Jenni A. Shearston

Nonmedical opioid use and heroin use in a nationally representative sample of us high school seniors

BACKGROUND Nonmedical use of opioids has become increasingly problematic in recent years with increases in overdoses, treatment admissions, and deaths. Use also appears to be contributing to heroin initiation, which has increased in recent years. Further research is needed to examine which adolescents are at highest risk for nonmedical use of opioids and heroin and to explore potential links between nonmedical opioid use and heroin use. METHODS Data were analyzed from a nationally representative sample of American high school seniors in the Monitoring the Future study (2009-2013, Weighted N=67,822). We examined associations between frequency and recency of nonmedical use of opioids and heroin. Sociodemographic correlates of use of each drug were also examined. RESULTS 12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use. As frequency of lifetime nonmedical opioid use increased, so too did the odds for reporting heroin use, with over three-quarters (77.3%) of heroin users reporting lifetime nonmedical opioid use. Recent (30-day) nonmedical opioid use was a robust risk factor for heroin use and almost a quarter (23.2%) of students who reported using opioids ≥40 times reported lifetime heroin use. Black and Hispanic students were less likely to report nonmedical opioid or heroin use than white students, but they were more likely to report heroin use in absence of nonmedical opioid use. DISCUSSION Recent and frequent nonmedical opioid use are risk factors for heroin use among adolescents. Prevention needs to be targeted to those at highest risk.

Discordant reporting of nonmedical opioid use in a nationally representative sample of US high school seniors

ABSTRACT Background: Nonmedical opioid use has become a major public health concern due to increases in treatment admissions, overdoses, and deaths. Use has also been linked to heroin initiation. Reliable data on nonmedical opioid use are needed to continue to inform prevention. Objective: To determine the prevalence and correlates of discordant self-report of nonmedical use of opioids in a national sample. Methods: Utilizing a nationally representative sample of 31,149 American high school seniors in the Monitoring the Future study (2009–2013), discordant responses between self-reported 12-month nonmedical opioid use and self-reported 12-month nonmedical Vicodin and OxyContin use (reporting Vicodin/OxyContin use, but not reporting “opioid” use) were assessed. We also used multivariable logistic regression to determine the characteristics of students who were most likely to provide a discordant response. Results: 37.1% of those reporting nonmedical Vicodin use and 28.2% of those reporting nonmedical OxyContin use did not report overall nonmedical opioid use. Prevalence of nonmedical opioid use (8.3%) would increase when factoring in Vicodin, OxyContin, or both, by 2.8%, 1.3%, and 3.3%, respectively. Females were more likely to provide a discordant response to Vicodin and highly religious students were more likely to provide a discordant response regarding OxyContin use. Those who reported cocaine or nonmedical tranquilizer use were at consistently low odds for discordant responses. Nonmedical amphetamine users were at low odds for providing a discordant Vicodin response. Conclusion: Prevalence of nonmedical opioid use may be underreported on some surveys, particularly among specific subpopulations. Further research on the effect of question order and skip-patterns (e.g., “gate” questions) is needed. Reliable data on nonmedical opioid use are needed to continue to accurately inform prevention.

Patterns of electronic cigarette use and level of psychological distress.

Background Psychological distress has been correlated with higher levels of nicotine dependence. To date, the possible association between individuals’ levels of psychological distress and e-cigarette use has not been investigated, despite the dramatic growth of e-cigarette use in the US. We examined this possible association using a nationally representative sample of US adults. Methods A total of 36,697 adults from the 2014 National Health Interview Survey (NHIS) were included. The Kessler 6 scale was used to measure psychological distress. Multivariate logistic regression analysis was conducted to assess the association between level of psychological distress and e-cigarette use. Results Both e-cigarette and cigarette use varied according to level of psychological distress as well as multiple socio-demographic characteristics. In a multivariate model, psychological distress was significantly associated with the following groups: (a) exclusive e-cigarette ever-use (aOR = 3.7; 95% CI = 1.6, 8.6), (b) current dual use of e-cigarettes and cigarettes (aOR = 4.6; 95% CI = 3.1, 6.7), (c) former cigarette use and ever use of e-cigarette (aOR = 3.2; 95% CI = 2.2, 4.8) and (d) current use of cigarettes only (aOR = 2.1; 95% CI = 1.7, 2.6). Conclusion These are the first data to demonstrate that, as is true for cigarettes, e-cigarette use is associated with increased levels of psychological distress. Further large-scale, longitudinal studies are needed to determine the direction of this relationship and to evaluate the long-term positive and negative consequences of such use.

