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    Research News Roundup: May 11, 2023

    Associations Between E-Cigarette Policies and Adolescent Use and Access to E-Cigarettes

    Journal: Drug and Alcohol Dependence Reports, 2023, doi: 10.1016/j.dadr.2023.100157

    Authors: Alexandra Pastrana, Christopher F. Baum & Summer Sherburne Hawkins


    Background: Tobacco control policies have been adapted to address rising levels of adolescent e-cigarette use. Despite new restrictions, adolescents are continuing to access e-cigarettes.

    Methods: We linked 2015-2019 Youth Risk Behavior Survey data on 503,154 14-18-year-olds from 40 states with state-level e-cigarette minimum legal sales age (MLSA) laws, taxes, and smoke-free legislation. Using two-way fixed effects probit regression models, we first examined the associations between these statewide e-cigarette policies and adolescent use and, second, with access to e-cigarettes. We subsequently tested interactions between age and each policy and present average marginal effects as percentage point (pp) changes.

    Results: While MLSA laws for e-cigarettes were associated with slight increases in e-cigarette use (2.72 pp; 1.29, 4.15), associations were no longer significant after at least 1-year post-implementation. MLSA laws were also associated with decreases in e-cigarette purchases in stores (-9.50 pp; -18.21, -0.79) and increases in acquiring them from someone else (13.26 pp; 4.10, 22.42), particularly among 18-year-olds. E-cigarette taxes were associated with decreases in use (-9.18 pp; -11.63, -6.73), but there were limited associations with e-cigarette access. While smoke-free legislation prohibiting e-cigarettes was associated with slight increases in use (1.87 pp; 0.23, 3.50), after at least 1-year post-implementation, they were associated with decreases in use. Smoke-free legislation was also associated with decreases in purchases in stores by 14-year-olds, but increases in online purchases by 18-year-olds.

    Conclusion: Understanding the immediate and longer-term consequences of e-cigarette policies is essential to influence adolescent e-cigarette use. Adolescents will continue acquiring e-cigarettes across varying sources if measures are not taken to address access alongside policies aimed at reducing use.

    To read the full text of the article, please visit the publisher’s website.

    Patient Feedback on a Mobile Medication Adherence App for Buprenorphine and Naloxone: Closed and Open-Ended Survey on Feasibility and Acceptability

    Journal: JMIR Formative Research, 2023, doi: 10.2196/40437

    Authors: Crystal L. Smith, Abigail Keever, Theresa Bowden, Katie Olson, Nicole Rodin, Michael G. McDonell, John M. Roll, … Sterling M. McPherson


    Background: Opioid use disorders impact the health and well-being of millions of Americans. Buprenorphine and naloxone (BUP and NAL) can reduce opioid overdose deaths, decrease misuse, and improve quality of life. Unfortunately, poor medication adherence is a primary barrier to the long-term efficacy of BUP and NAL.

    Objective: We aimed to examine patient feedback on current and potential features of a Bluetooth-enabled pill bottle cap and associated mobile app for patients prescribed BUP and NAL for an opioid use disorder, and to solicit recommendations for improvement to effectively and appropriately tailor the technology for people in treatment for opioid use disorder.

    Methods: A convenience sample of patients at an opioid use disorder outpatient clinic were asked about medication adherence, opioid cravings, experience with technology, motivation for treatment, and their existent support system through a brief e-survey. Patients also provided detailed feedback on current features and features being considered for inclusion in a technology designed to increase medication adherence (eg, inclusion of a personal motivational factor, craving and stress tracking, incentives, and web-based coaching). Participants were asked to provide suggestions for improvement and considerations specifically applicable to people in treatment for opioid use disorder with BUP and NAL.

    Results: Twenty people with an opioid use disorder who were prescribed BUP and NAL participated (mean age 34, SD 8.67 years; 65% female; 80% White). Participants selected the most useful, second-most useful, and least useful features presented; 42.1% of them indicated that motivational reminders would be most useful, followed by craving and stress tracking (26.3%) and web-based support forums (21.1%). Every participant indicated that they had at least 1 strong motivating factor for staying in treatment, and half (n=10) indicated children as that factor. All participants indicated that they had, at some point in their lives, the most extreme craving a person could have; however, 42.1% indicated that they had no cravings in the last month. Most respondents (73.7%) stated that tracking cravings would be helpful. Most respondents (84.2%) also indicated that they believed reinforcers or prizes would help them achieve their treatment goals. Additionally, 94.7% of respondents approved of adherence tracking to accommodate this feature using smart packaging, and 78.9% of them approved of selfie videos of them taking their medication.

