Nicholas Peiper

University faculty perceptions of the health risks related to cigarettes and smokeless tobacco.

INTRODUCTION AND AIMS It is now widely understood by tobacco research and policy experts that smokeless tobacco (ST) use confers significantly less risk than smoking, but no studies have assessed tobacco risk perceptions in highly educated populations. The purpose of this study was to explore the perception of risks related to smoking and ST use among full-time faculty on two campuses at the University of Louisville. DESIGN AND METHODS In October 2007, a survey that quantified risk perceptions of cigarette smoking and ST use with respect to four health domains (general health, heart attack/stroke, all cancer, oral cancer) was sent to 1610 full-time faculty at the Belknap and the Health Sciences Center (HSC) campuses of the University of Louisville, and 597 (37%) returned a completed survey. RESULTS Overall, cigarettes were considered as high risk for all health domains by large majorities (75-97%). Except for heart attack/stroke, ST was also considered as high risk by the majority of faculty (69-87%), and at least half perceived cigarettes and ST to be equally harmful across all domains. HSC faculty had somewhat more accurate risk perceptions than Belknap faculty for ST, but both groups overestimated the risks, especially for oral cancer. DISCUSSION AND CONCLUSIONS This study found that the risks of ST use are overestimated and conflated to that of cigarettes among highly educated professionals, demonstrating the need for better education about the risks of tobacco use and for communication of accurate information by health organisations and agencies.

The performance of the K6 Scale in a large school sample.

Timely prevalence data of psychiatric morbidity among adolescents in small areas remains vital for mental health policy planning at the regional and local levels. Furthermore, effective regional policy planning also requires the measurement of psychiatric morbidity using clinically validated instruments. The K6 scale was therefore included on the 2012 administration of the Kentucky Incentives for Prevention Survey as a measure of serious emotional disturbance in the past 30 days. Principal axis and confirmatory factor analyses were performed to determine the unidimensional structure of the K6 in a school-based sample of Kentucky students (n = 108,736). The documented cutoff of 13 on the K6 was then used to screen Kentucky students for serious emotional disturbance, estimate the state prevalence, and define epidemiologic correlates. Overall, the K6 performed well, with factor analyses confirming the 1-factor solution of the K6. Based upon the established cutoff, the prevalence of serious emotional disturbance was 13.9% in Kentucky. Grade, gender, race and ethnicity, and family structure emerged as significant predictors in a multivariable logistic regression model. Substance abuse, antisocial behavior, role impairments, and peer victimization were significantly higher among students with a positive screen. These results indicate the K6 is particularly useful for inclusion in large epidemiologic surveys that have limited space and logistics that demand timely administration.

Tasty THC: Promises and challenges of cannabis edibles

Food products containing cannabis extract (edibles) have emerged as a popular and lucrative facet of the legalized market for both recreational and medicinal cannabis. The many formulations of cannabis extracts used in edibles present a unique regulatory challenge for policy makers. Though edibles are often considered a safe, discreet, and effective means of attaining the therapeutic and/or intoxicating effects of cannabis without exposure to the potentially harmful risks of cannabis smoking, little research has evaluated how ingestion differs from other methods of cannabis administration in terms of therapeutic efficacy, subjective effects, and safety. The most prominent difference between ingestion and inhalation of cannabis extracts is the delayed onset of drug effect with ingestion. Consumers often do not understand this aspect of edible use and may consume a greater than intended amount of drug before the drug has taken effect, often resulting in profoundly adverse effects. Written for the educated layperson and for policy makers, this paper explores the current state of research regarding edibles, highlighting the promises and challenges that edibles present to both users and policy makers, and describes the approaches that four states in which recreational cannabis use is legal have taken regarding regulating edibles.

