Browsing by Subject "Marijuana Smoking"
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Item Open Access A dimensional approach to understanding severity estimates and risk correlates of marijuana abuse and dependence in adults.(International journal of methods in psychiatric research, 2012-06) Wu, Li-Tzy; Woody, George E; Yang, Chongming; Pan, Jeng-Jong; Reeve, Bryce B; Blazer, Dan GWhile item response theory (IRT) research shows a latent severity trait underlying response patterns of substance abuse and dependence symptoms, little is known about IRT-based severity estimates in relation to clinically relevant measures. In response to increased prevalences of marijuana-related treatment admissions, an elevated level of marijuana potency, and the debate on medical marijuana use, we applied dimensional approaches to understand IRT-based severity estimates for marijuana use disorders (MUDs) and their correlates while simultaneously considering gender- and race/ethnicity-related differential item functioning (DIF). Using adult data from the 2008 National Survey on Drug Use and Health (N = 37,897), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MUDs among past-year marijuana users were examined by IRT, logistic regression, and multiple indicators-multiple causes (MIMIC) approaches. Among 6917 marijuana users, 15% met criteria for a MUD; another 24% exhibited subthreshold dependence. Abuse criteria were highly correlated with dependence criteria (correlation = 0.90), indicating unidimensionality; item information curves revealed redundancy in multiple criteria. MIMIC analyses showed that MUD criteria were positively associated with weekly marijuana use, early marijuana use, other substance use disorders, substance abuse treatment, and serious psychological distress. African Americans and Hispanics showed higher levels of MUDs than Whites, even after adjusting for race/ethnicity-related DIF. The redundancy in multiple criteria suggests an opportunity to improve efficiency in measuring symptom-level manifestations by removing low-informative criteria. Elevated rates of MUDs among African Americans and Hispanics require research to elucidate risk factors and improve assessments of MUDs for different racial/ethnic groups.Item Open Access Alcohol, drugs, caffeine, tobacco, and environmental contaminant exposure: reproductive health consequences and clinical implications.(Critical reviews in toxicology, 2010-08) Sadeu, JC; Hughes, Claude L; Agarwal, Sanjay; Foster, Warren GReproductive function and fertility are thought to be compromised by behaviors such as cigarette smoking, substance abuse, and alcohol consumption; however, the strength of these associations are uncertain. Furthermore, the reproductive system is thought to be under attack from exposure to environmental contaminants, particularly those chemicals shown to affect endocrine homeostasis. The relationship between exposure to environmental contaminants and adverse effects on human reproductive health are frequently debated in the scientific literature and these controversies have spread into the lay press drawing increased public and regulatory attention. Therefore, the objective of the present review was to critically evaluate the literature concerning the relationship between lifestyle exposures and adverse effects on fertility as well as examining the evidence for a role of environmental contaminants in the purported decline of semen quality and the pathophysiology of subfertility, polycystic ovarian syndrome, and endometriosis. The authors conclude that whereas cigarette smoking is strongly associated with adverse reproductive outcomes, high-level exposures to other lifestyle factors are only weakly linked with negative fertility impacts. Finally, there is no compelling evidence that environmental contaminants, at concentrations representative of the levels measured in contemporary biomonitoring studies, have any effect, positive or negative, on reproductive health in the general population. Further research using prospective study designs with robust sample sizes are needed to evaluate testable hypotheses that address the relationship between exposure and adverse reproductive health effects.Item Open Access Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST.(Journal of substance abuse treatment, 2017-05) Schwartz, RP; McNeely, J; Wu, LT; Sharma, G; Wahle, A; Cushing, C; Nordeck, CD; Sharma, A; O'Grady, KE; Gryczynski, J; Mitchell, SG; Ali, RL; Marsden, J; Subramaniam, GAThere is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST.Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses.The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications.The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.Item Open Access Illicit and nonmedical drug use among Asian Americans, Native Hawaiians/Pacific Islanders, and mixed-race individuals.