Sociodemographic and Substance Use Correlates of Gambling Behavior in the Canadian General Population

ABSTRACT

This study describes sociodemographic and substance use correlates of gambling behaviors, measured among 9,481 past-year gamblers from the Canadian general population. Compared to non-problem gamblers in this study (N = 8,035), the 98 problem gamblers who scored 8 or more points on the Canadian Problem Gambling Research Index were more likely to report being “drunk or high” while gambling (adjusted odds ratio [AOR]: 8.92; 95% confidence interval [CI]: 5.46,14.55; p < .001), to admit to having an alcohol or drug problem (AOR: 3.80; 95% CI:2.21,6.52; p < .001), and to use electronic gambling devices (AOR: 4.85; 95% CI: 3.08-7.66; p< .001).     

Reasons to use e-cigarettes among adults and youth in the Population Assessment of Tobacco and Health (PATH) study

BackgroundWhile e-cigarette use is increasing, reasons to use e-cigarettes are poorly summarized in the literature. The objective of this study was to organize reasons to use e-cigarette items into factors and determine associations between these factors and e-cigarette user characteristics.MethodsData were drawn from youth (12–17) and adults (18+) in Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) study. Exploratory factor analysis was conducted on 13 reasons to use survey items from experimental and established adult e-cigarette users and past 30 day youth e-cigarette users to determine two factors – “alternative to cigarettes” and “larger social environment”. Weighted linear regression models tested the associations between e-cigarette user group and sociodemographics and reasons to use factors among youth and adults.ResultsAdult current established e-cigarette users were associated with both alternative to cigarettes (β = 0.128, p < .001) and larger social environment (β = 0.063, p < .001) factors, while former established e-cigarette users were associated with alternative to cigarettes (β = 0.064, p < .001). Several adult sociodemographic characteristics were associated with one but not the other factor, or both but in opposite directions. Youth that used e-cigarettes earlier today were also associated with both reasons to use factors (β = 0.127–0.130, p < .01, each); however, youth using any other day in the past 30 days was not associated with either factor.ConclusionsReasons to use are associated with patterns of e-cigarette use among youth and adults. These factors could support a comprehensive approach to addressing rising e-cigarette use among youth and adults and target certain user populations.     

Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

Background: Sexual minority youth, especially girls, are at risk for alcohol, cigarette, and marijuana use when these substances are examined individually. However, little is known about concurrent use of these substances (i.e., three-substance use) in relation to sexual orientation. Objectives: The present study compared profiles of past year alcohol, cigarette, and marijuana use between SMGs and heterosexual girls. In addition, because internalizing and externalizing symptoms are associated with substance use, we examined whether sexual orientation was associated with substance use profile over and above co-occurring psychopathology. Methods: Mixture modeling was used to identify patterns of alcohol (including binge drinking), cigarette, and marijuana use in the past year using a cross-sectional sample of urban adolescent girls (Pittsburgh Girls Study; N = 2,064; mean age = 17). Approximately 8% (n = 173) of the girls endorsed a lesbian or bisexual identity. Results: Five substance using classes were identified: low-level substance use (72%), marijuana use (5%), cigarette use (8%), alcohol use (8%), and three-substance use (7%). SMGs were at an increased risk for substance use than heterosexual girls, particularly three-substance use (OR = 6.69, p < .001), cigarette use (OR = 6.26, p < .001), and marijuana use (OR = 3.86, p < .001) classes. Substance use patterns were regressed on sexual orientation, internalizing symptoms (i.e., depression, anxiety), and externalizing symptoms (i.e., conduct problems, oppositional defiant disorder). The disparities remained robust after controlling for internalizing and externalizing symptoms. Conclusions/Importance: Clinicians and researchers should be aware of potential three-substance use among SMGs. Substance use interventions for SMG may benefit from targeting risk factors that cut-across several substances, particularly externalizing symptoms.     

