Web-based screening and brief intervention for student marijuana use in a university health center: Pilot study to examine the implementation of eCHECKUP TO GO in different contexts

This pilot study sought to test the feasibility of procedures to screen students for marijuana use in Student Health Services (SHS) and test the efficacy of a web-based intervention designed to reduce marijuana use and consequences. Students were asked to participate in voluntary screening of health behaviors upon arrival at SHS. One hundred and twenty-three students who used marijuana at least monthly completed assessments and were randomized to one of four intervention conditions in a 2 (intervention: Marijuana eCHECKUP TO GO vs. control) × 2 (site of intervention: on-site vs. off-site) between-groups design. Follow-up assessments were conducted online at 3 and 6 months. Latent growth modeling was used to provide effect size estimates for the influence of intervention on outcomes. One thousand and eighty undergraduate students completed screening. The intervention did not influence marijuana use frequency. However, there was evidence of a small overall intervention effect on marijuana-related consequences and a medium effect in stratified analyses in the on-site condition. Analyses of psychological variables showed that the intervention significantly reduced perceived norms regarding peer marijuana use. These findings demonstrate that it is feasible to identify marijuana users in SHS and deliver an automated web-based intervention to these students in different contexts. Effect size estimates suggest that the intervention has some promise as a means of correcting misperceptions of marijuana use norms and reducing marijuana-related consequences. Future work should test the efficacy of this intervention in a full scale randomized controlled trial.     

Perceived safety and controllability of events: Markers of risk for marijuana use in young adults?

Drawing on constructs from the trauma literature, the current study evaluated perceptions of safety and controllability of events as potential markers of risk for marijuana use. In addition, we characterized these perceptions in relation to individual level substance abuse risk factors (marijuana expectancies, impulsivity, depression, and anxiety), gender, and race. Data were collected via web survey from college students at two northeastern universities (n = 228, 82.0% female). Controllability of events (CE) was rated significantly higher by Blacks than Whites. Safety/vulnerability (SV) and CE were associated with impulsivity, depression, and anxiety. CE was also associated with marijuana expectancies. Logistic regression analyses revealed a modest but significant association between SV and lifetime use even after adjusting for race, gender, age, and individual level substance abuse risk factors (odds ratio = 1.10, 95% confidence intervals:1.02–1.18). No association between SV and past 3 month frequency of use or between CE and either marijuana outcome was found. Findings support a link between perceptions of safety and ever using marijuana. They further demonstrate overlap of both perceived safety and controllability of events with substance use related risk factors, and suggest that they differ by race. Additional studies that assess substance use more broadly and query trauma history, using larger, more diverse samples, are needed to more fully grasp the relevance of these constructs to substance use, including their potential as targets for substance abuse prevention efforts.     

The impact of the legalization of recreational marijuana on college students

In January of 2014 the Regulate Marijuana like Alcohol Act or, Amendment 64, went into effect in Colorado. Even though it was the first state to enact recreational legalization, attitudes towards marijuana use have been changing for decades. Prompted by medical marijuana legalization, studies have found mixed results in regards to the impact that legalization has on frequency of use and abuse. With college students having the highest rates of use in the United States (U.S.), whether legal or not, it was important to explore the impact that legalization has on this population. In the current study, rates of marijuana and alcohol use in college students before and after recreational legalization were explored. Data was collected in four waves from October 2013 to March 2015, to be able to determine the trends in marijuana and alcohol use, and relationship between the substances. In addition, grade point average was measured as a possible consequence of marijuana use. We found the frequency of marijuana use in Colorado college students is much higher than the national average t(94445) = 24.424, p < 0.001, especially the percentage of daily or almost daily users, t(2191) = 10.373, p < 0.001. There were significant differences between the marijuana non-users and the once a week or more often but not daily marijuana users in grade point average, F(6, 227) = 2.935, p < 0.001. In addition, it seems that the relationship between alcohol and marijuana use in general is decreasing since the passing of Amendment 64, but not among the binge drinkers.     

Is marijuana identity associated with marijuana use and consequences? An examination of direct and interactive associations

Background: There is relatively little research examining the relationship between identity and marijuana-related outcomes (e.g., marijuana use and consequences). Identity may both directly help shape marijuana use behaviors and moderate the influence of other risk factors on marijuana outcomes. Objectives: The current study examines the relationship between marijuana identity and marijuana-related outcomes among emerging adults and explores whether identity moderates the relationships between nonidentity correlates (e.g., perceived norms and negative affect) of marijuana-related outcomes. Methods: College students who reported marijuana use in the past 12?months completed measures of marijuana identity, perceived norms, negative affect, frequency of marijuana use, and marijuana consequences. Conclusions/Importance: The results indicated that marijuana identity is associated with marijuana use frequency and moderates the relationship between perceived norms and marijuana consequences. The findings have implications for both identity-based and social norms-based interventions targeting problematic marijuana use among emerging adults.     

