Patterns of Tobacco Product Use and Substance Misuse among Adolescents in the United States

Journal: Preventive Medicine Reports, 2023, doi: 0.1016/j.pmedr.2023.102207

Authors: John Erhabor, Ellen Boakye, Ngozi Osuji, Olufunmilayo Obisesan, Albert D. Osei, Hassan Mirbolouk, Andrew C. Stokes, … Michael J. Blaha


Among adolescents, sole use is the most common pattern of e-cigarette use. However, concurrent use of e-cigarettes with other tobacco products is not uncommon and may be associated with high-risk behaviors. We used data from 12,767 participants in the 2019 Youth Risk Behavior Survey to examine the patterns of tobacco product use among youth in the US. First, we examined the prevalence of e-cigarette-specific patterns of tobacco use (nonuse[no tobacco product use], sole use[sole e-cigarette use], dual-use[e-cigarette and one other tobacco product], and poly use[e-cigarette and two or more other tobacco products]). Then, using multivariable Poisson regression, we assessed how the tobacco use patterns were associated with the misuse of nine substances of abuse (alcohol, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, injectables, and methamphetamines).

62.9% of youth reported nonuse of any tobacco product. The weighted prevalence of sole e-cigarette use, dual use, and poly use was 23.2%, 4.2%, and 3.3%, respectively. Across all the substances explored, the prevalence was highest among poly users, followed by dual users, sole users, and non-users. Compared to non-users, sole, dual, and poly users had 7.8(95 %CI:6.1–10.0), 14.3(95 %CI:10.8–18.8), and 19.7(95 %CI:15.0–25.9) times higher adjusted prevalence of reporting past-30-day binge drinking, after adjusting for age, sex, race/ethnicity, sexual orientation, and depressive symptoms. This pattern was seen across all the different substances explored. These findings highlight the high prevalence of substance misuse among youth who use tobacco products and the need to educate and counsel on substances of abuse among this population, particularly among poly-tobacco users.

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A Qualitative Exploration of the Eight Dimensions of Wellness in Opioid Use Disorder Recovery During the Postpartum Period

Journal: Drug and Alcohol Dependence Reports, 2023, doi: 10.1016/j.dadr.2023.100160

Authors: Stephanie Mallahan, Julie Armin, Yvonne Bueno, Allison Huff & Alicia Allen


Background: Recovery from opioid use disorder (OUD) during the perinatal period has unique challenges. We examined services for perinatal women with OUD using the Substance Abuse and Mental Health Services Administration (SAMHSA) eight dimensions of wellness (DoW), which reflect whole person recovery.

Methods: We enrolled professionals from the Southwestern United States who work with people with OUD during the perinatal period. Semi-structured in-depth interviews were conducted from April to December 2020. Participants were shown the DoW diagram (emotional, social, environmental, physical, financial, spiritual, occupational, intellectual) and asked to share how their clinic/agency addresses each DoW for perinatal people with OUD. Responses were transcribed and coded by two researchers using Dedoose software.

Results: Thematic analysis revealed ways professionals (n = 11) see how the services they provide fit into the DoW. This included: the need to provide mothers emotional support with a nonjudgmental approach, groups providing social support; guidance on nutrition, self-care, and a focus on the mother/infant dyad; assistance with employment and activities of daily living; parenting education; connecting mothers with resources and grants; providing a variety of spiritual approaches depending on the desire of the mother; and navigating the interpersonal environment as well as the physical space.

Conclusions: There are opportunities to expand the treatment and services provided to women with OUD during the perinatal period within all eight DoWs. Additional research is needed to identify effective strategies to incorporate these components into patient-centered, holistic care approaches.

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Associations Between Cannabis Use, Polygenic Liability for Schizophrenia, and Cannabis-related Experiences in a Sample of Cannabis Users

Journal: Schizophrenia Bulletin, 2023, doi: 10.1093/schbul/sbac196

Authors: Emma C. Johnson, Sarah M. Colbert, Paul W. Jeffries, Rebecca Tillman, Tim B. Bigdeli, Nicole R. Karcher, Grace Chan, … Arpana Agrawal


Background and hypothesis: Risk for cannabis use and schizophrenia is influenced in part by genetic factors, and there is evidence that genetic risk for schizophrenia is associated with subclinical psychotic-like experiences (PLEs). Few studies to date have examined whether genetic risk for schizophrenia is associated with cannabis-related PLEs.

Study design: We tested whether measures of cannabis involvement and polygenic risk scores (PRS) for schizophrenia were associated with self-reported cannabis-related experiences in a sample ascertained for alcohol use disorders (AUDs), the Collaborative Study on the Genetics of Alcoholism (COGA). We analyzed 4832 subjects (3128 of European ancestry and 1704 of African ancestry; 42% female; 74% meeting lifetime criteria for an AUD).