Overview on Prevalence and Recent Trends in Adolescent Substance Use and Abuse

Substance use and consequent disorders have burdened US health care, criminal justice, and society at large for centuries. Pathological substance use almost invariably begins before 25 years of age, demonstrating how critical adolescence is within the etiology, prevention, and treatment of substance use disorder. This article provides a high-level overview of the prevalence of substance use disorders to provide a context within which the remaining issue provides in-depth descriptions of the evidence on specific topics. Described herein are trends in substance use, substance use disorder, and demographic comparisons.

The performance of the K6 scale in a large school sample: A follow-up study evaluating measurement invariance on the Idaho Youth Prevention Survey.

Since 2013, Idaho has been building capacity and infrastructure through the Strategic Prevention Framework State Incentive Grant to prevent substance abuse and related problems, namely psychiatric morbidity. As this federal initiative requires states to engage in data-driven strategic planning at the state and community levels, clinically validated instruments are particularly valuable in the context of school surveys that have limited space and require timely administration. Thus, the K6 scale was included on the 2014 Idaho Youth Prevention Survey as a measure of nonspecific psychological distress. To verify the unidimensional structure of the K6, principal axis and confirmatory factor analyses were performed in a school-based sample of Idaho students (n = 12,150). A series of multigroup confirmatory factor analyses were then performed to evaluate measurement invariance across gender, age, and race. Overall, the prevalence of serious psychological distress in the past 30 days was 17.2% in Idaho. Factor analyses confirmed the 1-factor solution of the K6. Four levels of measurement invariance were demonstrated across gender, age, and race. Together, these results further illustrate the construct validity of the K6 for use in adolescent populations. Other states are encouraged to include the K6 on their school surveys to facilitate policy planning and resource allocation as well as generate cross-state comparisons. (PsycINFO Database Record

Nonmedical prescription pain reliever and alcohol consumption among cannabis users

BACKGROUND This study examined poly-drug use involving the use of cannabis with nonmedical prescription pain reliever use (NMPR) and alcohol use. METHODS Computer-assisted survey data from the National Survey on Drug Use and Health were examined. The NSDUH is an annual, cross-sectional survey of non-institutionalized citizens in the United States (ages 12+). Replicate analyses were conducted using the 2013 and 2003 survey waves. RESULTS Higher levels of cannabis use were consistently associated with more frequent consumption of prescription pain relievers, with findings replicating in both 2013 and 2003. While the prevalence of dual users declined from 2003 (2.5%) to 2013 (2.3%), the average number of days used among dual users increased by an average of 20 days over that period. These changes largely occurred among those aged 35 or older, males, whites, and non-illicit drug users. Past-year marijuana use increased by 16% (10.8-12.6%, p-value<.001) whereas NMPR decreased by 15% (4.9-4.2%, p-value<.001). The largest changes occurred after 2011. Persons using the most cannabis generally had higher levels of alcohol use relative to those using the least amount of cannabis. There was a significant increase in the prevalence of dual use between 2003 (10.2%) and 2013 (11.6%), while the prevalence of past-year alcohol use remained relatively stable. CONCLUSIONS Clinical efforts and public health interventions should consider the possible co-ingestion of cannabis with NMPR and alcohol, as concomitant use may portend negative health effects in the short and long-term.

Youth engagement with an emerging Irish mental health early intervention programme (Jigsaw): participant characteristics and implications for service delivery.

Abstract Background/Aims: The transition to adulthood represents a critical period which influences mental health problems, but access to and utilisation of mental health services by young people is poor. Jigsaw is a response to the challenge of transforming how young people access mental health support and attain positive outcomes. This article presents an overview of the characteristics of young people engaging with this service. Method: Data about young people who engage with Jigsaw are captured through an online system designed to record salient clinical, case management, service delivery, and outcome information. Participant characteristics are summarised to portray the young people who engaged with the service for the first time during 2013 (N = 2420). Results: The majority of young people engaging with Jigsaw were female, aged 15–17 years, and were referred by their parents. Over half were in full-time education, although many 21–25-year-olds were unemployed. Young people presented with a range of difficulties which varied by age and gender. They reported high levels of distress, with age and gender having a significant impact on their well-being. Conclusions: This study provides emerging evidence to support the need for an early intervention component within the system of mental health care.