Association between psychological distress and elevated use of electronic devices among U.S. adolescents: Results from the youth risk behavior surveillance 2009-2017

ObjectiveThe purpose of this study was to provide updated information about the prevalence and temporal trends of elevated use of electronic devices (EUED) in leisure time (i.e., 3 h or more on an average school day) in nationally representative samples of U.S. adolescents in recent years and to determine whether there is a significant association between EUED and psychological distress.MethodsWe used the national Youth Risk Behavior Survey (YRBS) data from 2009, 2011, 2013, 2015, and 2017 (N = 75,807). Propensity score matching was used to reduce selection bias due to potential confounding factors with EUED. Ordinal logistic regression analyses were performed for the matched samples to predict the association between EUED and psychological distress.ResultsThe prevalence of EUED in U.S. youth has substantially increased from 24.9% in 2009 to 43.1% in 2017 (p < .001). Boys had higher rates of EUED than girls only in 2009 and 2011 but not in 2013, 2015, and 2017. A significant association between EUED and psychological distress was identified throughout all the five survey years. The odds of having a higher level of psychological distress increased approximately 1.5 times among youth with EUED than those without.ConclusionsThe prevalence of U.S. youth with psychological distress and EUED has increased simultaneously in the past several years. Future longitudinal studies are warranted to examine causal and/or reciprocal relationship between the two.     

The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland

BackgroundIn the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change.MethodData from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017–2018 were analysed using multivariate logistic regression.ResultsOverall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98–4.82) p<0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40–0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46–0.71) p<0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17–1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18–2.10) p = 0.002) both in the past year.ConclusionThe promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.     

Trends in hepatitis C antibody prevalence among Aboriginal and Torres Strait Islander people attending Australian Needle and Syringe Programs, 1996–2015

BackgroundResearch indicates that hepatitis C antibody (anti-HCV) prevalence is higher among Australian Aboriginal and Torres Strait Islander (Aboriginal) than non-Aboriginal people who inject drugs (PWID). We examined trends in demographic and drug use characteristics and anti-HCV prevalence among Australian Needle and Syringe Program Survey (ANSPS) respondents by Aboriginal status from 1996 to 2015.MethodsThe ANSPS survey involved collecting demographic, behavioural data and a dried blood spot for anti-HCV testing. We used logistic regression to determine demographic and behavioural factors associated with testing anti-HCV positive in the following time-periods (1996–2000, 2001–2005, 2006–2010, 2011–2015) among Aboriginal and non-Aboriginal PWID respondents.ResultsOverall, there were 16,948 PWID, with 11% identifying as Aboriginal. The proportion of Aboriginal respondents increased from 7% in 1996–2000 to 16% in 2011–2015. Overall anti-HCV prevalence was significantly higher among Aboriginal (60%) than non-Aboriginal PWID (52%, p < 0.01). Receptive syringe sharing (RSS) declined among non-Aboriginal PWID (p < 0.001) over time, however among Aboriginal PWID, RSS remained stable (p = 0.619). Factors independently associated with testing positive for anti-HCV among Aboriginal PWID in 2011–2015 were 16 or more years since first injection (adjusted odds ratio [AOR] 6.04, p < 0.001), history of incarceration (AOR: 1.74, p = 0.010) and currently or previously on opioid substitution therapy (AOR: 1.89, p = 0.003). Compared to 1996–2000, testing anti-HCV positive was significantly associated with the time-periods: 2001–2005 (unadjusted odds ratio [OR]: 1.39, p < 0.001), 2006–2010 (OR: 1.38, p < 0.001) and 2011-2015 (OR: 1.25, p < 0.001) among non-Aboriginal PWID; however this increase did not occur among Aboriginal PWID.ConclusionThe proportion of Aboriginal PWID attending Needle Syringe Programs appears to have increased. Overall, the prevalence of anti-HCV has remained higher among Aboriginal than non-Aboriginal PWID. Coupling increased access to NSPs with new interferon-free HCV treatments and culturally appropriate education and counselling services could influence new HCV infections among Aboriginal PWID.     

