consequences (CFC) of their present behaviours are at a reduced risk of negative health outcomes. However, it remains unclear to what degree consideration of immediate or long-term consequences are important. The present study examined whether higher CFC (immediate and future) scores moderated the relationship between trait aggression and self-reported alcohol use in a large sample of adolescents in the United Kingdom. Methods: Participants were 1058 adolescents from Northern Ireland. Participants completed questionnaires assessing Anger, Hostility, Verbal Aggression, Physical Aggression, Consideration of Future Consequences, and alcohol use. Results: Results revealed that higher CFC immediate and CFC future both significantly moderated the relationship between higher trait aggression and higher self-reported alcohol use, but only for females. Conclusions: This finding adds to the increasing body of literature examining the relationship between temporal orientation and health-related outcomes. However, more work is needed to help untangle the gender-specific effects.     

Naphthalene Biomarkers and Relationship with Hemoglobin and Hematocrit in White, Black, and Hispanic Adults: Results from the 2003–2004 National Health and Nutrition Examination Survey

Naphthalene is an important contaminant in indoor and outdoor air. Acute overexposure can have toxic effects, resulting in hemolysis. There have been no studies evaluating the impact of environmental exposure on red blood cell indices. We examined 1- and 2-hydroxynaphthalene urinary metabolites (NAP1 and NAP2) in non-Hispanic White, non-Hispanic Black, and Mexican-American adults in the USA and their relationship with hemoglobin (Hb) and hematocrit (HCT). Using the 2003–2004 National Health and Nutrition Examination Survey data, weighted generalized linear regression analyses were used to examine the association between Hb (in grams per deciliter) and HCT (in percent) with NAP1 and NAP2 (per 100,000 ng/L). Beta coefficients ± SE are reported. NAP1 and NAP2 were highest in non-Hispanic Blacks, followed by non-Hispanic Whites, and lowest in Mexican-American adults. There was a positive association between NAP1 and Hb (0.39?±?0.11, p?=?0.0034) and HCT (1.14?±?0.28, p?=?0.0009) after adjusting for age, gender, race, education, and smoking. Stratified analysis by smoking showed similar results with the association being stronger for smokers (Hb 0.63?±?0.23, p?=?0.02; HCT 1.43?±?0.79, p?=?0.09) than nonsmokers (Hb 0.34?±?0.14, p?=?0.03; HCT 1.08?±?0.42, p?=?0.02). The association was also stronger for non-Hispanic blacks (Hb 0.54?±?0.20, p?=?0.02; HCT 1.43?±?0.55, p?=?0.02) than for non-Hispanic whites (Hb 0.37?±?0.18, p?=?0.06; HCT 1.20?±?0.51, p?=?0.03) and was not significant for Mexican-Americans (Hb 0.30?±?1.7, p?=?0.10; HCT 0.99?±?0.52, p?=?0.08). NAP2 was not significantly associated with Hb or HCT. The observed disparity in NAP1 and NAP2 levels by race/ethnicity is consistent with published literature. The origin of these differences in exposure is unclear but may reflect differences in environmental exposure as well as genetic susceptibility. The positive association between NAP1 with HCT and Hb is an unexpected finding. Further research is needed to understand the possible biological mechanisms or other explanations for this association.     

Contraband Cigarette Purchasing from First Nation reserves in Ontario and Quebec: Findings from the 2002–2014 ITC Canada Survey

Backround: The availability of contraband cigarettes provides incentives for price-sensitive smokers to reduce their monetary costs of smoking. The objectives of this study were to examine whether Canadian smokers’ geographic proximity to First Nations reserves and attempts to quit smoking influenced the likelihood of purchasing lower-cost cigarettes from reserves. Methods: Data were from the International Tobacco Control (ITC) Canada Survey, a prospective survey of Canadian adult smokers conducted from 2002 to 2014 using telephone and online interviewing methods. Analysis was restricted to smokers from Ontario (n=2105) and Quebec (n=1427) participating in at least one survey wave. Smokers’ postal codes were used to calculate distance to the nearest reserve. Weighted logistic generalised estimating equations (GEE) regression examined the linear relationship between distance and the log odds of last purchasing cigarettes on reserve in each province. GEE models also examined the relationship between past-year quit attempts and the log odds of on-reserve purchasing. Results: Controlling for other factors, from 2002–2014, smokers from Ontario who lived 10 km closer to reserves than otherwise similar smokers had significantly higher odds of last purchasing on reserve (OR ranged from 1.16 to 1.65). Distance had little effect on smokers’ purchasing behaviours in Quebec. Moreover, in Ontario, for every 10 km increase in distance, smokers who did not try to quit had significantly greater odds of purchasing from a reserve than smokers who tried to quit (p=0.002). Conclusion: In order for tobacco taxation policies to achieve their maximal benefit, governments must limit potential sources of lower-cost cigarettes. Collaborative governance arrangements can ensure tobacco products sold on reserve to non-Indigenous people are appropriately taxed while allowing First Nations communities to keep the revenue generated by such taxes.     

