Dana A. Cavallo

Video-Gaming Among High School Students: Health Correlates, Gender Differences, and Problematic Gaming

OBJECTIVE: Video game playing may negatively impact youth. However, the existing literature on gaming is inconsistent and often has focused on aggression rather than the health correlates of gaming and the prevalence and correlates of problematic gaming. METHODS: We anonymously surveyed 4028 adolescents about gaming and reported problems with gaming and other health behaviors. A total of 51.2% of the sample reported gaming (76.3% of boys and 29.2% of girls). RESULTS: There were no negative health correlates of gaming in boys and lower odds of smoking regularly; however, girls who reported gaming were less likely to report depression and more likely to report getting into serious fights and carrying a weapon to school. Among gamers, 4.9% reported problematic gaming, defined as reporting trying to cut back, experiencing an irresistible urge to play, and experiencing a growing tension that could only be relieved by playing. Boys were more likely to report these problems (5.8%) than girls (3.0%). Correlates of problematic gaming included regular cigarette smoking, drug use, depression, and serious fights. Results suggest that gaming is largely normative in boys and not associated with many health factors. In girls, however, gaming seems to be associated with more externalizing behaviors and fewer internalizing symptoms. CONCLUSIONS: The prevalence of problematic gaming is low but not insignificant, and problematic gaming may be contained within a larger spectrum of externalizing behaviors. More research is needed to define safe levels of gaming, refine the definition of problematic gaming, and evaluate effective prevention and intervention strategies.

E-cigarette Use Among High School and Middle School Adolescents in Connecticut

INTRODUCTION There is limited evidence on electronic cigarette (e-cigarette) use among U.S. adolescents. METHODS Cross-sectional, anonymous surveys conducted in 4 high schools (HS; n = 3,614) and 2 middle schools (MS; n = 1,166) in Connecticut in November 2013 examined e-cigarette awareness, use patterns, susceptibility to future use, preferences, product components used (battery type, nicotine content, flavors), and sources of marketing and access. RESULTS High rates of awareness (MS: 84.3%; HS: 92.0%) and of lifetime (3.5% MS, 25.2 % HS) and current (1.5% MS, 12% HS) use of e-cigarettes was observed. Among those who had not tried e-cigarettes, 26.4% of MS and 31.7% of HS students reported being susceptible to future use. Males (OR = 1.70, p < .01), older students (OR = 1.39, p < .05), Caucasians (OR = 2.01, p < .001), ever cigarette smokers (OR = 13.04, p < .001), and current cigarette smokers (OR = 65.11, p < .001) were more likely to be lifetime e-cigarette users and to report greater future susceptibility (males: OR = 1.30; Caucasians: OR = 1.14; ever cigarette smokers; OR = 3.85; current cigarette smokers; OR = 9.81; ps < .01-.001). Among MS students who were lifetime e-cigarette users, 51.2% reported that e-cigarette was the first tobacco product they had tried. E-cigarettes that were rechargeable and had sweet flavors were most popular. Smokers preferred e-cigarettes to cigarettes. Current cigarette smokers were more likely to initiate with nicotine-containing e-cigarettes, and ever and never cigarette smokers to initiate with e-cigarettes without nicotine. Primary sources for e-cigarette advertisements were televisions and gas stations and, for acquiring e-cigarettes, were peers. CONCLUSIONS Longitudinal monitoring of e-cigarette use among adolescents and establishment of policies to limit access are imperatively needed.

Trends in use of electronic nicotine delivery systems by adolescents

Electronic nicotine delivery systems (ENDS) have been gaining in popularity. The few prevalence studies in adults have found that most ENDS users are current or former smokers. The objectives of this study were to estimate the prevalence of ENDS usage in adolescents, and examine the correlates of use. Self-administered written surveys assessing tobacco use behaviors were conducted in multiple waves as part of a larger intervention study in two large suburban high schools. The prevalence of past-30 day ENDS use increased from 0.9% in February 2010 to 2.3% in June 2011 (p=0.009). Current cigarette smokers had increased odds of past-30 day ENDS use in all study waves. When adjusted for school, grade, sex, race and smoking status, students in October 2010 (Adjusted OR 2.12; 95% confidence interval (CI): 1.12-4.02) and June 2011 (Adjusted OR 2.51; 95% CI: 1.17-4.71) had increased odds past-30 day ENDS use compared to February 2010. The prevalence of ENDS use doubled in this sample of high school students, and current cigarette smoking is the strongest predictor of current use. Continued monitoring of ENDS is needed to determine whether it increases the likelihood of cigarette smoking initiation and maintenance in youth.

Contingency management for smoking cessation in adolescent smokers.