Effects of hookah smoking on indoor air quality in homes

Introduction Hookahs (water pipes) are rapidly increasing in popularity worldwide. Evidence suggests that although perceived as safer than cigarette smoke, hookah smoke may be as, or even more, dangerous as cigarette smoke. Methods Air samples from 33 homes—11 where only hookah-smoking occurred, 12 with only cigarettes and 10 with no smoking—were collected to analyse concentrations of particulate matter (PM2.5), black carbon, elemental and organic carbon and carbon monoxide (CO). Air quality was assessed in rooms where smoking occurred and in an adjacent room. Results Hookah and cigarette smoking impaired home air quality. The rooms in which hookahs were smoked showed the highest concentrations for all pollutants. CO was significantly greater in the rooms where hookahs were smoked than in the cigarette-smoking rooms and the non-smoking households (p<0.05). In addition, CO levels in the rooms adjacent to where hookah was smoked were 2.5-fold to 4-fold greater than those in the smoking and non-smoking rooms of the cigarette homes (p<0.05). PM2.5 levels were also elevated in hookah homes compared to cigarette and non-smoking homes, although not significantly different. Conclusions This study, the first of its kind, demonstrates potentially hazardous levels of home air pollution in rooms where hookahs are being smoked as well as in adjacent rooms. These levels were greater than those in cigarette smoking homes, raising concerns about potential negative health effects on all individuals living in homes where hookahs are smoked.

Characteristics of Adults Who Switched From Cigarette Smoking to E-cigarettes

INTRODUCTION Because of the rapidly increasing use of electronic cigarettes (e-cigarettes), this study aimed to investigate the individual characteristics and state-level prevalence of U.S. adults who have switched to e-cigarettes from traditional cigarettes. METHODS Data from the 2012-2013 and 2013-2014 National Adult Tobacco Surveys were analyzed in 2016. Relative percent change in switching was estimated, and the state-specific prevalence of adults who switched to e-cigarettes from traditional cigarettes was calculated and mapped. Multivariate logistic regression was conducted to examine how switching varied by sociodemographic subgroups and region. RESULTS Overall, the number of individuals who switched from traditional cigarettes to e-cigarettes increased by approximately 100% over the 1-year interval. Significant increases were found among a number of sociodemographics and regions. Multivariate logistic regression analyses showed that young adults and those living in the South and West were more likely to switch to e-cigarettes, compared to former smokers who did not switch. Compared with current dual users, those with higher education and those who were not single were more likely to switch to e-cigarettes. The state with the highest prevalence of switching was New Mexico (7.3%), whereas Connecticut had the lowest prevalence (0.8 %) among former smokers. CONCLUSIONS There is an increase in the progression from traditional cigarette use to e-cigarette use. Further research is warranted to determine whether this change continues and facilitates cigarette smoking cessation as a possible public health benefit and opportunity to save lives rather than constitutes a potential threat to public health.

Discordant reporting of nonmedical opioid use: reply to letter to the editor

Below is our brief invited response to Ruan, Chiravuri, and Kaye who submitted a Letter to the Editor (1) regarding our recent manuscript “Discordant reporting of nonmedical opioid use in US high school seniors,” published here in The American Journal of Drug and Alcohol Abuse (2). The published prevalence estimates of nonmedical use of specific opioids such asVicodin reported by theNational Survey onDrugUse andHealth (NSDUH) are presented in Table 1.89B of the 2013 annual report. This table is found in the “Detailed Table” section of their annual report. While the most formal method of citing NSDUH annual results is to cite the main report (to appropriately provide the investigators with credit), here (3), we provide a citation to the direct online tables from the full report.We, too, wish these tables were easier to locate online as not all new versions of NSDUH reports contain links to these detailed tables. Similarly, these prevalence estimates can be computed via the publicly available NSDUH datasets made available by The Interuniversity Consortium for Political and Social Research (ICPSR). We are aware of the study by McCabe et al. (4) described by the authors and feel their results are a great contribution to the literature. However, as described in their report, they only utilized Survey Form 1 of the Monitoring the Future (MTF) dataset. This form contains variable V1564, which asks students about medical or prescribed use of opioids. This is something we ourselves wanted to consider in our analyses; however, as we describe in our report, only three (of six) MTF forms included variables assessing self-reported nonmedical use of (1) opioids as a general category, (2) Vicodin, and (3) OxyContin, and these three forms were Form 3, 5, and 6. Thus, we were not able to consider medical or prescribed use as McCabe et al. analyzed in Form 1 because it does not include the standard questions about Vicodin or OxyContin that are included in the other three forms. We do appreciate the authors’ insight and regret omitting a mention in our limitations section that it is possible that some students may have not closely read the MTF definition for nonmedical use which is accompanied with all nonmedical opioid use questions. Similar to our point above, since most variables (other than some core demographic and drug use variables) are split up between six different survey forms, we are unable to determine how the psychological correlates of use relate to reported nonmedical opioid use in our analytic sample. Reasons for use of various drugs, for example, are only queried in Form 1, so similar to what we discus above, in our analytic sample we are unable to determine the potential associations between reasons for use and nonmedical use of Vicodin and OxyContin, or regarding potential discordant reporting. Finally, we are aware that only a small portion of opioid users initiate heroin and we made no such claim implying that a large proportion of opioid users move on to heroin. In the introduction of this report and in the results of our other report published in Drug and Alcohol Dependence (5), we describe the link between nonmedical opioid use and heroin use in a correlational manner. Results did suggest that almost a quarter of students reporting nonmedical opioid use more than 40 times also reported heroin use, and over three quarters of heroin users also reported lifetime nonmedical use of opioids. We do fluctuate terminology with regard to heroin “use” and “initiation” at times as most students in the MTF sample who have reported heroin use reported using infrequently (hence “initiation” and not necessarily “continued use”). Wewere very cautious in both reports not to infer temporality as MTF is cross-sectional. We agree that if a student surveyed did in fact misread or misinterpret the questions and over-report nonmedical use (when use was only used medically) that this is problematic. As discussed above, we had no way to determine medical use within this analytic sample. As we continue to examine validity of survey