    Conclusions: Engaging patients taking treatment for opioid use disorder with BUP and NAL allowed us to identify preferences and considerations that are unique to this treatment area. As the technology developer of the pill cap and associated mobile app is able to take into consideration or integrate these preferences and suggestions, the smart cap and associated mobile app will become tailored to this population and more useful for them, which may encourage patient use of the smart cap and associated mobile app.

    To read the full text of the article, please visit the publisher’s website.

    Reducing Prenatal Alcohol Exposure and the Incidence of FASD: Is the Past Prologue?

    Journal: Alcohol Research: Current Reviews, 2023, doi: 10.35946/arcr.v43.1.02

    Author: Grace Chang


    Purpose: This narrative review summarizes and synthesizes the clinical trials and randomized clinical trials that evaluated selected and targeted approaches to reducing preconception and prenatal alcohol exposure (PAE) and alcohol-exposed pregnancy (AEP) since 2011.

    Search Methods: A professional hospital librarian completed the primary search using strategies specified within this review, resulting in 94 records returned in PubMed, Ovid MEDLINE, Clinical Key, the World Health Organization International Clinical Trials Registry Platform, and The author completed two supplementary literature searches.

    Search Results: From the total of 238 records returned from the three searches, 217 records were eliminated. Elimination reasons included other medical problem (119); duplicate entry (34); no content/results (23); secondary analysis (16); focus on effects of PAE (9); treatment of childhood fetal alcohol spectrum disorders (FASD) (6); maternal risk factors (3); and other (7). The remaining 21 studies were included with four overarching themes: (1) case management efforts (n = 4); (2) preconception efforts to reduce AEP (n = 5); (3) motivational interviewing and screening, brief intervention, and referral to treatment (n = 2); and (4) use of technology to deliver the intervention (n = 10).

    Discussion and Conclusions: Case management and home visits did not appear to have strong current empirical support. Study limitations included small sample sizes and no comparison groups, whereas larger efforts did not demonstrate definitive advantages to justify this intensive approach. The studies of preconception efforts, all based on the Project CHOICES approach, had similar outcomes, with the reduction in AEP risk largely due to improved contraception in women of childbearing age who were sexually active and drank alcohol but were not pregnant. It is unknown whether these women refrained from alcohol use when they became pregnant. Two studies of motivational interviewing to reduce prenatal alcohol use did not demonstrate the efficacy of the intervention. Both were small, with less than 200 pregnant women combined; moreover, the study samples had low baseline levels of alcohol use, allowing little opportunity for improvement. Finally, studies evaluating the impact of technological approaches to reducing AEP were reviewed. These exploratory investigations had small sample sizes and provided preliminary evaluations of techniques such as text messages, telephone contact, computer-based screening, and motivational interviewing. The potentially promising findings may inform future research and clinical efforts. Future directions may include research to address the limitations of the evidence to date and should reflect the complexities of FASD that include the biological and social context associated with prenatal alcohol use.

    To read the full text of the article, please visit the publisher’s website.

    Preliminary Feasibility of Integrating Tobacco Treatment into SUD Peer Recovery Coaching: A Mixed-Methods Study of Peer Recovery Coaches

    Journal: Addiction Science & Clinical Practice, 2023,

    Authors: Joanna M. Streck, Susan Regan, Michael Werner, Alexia Glynn, Andrea C. Villanti, Elyse R. Park, Sarah E. Wakeman, A. Eden Evins & Nancy A. Rigotti


    Background: Individuals with substance use disorder (SUD) have high prevalence of cigarette smoking and difficulty quitting. Peer recovery coaches (PRCs; individuals with lived SUD experience) facilitate SUD behavior change in recoverees but it is unknown if/how they address tobacco treatment in SUD recovery coaching. We assessed PRC’s tobacco-related practices and attitudes about tobacco treatment in SUD recovery.