This pilot study evaluated the use of contingency management (CM) procedures in combination with cognitive-behavioral therapy (CBT) for smoking cessation in adolescents. Twenty-eight treatment-seeking adolescent smokers participated in a 1-month, school-based smoking cessation program and were randomly assigned to receive either CM with weekly CBT or CBT alone. In the CM+CBT group, biochemical verification of abstinence was obtained twice daily during the first 2 weeks, followed by daily appointments during the 3rd week and once every other day during the 4th week. Participants were monetarily reinforced for abstinence on an escalating magnitude schedule with a reset contingency. At the end of 1 week and 1 month of treatment, abstinence verified using quantitative urine cotinine levels was higher in participants in the CM+CBT group (1 week: 76.7%; 1 month: 53.0%) when compared with the CBT-alone group (1 week: 7.2%; 4 weeks: 0%). These preliminary results provide a strong initial signal supporting the utility of CM techniques for smoking cessation in adolescents and demonstrate the feasibility of implementing such a program in a school setting.

High School Students’ Use of Electronic Cigarettes to Vaporize Cannabis

BACKGROUND AND OBJECTIVES: Electronic cigarette (e-cigarette) use is increasing rapidly among high school (HS) students. Of concern, e-cigarettes can be used to vaporize cannabis, although use rates among adolescents are unknown. We evaluated lifetime rates of using e-cigarettes to vaporize cannabis among all lifetime e-cigarette users (27.9%), all lifetime cannabis users (29.2%), and lifetime users of both e-cigarettes and cannabis (18.8%); common means of vaporizing cannabis including hash oil, wax infused with Δ-9-tetrahydrocannabinol (THC), and dried cannabis; and demographic predictors of using e-cigarettes to vaporize cannabis. METHODS: In the spring of 2014, 3847 Connecticut HS students completed an anonymous survey assessing e-cigarette and cannabis use. RESULTS: Vaporizing cannabis using e-cigarettes was common among lifetime e-cigarette users, lifetime cannabis users, and lifetime dual users (e-cigarette 18.0%, cannabis 18.4%, dual users 26.5%). Students reported using e-cigarettes to vaporize hash oil (e-cigarette 15.4%, cannabis 15.5%, dual users 22.9%) and wax infused with THC (e-cigarette 10.0%, cannabis 10.2%, dual users 14.8%) and using portable electronic vaporizers to vaporize dried cannabis leaves (e-cigarette 19.6%, lifetime cannabis 23.1%, lifetime dual users 29.1%). Binary logistic regression indicated that male students (odds ratio [OR] = 2.05), younger students (OR = 0.64), lifetime e-cigarette users (OR = 5.27), and lifetime cannabis users (OR = 40.89) were most likely to vaporize cannabis using e-cigarettes. Rates also differed by HS attended. CONCLUSIONS: Rates of vaporizing cannabis using e-cigarettes were high. These findings raise concerns about the lack of e-cigarette regulations and the potential use of e-cigarettes for purposes other than vaping nicotine.

Problematic Internet Use and Health in Adolescents: Data from a High School Survey in Connecticut

OBJECTIVE This study aims to explore the prevalence and health correlates of problematic Internet use among high school students in the United States. METHOD A cross-sectional survey with a sample size of 3,560 students was conducted among high schools in Connecticut. Demographic data, characteristics of Internet use, health measures, and risk behaviors were assessed. Chi-square and logistic regression analyses were used to study the relationship between problematic Internet use and risk behaviors as well as related gender differences. RESULTS When problematic Internet use was diagnosed with criteria modeled after the Minnesota Impulsive Disorder Inventory that address core features of impulse-control disorder (strong urge, growing tension, and attempts to cut back), the overall prevalence was about 4%, with no significant difference between genders. Problematic Internet use was more common among Asian (7.86%) and Hispanic (6.07%) students. Even though boys spent significantly more time on the Internet (16.52% of boys spent over 20 hours per week vs 12.62% of girls; P = .0001) and more frequently missed important school or social activities as a result (8.97% of boys vs 5.85% of girls; P = .0004), girls more frequently self-reported measures of excessive use of the Internet (11.81% of girls thought that they had a problem vs 8.90% of boys; P = .0048). After adjustment of sociodemographic factors, problematic Internet use was found to associate significantly with substance use (P = .0014), depression (P < .0001), and aggression (P < .0001), with largely similar patterns of associations between genders. CONCLUSIONS Problematic Internet use may be present in about 4% of high school students in the United States. It may be associated with depression, substance use, and aggressive behaviors. High school boys, though, may have heavier Internet use and may be less self-aware of the related problems.