Analysis of state-specific prevalence, regional differences, and correlates of hookah use in U.S. adults, 2012-2013

Objective To investigate the state-specific prevalence, regional differences, and correlates of hookah use among U.S. adults. Methods We analyzed the most recent nationally representative data of adults from the National Adult Tobacco Survey (NATS) 2012-2013 (n = 60192). State-specific prevalence of lifetime and current hookah use was calculated and mapped. Multivariate logistic regression was performed to determine the association between sociodemographic characteristics, regional differences, and hookah use. Results Among U.S. adults (≥18 years), overall prevalence of lifetime hookah use was 12.3%, while current use was 3.9%. Mapping of state-specific prevalence revealed that the West tended to have higher rates of use, while the South tended to have lower ones. In the adjusted model, we observed that current hookah use was positively associated with younger adults, males, non-Hispanic adults, those with higher education and income statuses, being single, those living in the West, and current cigarette use. Conclusion The prevalence of hookah use varies by state, region, and sociodemographic characteristics among adults. Future research, including longitudinal studies, are needed to identify geographic and sociodemographic characteristics and trends among hookah users, investigate hookah-related health outcomes, and evaluate targeted public health efforts aimed at this emerging threat. Implications This study investigates state-level prevalence, regional differences, and sociodemographic characteristics of hookah use among U.S. adults, using the most recent NATS. Hookah use was positively associated with younger adults and those living in the West. This study adds to the understanding of the geographic and sociodemographic factors underlying hookah use, which can be used to develop much needed evidence-based regulations and programs that are responsive to the needs of different risk groups.

Nonmedical Opioid Use in Relation to Recency of Heroin Use in a Nationally Representative Sample of Adults in the United States

ABSTRACT Nonmedical opioid use has been linked to lifetime heroin use; however, research is needed to examine associations between nonmedical opioid use and current or recent heroin use, as current users appear to be at highest risk for harm. Data were from a nationally representative sample of non-institutionalized adults (age 18–64) in households participating in the National Survey of Drug Use and Health who reported lifetime heroin use (2005–2014, N = 7,111). We examined associations between frequency and recency of nonmedical opioid use and recency of heroin use. Most (86.7%) lifetime heroin users reported no heroin use in the last 12 months, while 6.1% reported current use (use in the last 30 days). The majority of the sample (69.3%) reported lifetime nonmedical opioid use; 14.3% reported nonmedical use in the last 30 days. Adjusted odds for current heroin use increased as frequency of past-year nonmedical opioid use increased, with a quarter (24.7%) of current heroin users reporting nonmedical opioid use on 157–365 days in the last year. Over half (54.7%) of current heroin users reported current nonmedical opioid use. Prevention efforts should consider that high-frequency and current nonmedical opioid use is a robust correlate of continued heroin use.

Parental Psychological Distress and Family Food Insecurity: Sad Dads in Hungry Homes