Media exposure and tobacco product addiction beliefs: Findings from the 2015 Health Information National Trends Survey (HINTS–FDA 2015)

BackgroundAddiction beliefs about tobacco use are associated with intentions to use and use of tobacco products. Exposure to information about tobacco products in media sources may affect addiction beliefs.PurposeTo examine the relationship between media exposure and tobacco product addiction beliefs.MethodsA nationally representative sample of US adults (n = 3738) from the 2015 National Cancer Institute's Health Information National Trends Survey was used to examine addiction beliefs about cigarettes, cigars, smokeless tobacco, electronic cigarettes, hookah/waterpipe tobacco, and roll-your-own cigarettes. We used logistic regression to examine the relationship between media exposure and addiction beliefs. We defined media exposure by hours exposed, as well as exposure to tobacco use health effects information through media sources including social media. We categorized media sources by whether respondents actively or passively engaged with the source.FindingsA majority (60.6% to 87.3%) of respondents believed that cigarettes, cigars, roll-your-own cigarettes and smokeless tobacco are addictive. Less than half of respondents believed that electronic cigarettes or hookah/waterpipes are addictive (45.2% and 49.8%, respectively). Respondents exposed to messages about tobacco use health effects on active media channels (e.g., social media) had greater odds of believing that smokeless tobacco (adjusted odds ratio [AOR] = 1.48), hookah/waterpipe (AOR = 1.69), and roll-your-own cigarettes (AOR = 1.61) are addictive. Respondents exposed to tobacco use health effects messages on passive media channels (e.g., television), had greater odds of believing that cigarettes (AOR = 2.76) and electronic cigarettes (AOR = 2.12) are addictive.ConclusionsUS adult exposure to information about the health effects of tobacco use was associated with addiction beliefs about tobacco products.     

Alcohol use among Mexican American U.S.–Mexico border residents: Differences between those who drink and who do not drink in Mexico

The predominately Hispanic U.S.–Mexico border population is at an elevated risk for drinking and associated problems due to the area's low SES, poor services infrastructure, and drug-related violence. Among Mexican American residents, recent studies suggest this risk is particularly pronounced among younger age groups, and a key characteristic of this elevated risk involves crossing the border to drink in Mexico (where the legal drinking age is 18). However, few studies have compared the drinking behavior of U.S. residents who consume alcohol on the Mexico side of the border with those who do not. We address this gap in the present study. A multistage household probability sample of 1307 Mexican American border residents was interviewed about their drinking and associated problems over the past year. The survey response rate was 67%. Among current drinkers who reported going to Mexico in the past 12 months (N = 468), 36.1% reported consuming alcohol in Mexico. Those who drank in Mexico reported significantly more drinks per week (12.8 versus 8.7, p < .05), were more likely to have binged (58.3% versus 35.4%, p < .001), and were more likely to report one or more alcohol problem (35.5% versus 19.5%, p < .01) than those who did not drink in Mexico. Among those who drank in Mexico, men reported significantly more drinks per day while in Mexico than women (6.2 versus 4.0, p < .001). Male gender and lower income were significant predictors of drinking in Mexico. These findings suggest that drinking in Mexico contributes to the heightened risk for drinking and associated problems seen in previous research among Mexican Americans living on the U.S.–Mexico border.     

Partnerships and pathways of dissemination: The National Institute on Drug Abuse—Substance Abuse and Mental Health Services Administration Blending Initiative in the Clinical Trials Network

Since 2001, the National Drug Abuse Treatment Clinical Trials Network (CTN) has worked to put the results of its trials into the hands of community treatment programs, in large part through its participation in the National Institute on Drug Abuse—Substance Abuse and Mental Health Services Administration Blending Initiative and its close involvement with the Center for Substance Abuse Treatment's Addiction Technology Transfer Centers. This article describes (a) the CTN's integral role in the Blending Initiative, (b) key partnerships and dissemination pathways through which the results of CTN trials are developed into blending products and then transferred to community treatment programs, and (c) three blending initiatives involving buprenorphine, motivational incentives, and motivational interviewing. The Blending Initiative has resulted in high utilization of its products, preparation of more than 200 regional trainers, widespread training of service providers in most U.S. States, Puerto Rico, and the U.S. Virgin Islands and movement toward the development of Web-based implementation supports and technical assistance. Implications for future directions of the Blending Initiative and opportunities for research are discussed.     

Correct knowledge of medical cannabis legal status in one's own state: Differences between adolescents and adults in the United States, 2004–2013

BackgroundStudies have found age-specific effects of medical cannabis laws (MCLs), particularly affecting adult cannabis use but not adolescent use. We examined whether age differences in MCL knowledge are in accordance with age differences in MCL effects on cannabis use.MethodsData from the 2004–2013 repeated cross-sectional National Surveys on Drug Use and Health included people ages 12 and older in the United States. State-aggregated MCL knowledge was the proportion of people that correctly identified living in a state that did not allow medical cannabis prior to MCL enactment, or that allowed medical cannabis after MCL enactment. We regressed state-aggregated MCL knowledge on time-varying MCL enactment (i.e., no MCL by 2015, before MCL, after MCL), testing associations by age strata (12–17, 18–25, 26+), open dispensary status, and adjusting for time and state-level demographics.ResultsModel-based MCL knowledge was significantly lower among adolescents than adults; after enactment, 36.8% of ages 12–17, 48.8% of ages 18–25, and 45.4% of ages 26+ were aware of their state's MCL status. Correct MCL status knowledge decreased across all age groups after MCL enactment (i.e., low knowledge of MCL changes at the time they occurred). Open cannabis dispensaries significantly increased correct MCL knowledge, with a 7.7-point increase for adolescents and a 17.5-point increase for adults 26 + .ConclusionsLower MCL knowledge among adolescents than adults was in accordance with MCL effects on cannabis use previously observed among adults only. Studies should assess whether MCL knowledge is a consequence or predictor of individual-level cannabis use across age groups.