GENDER DIFFERENCES IN ADOLESCENT MARIJUANA USE AND ASSOCIATED PSYCHOSOCIAL CHARACTERISTICS

Marijuana use in adolescents is associated with many adverse outcomes, including neurobiological and health consequences. Despite this, little is known about gender differences in the correlates of adolescent marijuana use. This study attempted to fill this gap by examining gender differences in the correlates of lifetime and past 30-day marijuana use. Data from a cross-sectional statewide survey of adolescent risk behavior participation in Connecticut were analyzed using &khgr;2 and hierarchical logistic regression methodologies to examine the demographic, psychosocial, and risk behavior correlates of adolescent marijuana use. Gender-by-trait interactions were tested with hierarchical logistic regression. Of the 4523 participants (51.8% females, 75.8% white), 40.4% endorsed lifetime marijuana use and 24.5% endorsed past 30-day marijuana use. Risk behavior participation, particularly other substance use, had the most robust associations with lifetime and past 30-day adolescent marijuana use; participation in extracurricular activities seemed protective. Gender interactions were observed for African American, Asian, or other race and participation in extracurricular activities; in these 3 cases, males had a greater likelihood of use. They were also observed for having a job (lifetime use only), with females having elevated odds, and past 30-day cigarette smoking (past 30-day use only), with males having elevated odds. Finally, there was preliminary evidence of a faster transition from initiation of marijuana use to regular use in females, when compared with males. These results indicate important gender differences in the correlates of marijuana use in adolescents, and these findings may facilitate the development of gender-informed prevention and early intervention programs for adolescent marijuana use.

Health/functioning characteristics, gambling behaviors, and gambling-related motivations in adolescents stratified by gambling problem severity: findings from a high school survey.

In adults, different levels of gambling problem severity are differentially associated with measures of health and general functioning, gambling behaviors, and gambling-related motivations. Here we present data from a survey of 2,484 Connecticut high school students, and investigate the data stratifying by gambling problem severity based on DSM-IV criteria for pathological gambling. Problem/pathological gambling was associated with a range of negative functions; for example, poor academic performance, substance use, dysphoria/depression, and aggression. These findings suggest a need for improved interventions related to adolescent gambling and a need for additional research into the relationship (eg, mediating factors) between gambling and risk and protective behaviors.

Alternate Tobacco Product and Drug Use Among Adolescents Who Use Electronic Cigarettes, Cigarettes Only, and Never Smokers

PURPOSE To determine whether use of alternative tobacco products (i.e., cigars, blunts, hookah, smokeless tobacco), alcohol, and marijuana differs among adolescents who currently use (1) electronic cigarettes (e-cigarettes); (2) cigarettes only; and (3) never smokers. METHODS Analysis of a self-reported survey from four high schools in 2010-2011 (n = 3,102) with a subsample (n = 1,556) surveyed on alcohol and marijuana. Analyses were conducted with multinomial logistic regression models accounting for clustering by schools. RESULTS The sample contained 2.4% (n = 76) e-cigarette users, 12.4% (n = 386) cigarette smokers, and 85.1% (n = 3,197) never smokers. E-cigarette users were more likely than cigarette-only smokers to report blunt (adjusted odds ratio, 1.81; 95% confidence interval, 1.21-2.71) and hookah use (adjusted odds ratio, 3.12; 95% confidence interval, 1.90-5.13), but not cigar, smokeless tobacco, alcohol, or marijuana use. CONCLUSIONS E-cigarette users are more likely than cigarette smokers to use hookah and blunts.

IMPULSIVE SENSATION SEEKING, PARENTAL HISTORY OF ALCOHOL PROBLEMS, AND CURRENT ALCOHOL AND TOBACCO USE IN ADOLESCENTS

Objectives:This study attempted to evaluate whether impulsive sensation seeking mediated the relationship between parental alcohol problems and offspring alcohol and tobacco use. Methods:Participants were Connecticut high school students (n = 2733) completing a survey of high-risk behaviors. Variables of interest included past month alcohol use, past month binge alcohol use, frequency of past month alcohol use, past month tobacco use, having a biologic parent with an alcohol problem, and score on the Impulsive Sensation Seeking scale (ImpSS) from the Zuckerman–Kuhlman Personality Questionnaire—Form III. Results:ImpSS scores were elevated in past month users of alcohol, binge users of alcohol, users of both tobacco and alcohol, and they increased with increasing frequency of past month alcohol use. Also, parental history of alcohol use increased the likelihood of past month alcohol use, binge use, use of both tobacco and alcohol, and higher levels of past month alcohol use. Mediational analyses did not seem to support the hypothesis that impulsive sensation seeking mediates the relationship between parental history of alcohol problems and alcohol and tobacco use in offspring. Conclusions:Impulsive sensation seeking and parental history of alcohol problems seem to be independent factors that contribute to the co-occurrence of alcohol and tobacco use in adolescents. These findings can inform prevention and treatment efforts.