    Methods: The Tobacco use In Peer-recovery Study (TIPS) was a cross-sectional mixed-methods pilot survey (January–March 2022) of the 26 PRCs employed by a Massachusetts-based healthcare system’s 12 SUD treatment clinics/programs. PRCs completed a quantitative survey (n = 23/26; 88%) and a telephone-based qualitative interview (n = 20/26; 77%).

    Results: One-third of PRCs reported current smoking, 50% reported former smoking, and 18% never smoked. Among PRCs, 61% reported accompanying recoverees outdoors to smoke, 26% smoked with recoverees, 17% had provided cigarettes to recoverees, 32% used smoking to help build peer-relationships, and 74% rated smoking as socially acceptable in SUD treatment. PRCs reported regularly talking to recoverees about tobacco treatment (65%), believed they should have a role in helping recoverees quit smoking (52%), and were interested in tobacco treatment training (65%). A majority of both nonsmoking and current smoking PRCs (73% vs. 57%) regularly talked to recoverees about quitting smoking.

    Conclusion: PRCs’ attitudes about integrating tobacco treatment into SUD recovery coaching were generally positive and PRCs reported they could have a role in helping recoverees with tobacco treatment. Barriers to integrating tobacco treatment into SUD recovery include use of cigarettes as a peer-recovery tool and high prevalence and social acceptability of smoking in SUD recovery.

    To read the full text of the article, please visit the publisher’s website.

    Nondisordered Cannabis Use Among US Adolescents

    Journal: JAMA Network Open, 2023, doi: 10.1001/jamanetworkopen.2023.11294

    Authors: Ryan S. Sultan, Alexander W. Zhang, Mark Olfson, Muhire H. Kwizera & Frances R. Levin


    Importance: Cannabis use is increasingly viewed by adolescents as not harmful. Youths with cannabis use disorder (CUD) are recognized by clinicians as being at risk for adverse outcomes, yet little is known about the associations between subclinical cannabis use (ie, nondisordered cannabis use [NDCU]) and adverse psychosocial events.

    Objective: To describe the prevalence and demographics of NDCU and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, NDCU, and CUD.

    Design, Setting, and Participants: This cross-sectional study used a nationally representative sample derived from the 2015 to 2019 National Survey on Drug Use and Health. Participants were adolescents aged 12 to 17 years, separated into 3 distinct groups: nonuse (no recent cannabis use), NDCU (recent cannabis use below diagnostic threshold), and CUD. Analysis was conducted from January to May 2022.

    Exposures: CUD, NDCU, or cannabis nonuse. NDCU was defined as endorsing recent cannabis use but not meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) CUD criteria. CUD was defined using DSM-5 criteria.

    Main Outcomes and Measures: The main outcomes were prevalence of adolescents meeting criteria for NDCU and associations between adverse psychosocial events and NDCU, adjusted for sociodemographic characteristics.

    Results: The 68 263 respondents (mean [SD] age, 14.5 [1.7] years; 34 773 [50.9%] males) included in the analysis represented an estimated yearly mean of 25 million US adolescents during 2015 to 2019. Among respondents, 1675 adolescents (2.5%) had CUD, 6971 adolescents (10.2%) had NDCU, and 59 617 adolescents (87.3%) reported nonuse. Compared with nonusers, individuals with NDCU had approximately 2 to 4 times greater odds of all adverse psychosocial events examined, including major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08), suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29), slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96), difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00), truancy (aOR, 1.90; 95% CI, 1.67-2.16), low grade point average (aOR, 1.80; 95% CI, 1.62-2.00), arrest (aOR, 4.15; 95% CI, 3.17-5.43), fighting (aOR, 2.04; 95% CI, 1.80-2.31), and aggression (aOR, 2.16; 95% CI, 1.79-2.62). Prevalence of adverse psychosocial events was greatest for adolescents with CUD (range, 12.6% to 41.9%), followed by NDCU (range, 5.2% to 30.4%), then nonuse (range, 0.8% to 17.3%).

    Conclusions and Relevance: In this cross-sectional study of US adolescents, past-year NDCU was approximately 4 times as prevalent as past-year CUD. A stepwise gradient association was observed for odds of adverse psychosocial events between adolescent NDCU and CUD. In the context of US normalization of cannabis use, prospective research into NDCU is necessary.

    To read the full text of the article, please visit the publisher’s website.