Youth perception of harm and addictiveness of tobacco products: Findings from the Population Assessment of Tobacco and Health Study (Wave 1)

PurposeWe provide a US national assessment of youth perceptions of the harm and addictiveness of six separate tobacco products, identifying a continuum of perceived harm associated with a range of products in relation to patterns of current use, former use, and susceptibility to use tobacco products.MethodsWe evaluated youth respondents (N = 13,651) ages 12–17 from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Analyses (2015–2016) focused on refining measures of perceived harm for each product and delineating youth characteristics (demographic, tobacco use status) associated with beliefs about the harmfulness and addictiveness of tobacco products.ResultsCigars, hookah and e-cigarettes were each perceived as having significantly lower harm (p's < 0.05) than smokeless products, with the lowest ratings of harmfulness and addictiveness observed for hookah and e-cigarettes (p's < 0.001). Incrementally lower levels of harm and addictiveness perceptions were observed among youth at increasing risk for tobacco use (p's < 0.05).ConclusionsAmong U.S. youth, lower perceptions of harm and addictiveness of tobacco products were associated with susceptibility to use tobacco and patterns of tobacco product use. Future longitudinal assessments from the PATH Study can provide key information on youth development of perceptions of harm and addictiveness and influences on patterns of tobacco use.     

IN BRIEF

Abstract

This study provides new information about how acculturation and perceived social norms affect adolescents smoking among four Asian-American subgroups. Results showed differences in smoking prevalence rates across subgroups, with Koreans having the highest rates of smoking, while Chinese have the lowest rates. In contrast to the large gender disparity in the ancestral countries, smoking rates were equal for Asian-American boys and girls. Acculturation was significantly associated with an increased risk for lifetime smoking for Asian-American girls, but not for boys. Perceived social norms regarding peer smoking were significantly associated with smoking behaviors for both genders and for all subgroups.     

Cigarette use and smoking beliefs among older Americans: findings from a nationally representative survey*

Background: Between 2005 and 2015, the prevalence of smoking among US adults has decreased for all age subgroups, except those aged 65 and older.

Aim: In order to identify potential correlates of smoking behaviors in older adults, this research examined associations between age, smoking beliefs, and quitline utilization.

Methods: Self-reported, nationally representative data from the Health Information National Trends Survey 2015 cycle (HINTS-FDA) were used (n?=?3738). Multivariable logistic regression analyses examined associations between sociodemographic characteristics and beliefs about smoking behaviors. All analyses were conducted with jackknife estimation using sampling weights.

Results: Among all survey respondents, 10.5% of those aged 65+ were current smokers (smoked 100 lifetime cigarettes and currently smoked every day or some days). These older adults, compared to those aged 18–29 years, had significantly higher odds of agreeing that smoking behavior is something one can do little to change (AOR?=?1.89, 95% CI =1.08, 3.28) and agreeing that nicotine is the substance that causes cancer (AOR?=?3.93, 95% CI?=?2.17, 7.12). Post hoc analyses compared midlife adults (ages 50–64) with older adults (ages 65+), and indicated older adults had lower odds of having used a quitline/smoking cessation website (AOR?=?0.36, 95% CI?=?0.14, 0.94, p?=?0.04) compared to their midlife peers.

Discussion: US adults aged 65 and older hold erroneous beliefs about cigarette smoking behaviors and are less likely to utilize quitline supports. This may be contributing to the stagnant smoking rates among older adults. Smoking cessation efforts targeting older adult Americans are critical in order to stem tobacco use among all Americans.     

Recent Weapon Carrying and Substance Use among United States Virgin Islands Youth

The objective of the present study was to estimate the strength of the associations between recent weapon carrying and alcohol, cigarette, and illicit drug use among US Virgin Islands (USVI) youth. Data from 1,124 students in Grades 7–12 were analyzed using the conditional form of multiple logistic regression. Compared with youth who did not carry a weapon, youth who carried a weapon were more likely to be male and recent cigarette, alcohol, and illicit drug users. After matching on school and controlling for age, sex, race, neigborhood characteristics, and affiliation with friends who use alcohol and illegal drugs, the associations with cigarette smoking and illicit drug use remained both moderate and statistically significant (odds ratio [OR] =4.31, p <. 001; OR = 2.99, p <.001, respectively). These findings identify a potentially high-risk population that could be targeted for interventions to reduce weapon carrying among youth.     