Objective: To examine whether household food insecurity is associated with serious psychological distress (SPD) in fathers and mothers in a nationally representative US sample. Methods: We analyzed cross-sectional, matched child-parent data from the 2014 to 2015 National Health Interview Survey (N = 18,456). Parental psychological distress was assessed using the Kessler-6 (K-6) scale. Family food security was measured using the USDAs 10-item Food Security scale, and households were dichotomized as food secure or food insecure. Multivariate logistic regression analyses were performed to examine associations between SPD and food insecurity stratified by parental status (mother/father), controlling for sociodemographic factors. Results: One hundred forty-seven (2.0%) fathers, 444 (3.9%) mothers, and 591 (3.2%) of all parents had K-6 scores indicating SPD. A total of 2414 (13.1%) parents reported being food insecure, including 750 (10.4%) fathers and 1664 (14.8%) mothers. In multivariate analyses, food insecurity was significantly associated with SPD both among fathers and mothers (odds ratio [OR] = 4.2; 95% confidence interval [CI], 2.4–7.3 and OR = 2.6; 95% CI, 1.9–3.5, respectively). Conclusion: This is the first study we are aware of to demonstrate that food insecurity is independently associated with SPD among fathers and mothers, and that fathers may be at higher risk of SPD than mothers in food insecure homes. These findings highlight the need to assess and treat the mental health of fathers, a historically underrepresented group in the fields of mental health and pediatrics, in addition to mothers, in food insecure homes.

New Alternative Tobacco Products – A Threat to Adolescent Health

1. Lily Lee*,† 2. Jenni A. Shearston‡,§ 3. Michael Weitzman, MD*,‡ 1. *Department of Pediatrics, New York University School of Medicine, New York, NY. 2. ‡College of Global Public Health, New York University, New York, NY. 3. †Brooklyn College, City University of New York, New York, NY. 4. §Department of Population Health, New York University School of Medicine, New York, NY. 1. 1. Drummond MB, 2. Upson D Electronic Cigarettes: Potential Harms and Benefits. Drummond MB, Upson D. Ann Am Thorac Soc. 2014;11(2):236–242. doi: 10.1513/AnnalsATS.201311-391FR. [OpenUrl][1][CrossRef][2][PubMed][3] 2. 1. Lauterstein D, 2. Hoshino R, 3. Gordon T, 4. Watkins B, 5. Weitzman M, 6. Zelikoff J The Changing Face of Tobacco Use Among United States Youth. Lauterstein D, Hoshino R, Gordon T, Watkins B, Weitzman M, Zelikoff J. Curr Drug Abuse Rev. 2014;7(1): 29–43. [OpenUrl][4][CrossRef][5][PubMed][6] 3. 1. Maziak W, 2. Jawad M, 3. Jawad S, 4. Ward KD, 5. Eissenberg T, 6. Asfar T Interventions for Waterpipe Smoking Cessation. Maziak W, Jawad M, Jawad S, Ward KD, Eissenberg T, Asfar T. Cochrane Database Syst Rev. 2015 Jul 31;7:CD005549. doi: 0.1002/14651858.CD005549.pub3. Almost all cigarette use in the United States begins during adolescence, and about 3 of every 4 adolescent smokers continue to smoke into adulthood. Although overall cigarette consumption in the United States has decreased by 33% in the last decade, overall tobacco use among middle and high school students has demonstrated little to no decline. The United States has witnessed an increase in the use of new, so-called alternative tobacco products (ATPs). The many types of ATPs vary from the more popular smoked products such as electronic cigarettes (e-cigarettes) and hookahs (also known as water-pipes or narghile) to smokeless products such as snus. These ATPs are believed by the public and adolescents to be less harmful, less addictive, and more stylish than cigarettes. They are being promoted as and perceived by adolescents, the general public, and health care clinicians as safer alternatives to traditional cigarettes. Many in the public health community fear that, in the absence of widespread awareness and regulatory policies, ATPs will encourage adolescents to start smoking and, thus, undermine a decades-long campaign to “denormalize” smoking. Rates of past 30-day use of e-cigarettes among middle and high school students tripled from 2013 to 2014, after doubling the year before. From 2010 to 2014, the percentage of high school seniors who used hookahs in the last year increased from 17% to 23%. In 2014, for the first time, e-cigarettes were reported to be the most commonly used tobacco product by high school students (13.4%), ahead of both hookahs … [1]: {openurl}?query=rft.jtitle%253DAnn%2BAm%2BThorac%2BSoc%26rft.volume%253D11%26rft.spage%253D236%26rft_id%253Dinfo%253Adoi%252F10.1513%252FAnnalsATS.201311-391FR%26rft_id%253Dinfo%253Apmid%252F24575993%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1513/AnnalsATS.201311-391FR&link_type=DOI [3]: /lookup/external-ref?access_num=24575993&link_type=MED&atom=%2Fpedsinreview%2F37%2F7%2F310.atom [4]: {openurl}?query=rft.jtitle%253DCurr%2BDrug%2BAbuse%2BRev%26rft.volume%253D7%26rft.spage%253D29%26rft_id%253Dinfo%253Adoi%252F10.2174%252F1874473707666141015220110%26rft_id%253Dinfo%253Apmid%252F25323124%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/external-ref?access_num=10.2174/1874473707666141015220110&link_type=DOI [6]: /lookup/external-ref?access_num=25323124&link_type=MED&atom=%2Fpedsinreview%2F37%2F7%2F310.atom