(Drug and alcohol dependence, 2013-12) Wu, Li-Tzy; Blazer, Dan G; Swartz, Marvin S; Burchett, Bruce; Brady, Kathleen T; NIDA AAPI WorkgroupThe racial/ethnic composition of the United States is shifting rapidly, with non-Hispanic Asian-Americans, Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race individuals the fastest growing segments of the population. We determined new drug use estimates for these rising groups. Prevalences among Whites were included as a comparison.Data were from the 2005-2011 National Surveys on Drug Use and Health. Substance use among respondents aged ≥ 12 years was assessed by computer-assisted self-interviewing methods. Respondents' self-reported race/ethnicity, age, gender, household income, government assistance, county type, residential stability, major depressive episode, history of being arrested, tobacco use, and alcohol use were examined as correlates. We stratified the analysis by race/ethnicity and used logistic regression to estimate odds of drug use.Prevalence of past-year marijuana use among Whites increased from 10.7% in 2005 to 11.6-11.8% in 2009-2011 (P<0.05). There were no significant yearly changes in drug use prevalences among Asian-Americans, NHs/PIs, and mixed-race people; but use of any drug, especially marijuana, was prevalent among NHs/PIs and mixed-race people (21.2% and 23.3%, respectively, in 2011). Compared with Asian-Americans, NHs/PIs had higher odds of marijuana use, and mixed-race individuals had higher odds of using marijuana, cocaine, hallucinogens, stimulants, sedatives, and tranquilizers. Compared with Whites, mixed-race individuals had greater odds of any drug use, mainly marijuana, and NHs/PIs resembled Whites in odds of any drug use.Findings reveal alarmingly prevalent drug use among NHs/PIs and mixed-race people. Research on drug use is needed in these rising populations to inform prevention and treatment efforts.Item Open Access Is inhalant use a risk factor for heroin and injection drug use among adolescents in the United States?(Addictive behaviors, 2007-02) Wu, Li-Tzy; Howard, Matthew OWe examined whether inhalant use was associated with heroin and injection drug use (IDU) among adolescents aged 12 to 17 in the United States.Data were drawn from the 2002/2003 administrations of the National Survey on Drug Use and Health (NSDUH). We conducted logistic regression analyses to estimate associations of inhalant use with heroin use, heroin injection, and IDU, respectively, among adolescent drug users (N=8161).Approximately 30.9% of adolescents had ever used at least one illicit drug. More than one-fifth (22.2%) of adolescents were past-year or recent drug users. Among past-year adolescent drug users, 1.4% had progressed to heroin use and 1.2% reported IDU. Adolescents who had used inhalants and marijuana were 2.8 and 2.9 times as likely as adolescents who had used marijuana but not inhalants to report heroin use and any IDU, respectively. Adolescents who had used inhalants or other drugs but not marijuana were unlikely to use heroin. However, inhalant users, irrespective of their marijuana use histories, had greater odds of IDU than drug users who had not used inhalants. Adolescent drug users who were females, school dropouts, whites, or delinquents had significantly increased odds of heroin use and IDU. Cigarette smoking before the age of 15 was strongly associated with heroin use, and a history of foster care placement was associated with IDU.This national study of American adolescents identifies several subgroups of recent drug users, such as females, school dropouts, and youth who have used inhalants and marijuana, which have substantially increased odds of heroin use and IDU. Screening, prevention, and treatment interventions targeted to these groups might reduce medical and social complications of heroin use and IDU.Item Open Access Perceived cannabis use norms and cannabis use among adolescents in the United States.(J Psychiatr Res, 2015-05) Wu, Li-Tzy; Swartz, Marvin S; Brady, Kathleen T; Hoyle, Rick H; NIDA AAPI WorkgroupDue to changes in cannabis policies, concerns about cannabis use (CU) in adolescents have increased. The population of nonwhite groups is growing quickly in the United States. We examined perceived CU norms and their association with CU and CU disorder (CUD) for White, Black, Hispanic, Native-American, Asian-American, Native Hawaiian/Pacific Islander (NH/PI), and mixed-race adolescents. Data were from adolescents (12-17 years) in the 2004-2012 National Surveys on Drug Use and Health (N = 163,837). Substance use and CUD were assessed by computer-assisted, self-interviewing methods. Blacks, Hispanics, Native-Americans, and mixed-race adolescents had greater odds of past-year CU and CUD than Whites. Among past-year cannabis users (CUs), Hispanics