Cross-national comparison of adolescent drinking and cannabis use in the United States,Canada, and the Netherlands

BackgroundThis research examined the prevalence of drinking and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with substantially different laws and policies relating to these substances.MethodsLaws regarding drinking and cannabis use were rated for each country. Substance use prevalence data among 10th graders from the Health Behaviour in School-Aged Children Survey conducted in each country in 2005–2006 were examined.ResultsLaws regarding alcohol and cannabis were found to be strictest in the United States, somewhat less strict in Canada, and least strict in the Netherlands. On most measures of drinking, rates were lower in the United States than in Canada or the Netherlands. With United States as the referent, relative risks (RR) for monthly drinking were 1.30 (1.11–1.53) for Canadian boys and 1.55 (1.31–1.83) for girls, and 2.0 (1.73–2.31) for Dutch boys and 1.92 (1.62–2.27) for Dutch girls. Drunkenness was also higher among Canadian boys and girls and Dutch boys. However, rates of cannabis use did not differ between the countries, except that Dutch girls were less likely to use cannabis in the past year (RR = .67; .46–.96).ConclusionsThe lower prevalence of adolescent drinking and drunkenness (except among Dutch girls) in the United States is consistent with the contention that strict drinking policies may limit drinking among 10th graders. However, the finding that cannabis use rates did not differ across countries is not consistent with the contention that prohibition-oriented policies deter use or that liberal cannabis policies are associated with elevated adolescent use. Based on these findings, the case for strict laws and policies is considerably weaker for cannabis than for alcohol.     

Relations Among Internalizing and Externalizing Symptoms and Drinking Frequency During Adolescence

Background: In adolescence, internalizing (e.g., anxious, depressive, and withdrawn) and externalizing (e.g., aggressive, oppositional, delinquent, and hyperactive) symptoms are related with alcohol use. However, the directionality among internalizing symptoms, externalizing symptoms, and alcohol use during adolescence is equivocal. Moreover, gender differences and similarities among these behaviors are not definitive in existing literature. Objectives: This study examined longitudinal relationships between internalizing and externalizing symptoms and past-month alcohol use among adolescent boys and girls. Methods: Using longitudinal survey data from a study of community-dwelling adolescents (n = 724), we estimated cross-lagged structural equation models to test relations between internalizing and externalizing symptoms (as measured by the Youth Self Report, YSR [Achenbach, 1991]) and self-report alcohol use in the past month among adolescents. Gender differences were tested in a multiple group structural equation model. Results: Alcohol use at age 12 was a predictor of internalizing and externalizing symptoms at age 15 for both boys and girls. With regard to gender differences, girls demonstrated an association between internalizing symptoms and drinking at age 12, whereas boys showed a stronger association between externalizing symptoms and drinking at age 18. Conclusions/Importance: Early alcohol use is problematic for youth, and results of this study lend support to prevention programs for youth. Preventing or curbing early drinking may offset later externalizing and internalizing symptoms, as well as ongoing alcohol use, regardless of gender.     

Marijuana and Alcohol Use and Attempted Smoking Cessation in Adolescent Boys and Girls

ABSTRACT. Background: This study sought to determine the relationship between the frequency of current marijuana and alcohol use and cigarette quit attempts in male and female adolescent smokers. Methods: Data from a cross-sectional survey of health behaviors in high-school-aged adolescents were analyzed. Current cigarette smokers (n = 804) who reported use of at least 1 cigarette in the past month were divided into those with and without a history of at least 1 quit attempt (a self-reported episode of trying to “stop smoking”). Logistic regression models were fit to describe the association between the frequency of marijuana/alcohol use and a history of cigarette quit attempts. Results: Among the total sample, higher-frequency marijuana use (more than 6 times in the past 30 days) and frequent binge drinking (more than 5 days of binge drinking in the past 30 days) decreased the odds of having a past cigarette quit attempt (higher-frequency marijuana: adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] = 0.36–0.86; frequent binge drinking: AOR = 0.49, 95% CI = 0.29–0.83). A significant gender interaction was observed for the relationship between higher-frequency marijuana use and a history of cigarette quit attempts (P = .03), with decreased odds in boys (AOR = 0.41, 95% CI = 0.22–0.77) but not in girls (AOR = 0.71, 95% CI = 0.37–1.33). Conclusions: Adolescent smokers who report higher-frequency marijuana use or frequent binge drinking have a decreased likelihood of a history of a cigarette quit attempt. The gender-related association between higher-frequency marijuana use and a history of quit attempts suggests that boys with greater substance use may need particularly intensive support to initiate quit attempts.     