Post-traumatic stress and marijuana outcomes: The mediating role of marijuana protective behavioral strategies

Abstract

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (M_age = 20.26, SD?=?3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30?days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana.     

The relationships between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents

IntroductionSensation seeking is strongly associated with cigarette use in adolescents. However, few studies have investigated its relationship with adolescent e-cigarette use. This study examined cross-sectional and longitudinal associations between sensation seeking and a variety of e-cigarette use behaviors among Texas adolescents.MethodsThis study utilized two waves of data collected 6 months apart through the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in 2014–2015 (n = 2,488/N = 461,069). TATAMS employs a complex probability-sampling design and is representative of students in 6th, 8th and 10th grades from five counties surrounding the four largest cities in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Weighted multivariable logistic regression was used to examine the cross-sectional and longitudinal associations between sensation seeking and susceptibility to e-cigarette use, ever e-cigarette use, and current (past 30 day) e-cigarette use.ResultsIn the cross-sectional analyses, higher mean sensation seeking scores were associated with higher odds of both susceptibility to e-cigarette use and ever e-cigarette use (AOR = 1.25, 95% CI = 1.07, 1.47; AOR = 1.24, 95% CI = 1.08, 1.43, respectively). For the longitudinal analyses, only the association between higher mean sensation seeking scores and transition to ever e-cigarette use remained statistically significant (AOR = 1.45, 95% CI = 1.01, 2.08). There were no significant associations between sensation seeking and current e-cigarette use in either the cross-sectional or longitudinal analyses.ConclusionsHigher sensation seeking scores were consistently and significantly related to experimentation with e-cigarette use among Texas adolescents. Future interventions (e.g., communication campaigns) should target high sensation seeking adolescents to reduce initiation of e-cigarette use among this population.     

Alcohol attitudes,motives, norms,and personality traits longitudinally classify nondrinkers,moderate drinkers,and binge drinkers using discriminant function analysis

IntroductionBinge drinking is commonly defined in the literature as consuming at least 5 drinks for males and 4 drinks for females. These quantities correspond to approximately a blood alcohol concentration of 0.08%, the level of intoxication making it illegal to drive in the United States.MethodsThe study scrutinized the longitudinal classification of three drinker types using male (n = 155) and female (n = 351) college students. Measures of personality (sensation seeking, extraversion, agreeableness, conscientiousness, neuroticism, and openness), alcohol attitudes, alcohol motivations (social, coping, enhancement, and conformity), and alcohol social norms (typical students, friends, closest friends, and parents) were administered at Time 1. Drinker type (nondrinkers, moderate drinkers, or binge drinkers) was assessed one month later.ResultsDiscriminant function analyses revealed that the set of measures statistically distinguished among the three drinker types. The first function was significant and yielded high loadings for attitudes, social motives, enhancement motives, coping motives, closest friend norms, and friend norms for both genders. Model classification accuracy was 73% for the male and 67% female samples. Multivariate analysis of variance (MANOVA) compared mean differences in a 2 (gender: males or females) × 3 (drinker type: nondrinkers, moderate drinkers, or binge drinkers) design. Measures systematically differing across all pairwise comparisons of the three drinker types, starting from the strongest effect (eta-squared), were as follows: alcohol attitudes, social motives, enhancement motives, closest friend norms, friend norms, coping motives, sensation seeking, and extraversion.ConclusionsAttitude, motivation, and norm variables tended to be more important than personality in distinguishing drinker types. Considering the malleability of attitudes and belief motivations, the risk variables of alcohol attitudes, social motives, and enhancement motives identified in this research warrant consideration in prevention and campaign efforts targeting problematic drinking.     

Social anxiety and marijuana-related problems: The role of social avoidance

BackgroundPeople with elevated social anxiety seem vulnerable to marijuana-related impairment. Yet little work has examined core facets of social anxiety that may be especially related to marijuana-related problems.MethodThe present study examined the relationships between current (past three months) marijuana-related problems and two aspects of social anxiety (fear in social situations and social avoidance) among current (N = 102) marijuana users.ResultsAlthough both social fear and social avoidance were significantly correlated with marijuana-related problems, only social avoidance was uniquely related to marijuana problems (after controlling for social fear, sex, negative affect, alcohol problems, and marijuana use frequency). Sex moderated the relationship between social avoidance and marijuana-related problems such that men with greater social avoidance exhibited the greatest severity of marijuana-related problems.ConclusionsAvoidance of social situations appears robustly related to marijuana-related problems. This finding has important implications for theoretical models that can inform treatment of co-occurring social anxiety and marijuana problems.     