and Native-Americans had greater odds of having a CUD than Whites. Asian-Americans had the highest prevalence of perceived parental or close friends' CU disapproval. Native-Americans and mixed-race adolescents had lower odds than Whites of perceiving CU disapproval from parents or close friends. In adjusted analyses, adolescent's disapproval of CU, as well as perceived disapproval by parents or close friends, were associated with a decreased odds of CU in each racial/ethnic group, except for NHs/PIs. Adolescent's disapproval of CU was associated with a decreased odds of CUD among CUs for Whites (personal, parental, and close friends' disapproval), Hispanics (personal, parental, and close friends' disapproval), and mixed-race adolescents (personal, close friends' disapproval). Racial/ethnic differences in adolescent CU prevalence were somewhat consistent with adolescents' reports of CU norm patterns. Longitudinal research on CU health effects should oversample nonwhite adolescents to assure an adequate sample for analysis and reporting.Item Open Access Prevalence and correlates of treatment utilization among adults with cannabis use disorder in the United States.(Drug and alcohol dependence, 2017-08) Wu, Li-Tzy; Zhu, He; Mannelli, Paolo; Swartz, Marvin SThe increase in cannabis potency may have treatment implications for cannabis use disorder (CUD). Given the reported increase in prevalence of cannabis use among adults, there is a need to understand substance use treatment needs for CUD.We examined demographics and behavioral health indicators of adults aged ≥18 years that met criteria for past-year CUD (n=10,943) in the 2005-2013 National Surveys on Drug Use and Health. We determined prevalence and correlates of past-year treatment use for alcohol/drug, any drug, and cannabis use related problems, to inform treatment efforts for CUD.The majority of adults with past-year CUD were young adults aged 18-25 or men, had low income, and did not attend college. Two-thirds of adults with CUD met criteria for cannabis dependence, which was comparatively common among younger adults, women, low-income or publicly insured adults, and college-educated adults. Nicotine dependence (40.92%) and alcohol (44.07%) or other drug use disorder (19.70%) were prevalent among adults with CUD. Overall, less than 13% of adults with CUD had received alcohol/drug use treatment the past year; only 7.8% received cannabis-specific treatment. There was no significant yearly variation in treatment use prevalence over 9 years. In particular, Asian-Americans, women, and college-educated adults underutilized cannabis-specific treatment.This large sample of adults with CUD reveals pervasive underutilization of cannabis-related treatment, especially in women, married adults, and those with college education, despite a high proportion of comorbid behavioral health problems.Item Open Access Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco.(Drug and alcohol dependence, 2019-01) John, William S; Zhu, He; Mannelli, Paolo; Subramaniam, Geetha A; Schwartz, Robert P; McNeely, Jennifer; Wu, Li-TzyBACKGROUND:Current data suggest that opioid misuse or opioid use disorder (OUD) may be over represented among tobacco users. However, this association remains understudied in primary care settings. A better understanding of the extent of heterogeneity in opioid misuse among primary care patients who use tobacco may have implications for improved primary care-based screening, prevention, and intervention approaches. METHODS:Data were derived from a sample of 2000 adult (aged ≥18) primary care patients across 5 distinct clinics. Among past-year tobacco users (n = 882), we assessed the prevalence of opioid misuse and OUD by sociodemographic characteristics and past-year polysubstance use. Latent class analysis (LCA) was used to identify heterogeneous subgroups of tobacco users according to past-year polysubstance use patterns. Multinomial logistic regression was used to examine variables associated with LCA-defined class membership. RESULTS:Past-year tobacco use was reported by >84% of participants who reported past-year opioid misuse or OUD. Among those reporting past-year tobacco use, the prevalence of past-year opioid misuse and OUD was 14.0% and 9.5%, respectively. The prevalence of opioid misuse or OUD was highest among tobacco users who were male or unemployed. Three LCA-defined classes among tobacco users were identified including a tobacco-minimal drug use group (78.0%), a tobacco-cannabis use group (10.1%), and a tobacco-opioid/polydrug use group (11.9%). Class membership differed by sociodemographic characteristics. CONCLUSIONS:Results from this study support the benefit of more comprehensive assessment of and/or monitoring for opioid misuse among primary care patients who use tobacco, particularly for those who are male, unemployed, or polydrug users.Item Open Access Problem alcohol use and healthcare utilization among persons with cannabis use disorder in the United States.