Patterns of excess alcohol consumption among school children in two English comprehensive schools

BackgroundThe patterns of excess alcohol consumption among children aged 11–15 years are not routinely assessed in England and neither are the alcohol consumption patterns of adolescents aged 16–18 years. The aim of the present research was to examine patterns of excess alcohol consumption among English school children aged 11–18 years.Methods1230 children and adolescents, aged 11–18 years were surveyed about their alcohol consumption, and specifically their hazardous drinking, binge drinking and problem drinking.ResultsSixteen per cent of 11 year olds and 71% of 18 year olds reported having drunk any alcohol in the previous seven days. Thirty-two per cent (n = 199) of girls and 24% (n = 142) of boys gave an affirmative answer to at least one of the CAGE questions, indicating possible problem drinking. Hazardous drinking was associated with norms and age; binge drinking and problem drinking were associated with norms, age and gender.ConclusionsThe study provides further evidence to support the case that excessive alcohol consumption among girls now exceeds that of boys. It would be valuable to collect data on patterns of excess alcohol consumption routinely to enable policy makers to target information and resources appropriately.     

The Dark Web and cannabis use in the United States: Evidence from a big data research design

BackgroundCannabis is one of the most commonly sold drugs on cryptomarkets. Because of the anonymity-granting functions of Tor, no study has traced the within-country effect of the Dark Web on cannabis consumption patterns. This article uses a big data research design to examine the association between revealed interest in the Dark Web and self-reported cannabis use within US states from 2011 when Silk Road launched to 2015 when Operation Onymous shuttered nine markets.MethodsThis study uses mixed effects ordinary least squared regressions to analyze U.S. state/year panel data, using robust standard errors to correct for heteroscedasticity. Marginal effect plots illustrate substantive effects. The dataset consists of state-level variables drawn from the Uniform Crime Report (UCR), the American Community Survey (ACS), the National Survey on Drug Use and Health, the Correlates of State Policy Project, and the Bureau of Justice Statistics Justice Expenditure and Employment Extracts. Data for the Dark Web interest measure are drawn from Google Trends. The proxy for Dark Web interest is an index of eight Dark Web related search queries.ResultsThe regression analysis indicates that Dark Web interest in US states positively correlates with cannabis consumption rates overall and among older adults (26+), but not youth (12–17) or younger adults (18–25). Additionally, Dark Web interest is positively associated with more frequent cannabis usage rates (i.e. use in the past month, excluding first time use) both overall and among older adults, but not among youth or younger adults. Dark Web interest does not correlate with casual use (i.e. use in the last year, excluding use in the past month) for any age bracket. Interacting Dark Web interest with state-level legalization regimes indicates that the association between Dark Web interest and cannabis consumption in the past year is no different in medically legalized states and amplified in states with recreational legalization. Lastly, the Dark Web interest term does not correlate with first time cannabis either overall or for any age category.ConclusionsInterest in the Dark Web is associated with increased cannabis use in U.S. states from 2011–2015, but the effect is concentrated in states with more frequent cannabis users, older users, and in states with recreational legalization of cannabis.     

High-Intensity Drug Use and Health Service Access Among Street-Involved Youth in a Canadian Setting

Background/Objectives: Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high-intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access.

Methods: Data were derived from the At-Risk Youth Study, a Vancouver-based prospective cohort of street-involved youth aged 14–26. We used generalized estimating equations to examine variables associated with high-intensity drug use, defined as daily use of crack cocaine, cocaine, heroin, or crystal methamphetamine. Results: From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high-intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age (Adjusted Odds Ratio [AOR] = 1.47); residing in the Downtown Eastside of Vancouver (AOR = 1.46); homelessness (AOR = 1.30); recent incarceration (AOR = 1.25); inability to access addiction treatment (AOR = 1.42); and crack pipe sharing and/or used syringe injecting (AOR = 2.64), were all positively and independently associated with high-intensity drug use (p < 0.05). The most common barrier to accessing addiction treatment reported by these youth was long waiting lists. Conclusions: High-intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.