Patterns of Twitter Behavior Among Networks of Cannabis Dispensaries in California

Background Twitter represents a social media platform through which medical cannabis dispensaries can rapidly promote and advertise a multitude of retail products. Yet, to date, no studies have systematically evaluated Twitter behavior among dispensaries and how these behaviors influence the formation of social networks. Objectives This study sought to characterize common cyberbehaviors and shared follower networks among dispensaries operating in two large cannabis markets in California. Methods From a targeted sample of 119 dispensaries in the San Francisco Bay Area and Greater Los Angeles, we collected metadata from the dispensary accounts using the Twitter API. For each city, we characterized the network structure of dispensaries based upon shared followers, then empirically derived communities with the Louvain modularity algorithm. Principal components factor analysis was employed to reduce 12 Twitter measures into a more parsimonious set of cyberbehavioral dimensions. Finally, quadratic discriminant analysis was implemented to verify the ability of the extracted dimensions to classify dispensaries into their derived communities. Results The modularity algorithm yielded three communities in each city with distinct network structures. The principal components factor analysis reduced the 12 cyberbehaviors into five dimensions that encompassed account age, posting frequency, referencing, hyperlinks, and user engagement among the dispensary accounts. In the quadratic discriminant analysis, the dimensions correctly classified 75% (46/61) of the communities in the San Francisco Bay Area and 71% (41/58) in Greater Los Angeles. Conclusions The most centralized and strongly connected dispensaries in both cities had newer accounts, higher daily activity, more frequent user engagement, and increased usage of embedded media, keywords, and hyperlinks. Measures derived from both network structure and cyberbehavioral dimensions can serve as key contextual indicators for the online surveillance of cannabis dispensaries and consumer markets over time.

Perceptions of the health risks related to cigarettes and nicotine among university faculty

Although experts have established that tobacco combustion, not nicotine, is responsible for illnesses among smokers, there is confusion among the general public about the health risks of nicotine. This study assessed the differences in the perception of risks related to smoking and nicotine among a highly educated population. A survey of 1610 full-time faculty members at the Belknap and Health Sciences Center (HSC) campuses of the University of Louisville collected information on the perception of harm resulting from cigarettes and nicotine with respect to four health domains (general health, heart attack/stroke, all cancer, and oral cancer). While virtually all faculty members correctly perceived cigarettes as moderate or high risk for all health domains, 78–91% also perceived nicotine in the same way, with somewhat higher proportions from the Belknap campus. With respect to a direct comparison, about two-thirds of respondents scored cigarettes as riskier than nicotine, but HSC respondents were no more likely than men to respond correctly. The study documents that highly educated individuals, including health professionals, are aware of the consequences of cigarette smoking, but are inadequately informed about nicotine. Health promotion and education programs are necessary to correct these misperceptions and empower smokers to utilize noncombustible nicotine products to avoid the deadly consequences of smoking. The US Food and Drug Administration, which since 2009 has had regulatory authority over both tobacco and pharmaceutical nicotine, could serve as an important educational resource for this endeavor.

Utilizing Big Data and Twitter to Discover Emergent Online Communities of Cannabis Users

Large shifts in medical, recreational, and illicit cannabis consumption in the United States have implications for personalizing treatment and prevention programs to a wide variety of populations. As such, considerable research has investigated clinical presentations of cannabis users in clinical and population-based samples. Studies leveraging big data, social media, and social network analysis have emerged as a promising mechanism to generate timely insights that can inform treatment and prevention research. This study extends a novel method called stochastic block modeling to derive communities of cannabis consumers as part of a complex social network on Twitter. A set of examples illustrate how this method can ascertain candidate samples of medical, recreational, and illicit cannabis users. Implications for research planning, intervention design, and public health surveillance are discussed.