(Drug and alcohol dependence, 2017-09) John, William S; Wu, Li-TzyThe emergency department (ED) and hospital settings represent crucial opportunities for engaging treatment for cannabis use disorder (CUD). Thus, there is a need to identify factors associated with healthcare utilization among persons with CUD to improve screening and intervention approaches. Problematic alcohol use may be a salient risk factor.Using data from the 2005-2013 National Surveys on Drug Use and Health, we determined factors, including different patterns of alcohol use, associated with past-year ED admission and inpatient hospitalization among persons aged 12 years or older meeting criteria for CUD in the past year (N=16,757). We also determined the prevalence and correlates of problem alcohol use among persons with CUD to further inform its association with healthcare utilization.Among persons with CUD, 40.15% and 10.04% reported past-year ED admission and inpatient hospitalization, respectively. Severe alcohol use disorder (AUD) (≥6 AUD symptoms), female sex, Black race, low income, major depressive episode (MDE), and other substance use disorders were associated with increased odds of healthcare utilization; current (i.e., last month) alcohol use patterns were not. Persons with CUD that were males, ages 18-25 (vs. ages 12-17), Hispanic (vs. White), and with low income, other drug use disorders, or MDE had increased odds of AUD.Findings suggest that screening and intervention efforts for improving treatment initiation or engagement for CUD may target cannabis-using women, blacks, low-income adults or those with severe AUD in the past year, another substance use disorder, or MDE.Item Open Access Regulatory Focus and Substance Use in Adolescents: Protective Effects of Prevention Orientation.(Substance use & misuse, 2021-01) Franzese, Alexis T; Blalock, Dan V; Blalock, Kyla M; Wilson, Sarah M; Medenblik, Alyssa; Costanzo, Philip R; Strauman, Timothy JBackground
Substance use is a major risk factor for negative health and functioning outcomes among middle schoolers. The purpose of this study was to assess whether individual differences in the adolescents' goal orientation are associated with elevated or attenuated risk for substance use. Regulatory focus theory stipulates that individuals vary in their strength of orientation toward promotion goals ("making good things happen") and prevention goals ("keeping bad things from happening"). Objectives: We sought to examine the association between individual differences in regulatory focus and adolescents' reports of their own and their friends' substance use. Methods: Participants were 241 seventh grade students who completed measures of regulatory focus (promotion and prevention orientation), self-reported substance use, perceived substance use habits of peers, and demographics. Logistic regression models were used to examine adjusted odds of lifetime tobacco use, alcohol use, and marijuana use for both participants' own use and their reports of friends' use. Results: Prevention orientation was associated with lower odds of all self-reported lifetime substance use outcomes (tobacco, alcohol, and marijuana). Prevention orientation was also associated with lower odds of reporting all types of substance use among friends. Promotion orientation was not associated with any self-reported substance use outcome, and was only associated with higher odds of reporting lifetime alcohol use among friends. Conclusions: These findings underscore the importance of regulatory focus as it relates to adolescent substance use. Future research may seek to incorporate regulatory focus within interventions intended to prevent or delay initiation of substance use in adolescents.Item Open Access Substance Use and Suicide in Pacific Islander, American Indian, and Multiracial Youth.(American journal of preventive medicine, 2018-06) Subica, Andrew M; Wu, Li-TzyINTRODUCTION:National estimates of U.S. Native Hawaiian and other Pacific Islander (NHPI), American Indian/Alaskan Native (AIAN), and multiracial adolescent substance use and suicidality are scarce because of their small population sizes. The aim was to estimate the national prevalence of, and disparities in, substance use and suicidality among these understudied adolescents. METHODS:Analyses conducted in 2017 of U.S. adolescents (grades ninth to 12th) from the 1991-2015 Combined National Youth Behavioral Risk Surveys estimated (1) prevalence of lifetime and current (past 30-day) substance use, past 12-month depressed mood, and suicidality by racial group; and (2) AORs for depressed mood and suicidality regressed on current alcohol, cigarette, and