Early predictors of maturing out of marijuana use among young men

ObjectiveAlthough several studies have delineated risk factors for adolescent regular marijuana use, few studies have identified those factors that differentiate who will and will not eventually stop using marijuana during young adulthood. This study examined the extent to which adolescent risk factors, including individual attitudes, temperament, and behaviors and peer, family, and neighborhood factors, could prospectively identify which adolescence-onset monthly marijuana users (AMMU) would stop using marijuana in young adulthood and whether race moderated these associations.MethodData came from 503 young men who were followed annually from the first grade through mean age 20 and then re-interviewed at mean ages 26 and 29. Young men who used marijuana at least monthly at least one year between ages 14 and 17 (N = 140) were compared to their peers who had not tried marijuana by age 17 (N = 244). The former group was divided into those who used at least weekly in adulthood (N = 54) and those who did not use at all in adulthood (N = 66) and these groups were compared to each other.ResultsLogistic regression analyses indicated that all except one of the adolescent risk factors significantly differentiated AMMU from nonusers. None of the predictors differentiated those who matured out from those who used weekly in young adulthood.ConclusionsFuture research on marijuana cessation should incorporate subjective life experiences, such as reasons for using and negative consequences from use, to help identify adolescents who are at risk for problematic use in adulthood.     

Lifetime marijuana use and sexually transmitted infection history in a sample of Black college students

BackgroundSexually transmitted infections (STIs) and marijuana use are more prevalent in African Americans/Blacks (Blacks) than any other ethnicity in the United States. Given the significant health care costs and deleterious health correlates of using marijuana or contracting a STI, it is imperative to examine their association, especially in the vulnerable and underrepresented group of young adult Blacks.PurposeThe current study examines the association between lifetime marijuana use on history of STI diagnosis in a sample of Black college students.ResultsApproximately 81% of the 213 participants were female, with approximately 81% also being 21 years of age or younger. Alcohol (88%) led the prevalence of substances ever used, followed by marijuana (75%), and cigarettes (57%). When including demographic and substance use covariates, lifetime marijuana use (AOR = 2.51; 95% CIs, 1.01, 6.21) and age (AOR = 2.72; 95% CIs, 1.32, 5.64) were associated with history of STI.ConclusionThese findings will inform intervention and prevention methods used to reduce STI prevalence and marijuana use among Black young adults. Both epidemiological and biological foundations will be discussed.     

Characterizing users of new psychoactive substances using psychometric scales for risk-related behavior

IntroductionStudies investigating risk-related behavior in relation to new psychoactive substance (NPS) use are sparse. The current study investigated characteristics of NPS users by comparing risk-related behavior of NPS users to that of illicit drugs (ID) users and licit substances users and non-users (NLC) users.MethodsIn this cross-sectional study we included 528 individuals across an age range of 18–72 years. Using a web-based questionnaire we collected self-report data on substance use, sensation seeking, impulsivity, peer substance use and risk perception of substance use.ResultsNPS and ID users had a higher level of sensation seeking compared to NLC users (NPS users: p < 0.001; ID users: p < 0.001). NPS users (p < 0.001), but not ID users (p = 0.16), had increased levels of impulsivity compared to NLC users. NPS users had significantly higher scores for sensation seeking (F_1,423 = 51.52, p < 0.001) and impulsivity (F_1,423 = 6.15, p = 0.01) compared to ID users. Additionally, NPS users had significantly more peers who use substances compared to ID and NLC users. Also, NPS and ID users had lower risk perception for most substances than NLC users. NPS users had lower risk perception for most substances than ID users.ConclusionsThe findings highlight that NPS users show substantial more risk-related behavior than both ID and NLC users. Therefore, NPS users might be considered as a distinctive group of substance users that need another approach in terms of prevention.     