Study results: Cannabis use disorder (CUD) was prevalent in this analytic sample (70%), with 40% classified as mild, 25% as moderate, and 35% as severe. Polygenic risk for schizophrenia was positively associated with cannabis-related paranoia, feeling depressed or anhedonia, social withdrawal, and cognitive difficulties, even when controlling for duration of daily cannabis use, CUD, and age at first cannabis use. The schizophrenia PRS was most robustly associated with cannabis-related cognitive difficulties (β = 0.22, SE = 0.04, P = 5.2e-7). In an independent replication sample (N = 1446), associations between the schizophrenia PRS and cannabis-related experiences were in the expected direction and not statistically different in magnitude from those in the COGA sample.

Conclusions: Among individuals who regularly use cannabis, genetic liability for schizophrenia-even in those without clinical features-may increase the likelihood of reporting unusual experiences related to cannabis use.

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Gender Differences in Family Meal Frequency and Their Association with Substance Use and Mental Health Among Middle and High School Students

Journal: Frontiers in Public Health, 2023, doi: 10.3389/fpubh.2023.1123396

Authors: Ting Luo, Sharon E. Cummins, & Shu-Hong Zhu


Background: Family meals are associated with adolescent health outcomes. Studies have reported that girls are less likely than boys to have dinner with their families.

Purpose: This study examined gender differences in family meal frequency and the relationship between meal frequency and other health measures, using a large and representative sample of California middle and high school students.

Methods: This study analyzed data from the 2019-2020 California Student Tobacco Survey (159,904 students in grades 8, 10, and 12). Dinner with the family 5-7 times per week was defined as high frequency. Students reported substance use (of tobacco, marijuana, and alcohol) and rated their mental health and happiness in their home life. All analyses were weighted to reflect the California student population.

Results: Fewer than half (44.7%) of students reported a high frequency of family meals, with boys more likely than girls and those who identified their gender in another way the least likely to do so (48.3%, 42.2%, 34.0%, respectively). Gender differences persisted across demographics and the quality of family relationships, and were evident as early as eighth grade. Less frequent family meals were associated with poorer mental health (OR = 1.34, 95% CI: 1.29-1.40) and substance use (OR = 1.27, 95% CI: 1.21-1.32), controlling for the effects of demographics and family dynamics.

Conclusion: Gender differences in family meal frequency emerge early in adolescence and persist across demographics and family relationships. Given that family meals play a protective role in an adolescent’s life, these gender differences are concerning.

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Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes

Journal: JAMA Network Open, 2023, doi: 10.1001/jamanetworkopen.2023.14328

Authors: Erin A. Taylor, Jonathan H. Cantor, Ashley C. Bradford, Kosali Simon, & Bradley D. Stein


Importance: A significant proportion of Medicare beneficiaries have a diagnosed opioid use disorder (OUD). Methadone and buprenorphine are both effective medications for the treatment of OUD (MOUDs); however, Medicare did not cover methadone until 2020.

Objective: To examine trends in methadone and buprenorphine dispensing among Medicare Advantage (MA) enrollees after 2 policy changes in 2020 related to methadone access.

Design, setting, and participants: This cross-sectional analysis of temporal trends in methadone and buprenorphine treatment dispensing assessed MA beneficiary claims from January 1, 2019, through March 31, 2022, captured by Optum’s Clinformatics Data Mart. Of 9 870 791 MA enrollees included in the database, 39 252 had at least 1 claim for methadone, buprenorphine, or both during the study period. All available MA enrollees were included. Subanalyses by age and dual eligibility for Medicare and Medicaid status were conducted.

Exposures: Study exposures were (1) the Centers for Medicare & Medicaid Services (CMS) Medicare bundled payment reimbursement policy for OUD treatment and (2) the Substance Abuse and Mental Health Administration and CMS Medicare policies designed to facilitate access to treatment for OUD, specifically during the COVID-19 pandemic.

Main outcomes and measures: Study outcomes were trends in methadone and buprenorphine dispensing by beneficiary characteristics. National methadone and buprenorphine dispensing rates were calculated as claims-based dispensing rates per 1000 MA enrollees.

Results: Among the 39 252 MA enrollees with at least 1 MOUD dispensing claim (mean age, 58.6 [95% CI, 58.57-58.62] years; 45.9% female), 195 196 methadone claims and 540 564 buprenorphine pharmacy claims were identified, for a total of 735 760 dispensing claims. The methadone dispensing rate for MA enrollees was 0 in 2019 because the policy did not allow any payment until 2020. Claims rates per 1000 MA enrollees were low initially, increasing from 0.98 in the first quarter of 2020 to 4.71 in the first quarter of 2022. Increases were primarily associated with dually eligible beneficiaries and beneficiaries younger than 65 years. National buprenorphine dispensing rates were 4.64 per 1000 enrollees in quarter 1 of 2019, increasing to 7.45 per 1000 enrollees in quarter 1 of 2022.

Conclusions and relevance: This cross-sectional study found that methadone dispensing increased among Medicare beneficiaries after the policy changes. Rates of buprenorphine dispensing did not provide evidence that beneficiaries substituted buprenorphine for methadone. The 2 new CMS policies represent an important first step in increasing access to MOUD treatment for Medicare beneficiaries.

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