marijuana use. RESULTS:Among 184,494 U.S. adolescents, alcohol, cigarettes, and marijuana were commonly used with lifetime prevalence of 75.32%, 58.11%, and 40.55%, respectively, and current prevalence of 44.51%, 24.58%, and 22.01%, respectively. Past 12-month prevalence of suicidal thoughts, suicide planning, and attempted suicide were 18.87%, 14.75%, and 7.98%, respectively. Relative to non-Hispanic whites, NHPI, AIAN, and multiracial adolescents had higher prevalence of using many illicit substances (e.g., marijuana, heroin), depressed mood, and suicidal thoughts, planning, and attempts (p<0.05). Except for NHPIs and current alcohol use, current alcohol and cigarette use were independently associated with 2.0-2.3 times greater AORs (p<0.05) for attempted suicide among the target adolescents. CONCLUSIONS:U.S. NHPI, AIAN, and multiracial adolescents are disproportionately burdened by illicit substance use, depressed mood, and suicidality. Current alcohol and cigarette use may predispose these adolescents toward suicidality, offering potential pathways to alleviate suicide risk.Item Open Access Suicidal ideation and substance use among adolescents and young adults: a bidirectional relation?(Drug and alcohol dependence, 2014-09) Zhang, Xiaoyun; Wu, Li-TzyTo examine reciprocal associations between substance use (cigarette smoking, use of alcohol, marijuana, and other illegal drugs) and suicidal ideation among adolescents and young adults (aged 11-21 at wave 1; aged 24-32 at wave 4).Four waves public-use Add Health data were used in the analysis (N=3342). Respondents were surveyed in 1995, 1996, 2001-2002, and 2008-2009. Current regular smoking, past-year alcohol use, past-year marijuana use, and ever use of other illegal drugs as well as past-year suicidal ideation were measured at the four waves (1995, 1996, 2001-2002, and 2008-2009). Fixed effects models with lagged dependent variables were modeled to test unidirectional associations between substance use and suicidal ideation, and nonrecursive models with feedback loops combining correlated fixed factors were conducted to examine reciprocal relations between each substance use and suicidal ideation, respectively.After adjusting for the latent time-invariant effects and lagged effects of dependent variables, the unidirectional associations from substance use to suicidal ideation were consistently significant, and vice versa. Nonrecursive model results showed that use of cigarette or alcohol increased risk of suicidal ideation, while suicidal ideation was not associated with cigarette or alcohol use. Reversely, drug use (marijuana and other drugs) did not increase risk of suicidal ideation, but suicidal ideation increased risk of illicit drug use.The results suggest that relations between substance use and suicidal ideation are unidirectional, with cigarette or alcohol use increasing risk of suicidal ideation and suicidal ideation increasing risk of illicit drug use.Item Open Access Trends in cannabis use disorders among racial/ethnic population groups in the United States.(Drug and alcohol dependence, 2016-08) Wu, Li-Tzy; Zhu, He; Swartz, Marvin SBACKGROUND:Minority groups generally experience more disparities than whites in behavioral healthcare use. The population of racial/ethnic groups is growing faster than whites. Given increased concerns of cannabis use (CU) and its associations with health conditions, we examined national trends in cannabis use disorder (CUD) among adults aged ≥18 by race/ethnicity. METHODS:Data were from the 2005-2013 National Surveys on Drug Use and Health (N=340,456). We compared CU patterns and the conditional prevalence of CUD among cannabis users by race/ethnicity to understand racial/ethnic variations in CUD. RESULTS:Approximately 1.5% of adults met criteria for a CUD in the past year. Regardless of survey year, cannabis dependence was more common than cannabis abuse, representing 66% of adults with a CUD. Across racial/ethnic groups, the prevalence of cannabis abuse and dependence remained stable during 2005-2013. In the total adult sample, the odds of weekly CU, monthly CU, and cannabis dependence were greater among blacks, native-Americans, and mixed-race adults than whites. Among cannabis users, the odds of cannabis abuse and dependence were greater among blacks, native-Americans, and Hispanics than whites. Logistic regression controlling for age, sex, education, and survey year indicated an increased trend in monthly CU and weekly CU in the total sample and among past-year cannabis users. Younger age, male sex, and low education were associated with increased odds of cannabis dependence. CONCLUSIONS:The large sample provides robust information that indicates a need for research to monitor CUD and identify culturally appropriate interventions especially for targeting minority populations.