Parent and peer pathways linking childhood experiences of abuse with marijuana use in adolescence and adulthood

IntroductionThe social developmental processes by which child maltreatment increases risk for marijuana use are understudied. This study examined hypothesized parent and peer pathways linking preschool abuse and sexual abuse with adolescent and adult marijuana use.MethodsAnalyses used data from the Lehigh Longitudinal Study. Measures included child abuse (physical abuse, emotional abuse, domestic violence, and neglect) in preschool, sexual abuse up to age 18, adolescent (average age = 18 years) parental attachment and peer marijuana approval/use, as well as adolescent and adult (average age = 36 years) marijuana use.ResultsConfirming elevated risk due to child maltreatment, path analysis showed that sexual abuse was positively related to adolescent marijuana use, whereas preschool abuse was positively related to adult marijuana use. In support of mediation, it was found that both forms of maltreatment were negatively related to parental attachment, which was negatively related, in turn, to having peers who use and approve of marijuana use. Peer marijuana approval/use was a strong positive predictor of adolescent marijuana use, which was a strong positive predictor, in turn, of adult marijuana use.ConclusionsResults support social developmental theories that hypothesize a sequence of events leading from child maltreatment experiences to lower levels of parental attachment and, in turn, higher levels of involvement with pro-marijuana peers and, ultimately, to both adolescent and adult marijuana use. This sequence of events suggests developmentally-timed intervention activities designed to prevent maltreatment as well as the initiation and progression of marijuana use among vulnerable individuals.     

Distress tolerance predicts coping motives for marijuana use among treatment seeking young adults

Given increasing marijuana use and abuse among young adults in the United States and the associated physical and mental health consequences, it is important to improve our understanding of factors that may contribute to problematic marijuana use. A convergence of theory and research underscores the relevance of particular marijuana use motives generally, and coping-related motives specifically, in enhancing risk for marijuana use problems. Distress tolerance is a transdiagnostic emotion vulnerability factor that may relate to coping-related motives for marijuana use. The current study was designed to further explore this relationship within a treatment-seeking sample of young adults (M_age = 24.40; SD = 2.06 years). Results were consistent with hypotheses, suggesting distress tolerance is related to coping motives for marijuana use within this treatment-seeking sample, even after accounting for a number of theoretically relevant covariates. Theoretical and applied implications of distress tolerance as it relates to coping motives for marijuana use as treatment targets are discussed.     

Associations between coping and marijuana use in a nationally representative sample of adolescents in the United States

Maladaptive coping strategies have been linked with substance use. Little is known, however, about associations between coping and marijuana use in the general U.S. adolescents. We used nationally representative data to examine associations between coping and marijuana use among U.S. adolescents. We hypothesized that marijuana use would be positively associated with both avoidance and distraction coping and negatively associated with problem solving. We calculated adjusted prevalence ratios and odds ratios to assess associations of three coping styles (avoidance, distraction, problem solving) and six coping profiles based on combinations of the styles (adaptive, low on all styles, distracted, high on all styles, avoidant, maladaptive) with lifetime marijuana use and past 12-month frequency of use using data from the National Comorbidity Survey: Adolescent Supplement (n = 8476, ages 14–18 years). Avoidance and distraction coping were positively and problem solving was negatively associated with lifetime marijuana use. Avoidance coping was positively associated, and problem solving negatively associated, with past 12-month frequency of use. Compared to the adaptive coping profile (low avoidance and distraction, high problem solving), maladaptive profile (high avoidance and distraction, low problem solving) and avoidance profile (high avoidance, low distraction and problem solving) were each positively associated with lifetime marijuana use and past 12-month frequency of use. Avoidance coping, especially in combination with limited problem solving, was positively associated with lifetime marijuana use and past 12-month frequency of use. Our findings have potential to inform interventions for reducing adolescent marijuana use.     

Alcohol use during a trial of N-acetylcysteine for adolescent marijuana cessation

AimsCurrent adolescent alcohol treatments have modest effects and high relapse rates. Evaluation of novel pharmacotherapy treatment is warranted. N-acetylcysteine (NAC), an over-the-counter antioxidant supplement with glutamatergic properties, is a promising treatment for marijuana cessation in adolescents; however, its effects on adolescent drinking have not been examined. To that end, this secondary analysis evaluated: (1) the effect of NAC vs. placebo on alcohol use over an eight-week adolescent marijuana cessation trial and (2) the role of marijuana cessation and reduction on subsequent alcohol use.MethodsMarijuana-dependent adolescents (ages 15–21; N = 116) interested in treatment were randomized to NAC 1200 mg or matched placebo twice daily for eight weeks. Participants were not required to be alcohol users or interested in alcohol cessation to qualify.ResultsThere were no demographic or baseline alcohol use differences between participants randomized to NAC vs. placebo (ps > 0.05). Of the 89 participants returning for ≥ one visit following randomization, 77 reported ≥ one alcoholic drink in the 30 days prior to study entry and averaged 1.3 (SD = 1.4) binge drinking days per week. During treatment, less marijuana use (measured via urine cannabinoid levels) was associated with less alcohol use in the NAC-treated group but not in the placebo-treated group (p = 0.016).ConclusionsThere was no evidence of compensatory alcohol use during marijuana treatment. In fact, in the NAC group, lower levels of marijuana use were associated with less alcohol use, suggesting NAC effects may generalize to other substances and could be useful in decreasing adolescent alcohol use. NAC trials specifically focused on alcohol-using adolescents are warranted.     

Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications

Widespread legalisation of marijuana raises safety concerns for its use in pregnancy. This study investigated the association of marijuana use prior to and during pregnancy with pregnancy outcomes in a prospective cohort of 5588 nulliparous women from the international SCOPE study. Women were assessed at 15 ± 1 and 20 ± 1 weeks’ gestation. Cases [278 Preeclampsia, 470 gestational hypertension, 633 small-for-gestational-age, 236 spontaneous preterm births (SPTB), 143 gestational diabetes] were compared separately with 4114 non-cases. Although the numbers are small, continued maternal marijuana use at 20 weeks’ gestation was associated with SPTB independent of cigarette smoking status [adj OR 2.28 (95% CI:1.45–3.59)] and socioeconomic index (SEI) [adj OR 2.17 (95% CI:1.41–3.34)]. When adjusted for maternal age, cigarette smoking, alcohol and SEI, continued maternal marijuana use at 20 weeks’ gestation had a greater effect size [adj OR 5.44 (95% CI 2.44–12.11)]. Our data indicate that increasing use of marijuana among young women of reproductive age is a major public health concern.     

Do personality traits related to affect regulation predict other tobacco product use among young adult non-daily smokers?

IntroductionUnderstanding factors that influence non-cigarette tobacco use is important given these products' prevalence and health risks. The goal of this study was to test the hypothesis that personality traits related to affect regulation would be associated with greater frequency of other tobacco product (OTP) use in a sample of young adult non-daily smokers.MethodsParticipants (n = 518, 51% male) aged 18–24 were non-daily cigarette smokers recruited from the community for a longitudinal study of tobacco use. Personality characteristics (impulsivity, anhedonia, and negative affectivity) were measured at baseline, and participants reported recent tobacco use at baseline and 3, 6, and 9 months later. Assessments were conducted online or via mobile phone.ResultsAcross the 4 assessments, 33–52% of participants reported recent OTP use, with frequency of use decreasing over time. Longitudinal negative binomial regression models indicated that greater sensation seeking and lack of premeditation were associated with more frequent OTP use (ps < 0.05). These effects were consistent over time.ConclusionsFindings suggest that young adult non-daily cigarette smokers with greater propensity for immediately rewarding behaviors may use OTPs more frequently. Young, non-daily cigarette smokers with high levels of sensation seeking and/or lack of premeditation may be at increased risk for harms related to OTP use and may benefit from prevention and cessation strategies that specifically address affect.     

Factors associated with early marijuana initiation in a criminal justice population

PurposeInitiation of marijuana during adolescence is associated with negative outcomes and is more common among those with criminal justice involvement. We sought to determine demographics, psychosocial factors, mental health factors, and criminal outcomes associated with earlier age at first marijuana use in a criminal justice population.MethodsData from structured, in-person interviews of adults in a criminal corrections program were analyzed. Participants (689 men and women ages 19 and older) were recruited for a larger smoking cessation trial (2009–2013) as a volunteer sample by flyers at a community corrections site. 516 had smoked both nicotine and marijuana and were included in the analysis. We determined associations between self-reported age at first marijuana use and sex, race, income, educational attainment, history of abuse, family problems, psychiatric problems, criminal record, and age of nicotine and alcohol initiation.ResultsOf 516 participants, 68% were men, and 64.5% were Black. No participants were of Hispanic ethnicity. Average age of marijuana initiation was 15.1 years (SD 3.7 years). After linear regression, earlier age at marijuana initiation was associated with male sex and more criminal offenses (person/violent and court). Race and psychiatric problems were not associated with earlier marijuana initiation.ConclusionsEarlier adolescent marijuana initiation is associated with more criminal offenses in a criminal justice population. Men initiate marijuana earlier than women. Adolescents at high risk of justice involvement may benefit from delayed initiation of marijuana, specifically men. Additional studies should examine prevention strategies for adolescent marijuana use that target those at highest risk.