Phil Veliz

Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976–2015

National trends in medical and nonmedical use of prescription opioids among US adolescents overall and in different sociodemographic subgroups were examined between 1976 and 2015. OBJECTIVES: Most US studies of national trends in medical and nonmedical use of prescription opioids have focused on adults. Given the limited understanding in these trends among adolescents, we examine national trends in the medical and nonmedical use of prescription opioids among high school seniors between 1976 and 2015. METHODS: The data used for the study come from the Monitoring the Future study of adolescents. Forty cohorts of nationally representative samples of high school seniors (modal age 18) were used to examine self-reported medical and nonmedical use of prescription opioids. RESULTS: Lifetime prevalence of medical use of prescription opioids peaked in both 1989 and 2002 and remained stable until a recent decline from 2013 through 2015. Lifetime nonmedical use of prescription opioids was less prevalent and highly correlated with medical use of prescription opioids over this 40-year period. Adolescents who reported both medical and nonmedical use of prescription opioids were more likely to indicate medical use of prescription opioids before initiating nonmedical use. CONCLUSIONS: Prescription opioid exposure is common among US adolescents. Long-term trends indicate that one-fourth of high school seniors self-reported medical or nonmedical use of prescription opioids. Medical and nonmedical use of prescription opioids has declined recently and remained highly correlated over the past 4 decades. Sociodemographic differences and risky patterns involving medical and nonmedical use of prescription opioids should be taken into consideration in clinical practice to improve opioid analgesic prescribing and reduce adverse consequences associated with prescription opioid use among adolescents.

Prevalence of Concussion Among US Adolescents and Correlated Factors

Prevalence of Concussion Among US Adolescents and Correlated Factors Little is known about the prevalence and correlates of concussions among US adolescents. A regional study of Canadian adolescents found that approximately 20% had sustained a concussion.1,2 Providing a national baseline of concussion prevalence and correlates is necessary to target and monitor prevention efforts to reduce these types of injuries during this important developmental period.

Tobacco Use and Sexual Orientation in a National Cross-sectional Study: Age, Race/Ethnicity, and Sexual Identity–Attraction Differences

INTRODUCTION The purpose of this study is to determine the past-year prevalence estimates of any nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder based on sexual identity among U.S. adults, and to examine potential variations in these estimates by age, race/ethnicity, and sexual identity-attraction concordance/discordance. METHODS The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions collected data via in-person interviews with a cross-sectional nationally representative sample of non-institutionalized adults (response rate=60.1%) and analyses for the present study were conducted in 2017. RESULTS Any past-year nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder were most prevalent among sexual minority-identified adults compared with heterosexual-identified adults, with notable variations based on sex, age, race/ethnicity, and sexual identity-attraction discordance. Elevated rates of any nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder among sexual minorities were most prevalent among younger lesbian women and gay men, and all age groups of bisexual men and women. The odds of any nicotine/tobacco use, cigarette smoking, and DSM-5 tobacco use disorder were significantly greater among sexual identity-attraction discordant women and significantly lower among sexual identity-attraction discordant men. CONCLUSIONS These findings provide valuable new information about sexual minority subgroups, such as self-identified bisexual older adults and sexual identity-attraction discordant women, that appear to be at higher risk for adverse smoking-related health consequences as a result of their elevated rates of cigarette smoking. Additional attention is warranted to examine these high-risk subpopulations prospectively and, if the results are replicated with larger samples, this information can be used to target smoking-cessation and lung cancer screening efforts.

Early exposure to stimulant medications and substance-related problems: The role of medical and nonmedical contexts

BACKGROUND The age of onset (early vs. late) and context (medical vs. nonmedical) of exposure to stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have been identified as important factors in the addictive potential of these controlled medications. This study examines the role of medical and nonmedical contexts in the association between early exposure to stimulant medications and substance use and substance-related problems among adolescents. METHODS A Web-based survey was self-administered by Detroit-area secondary school students (N=4755) between the 2009-10 and 2012-13 school years. The sample consisted of 51% females, 62% Whites, 32% African-Americans, and 6% from other racial categories. RESULTS During the study period, an estimated 11.7% of respondents were ever diagnosed with ADHD. Approximately 6.7% (n=322) of respondents indicated lifetime medical use of prescription stimulants while 2.6% (n=124) indicated lifetime nonmedical use. The odds of substance use and substance-related problems were significantly lower among those who initiated earlier medical use of stimulant medications relative to later medical initiation. In contrast, the odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation. CONCLUSIONS More than one in every ten adolescents in this epidemiologically-derived community-based sample was diagnosed with ADHD. This is the first investigation to demonstrate that context (medical vs. nonmedical) plays a critical role in the relationship between early exposure to stimulant medications and the subsequent risk of substance-related problems during adolescence within the same diverse youth sample.

Differences in smoking prevalence and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older U.S. adults: role of sexual orientation

The purpose of this study was to determine the past-year prevalence estimates of cigarette smoking and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older U.S. adults and examine potential variations in these estimates by sexual orientation. Data were from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) and included in-person interviews with a nationally representative sample of non-institutionalized adults aged 18 and older. Eligibility for LDCT was based on U.S. Centers for Medicare and Medicaid Services (CMS) guidelines. Analyses included participants aged 55–77 (n = 9,635). Overall, 17.5% of older adult respondents reported past-year smoking. Overall rates of past-year cigarette smoking were influenced by sex and sexual orientation with males reporting higher rates compared to females. Among both males and females, smoking was most prevalent among bisexual individuals. Eligibility for LDCT was also higher among males compared to females and among bisexually identified adults relative to homosexual and heterosexual-identified adults. Overall, 11.2% of older U.S. adults met eligibility for LDCT lung cancer screening. Eligibility for LDCT lung screening is associated with sexual orientation; the highest rates of eligibility are among bisexual women and men (26.9 and 24.5%, respectively). The current study found variations in cigarette smoking and eligibility for LDCT lung cancer screening (a proxy for chronic high-risk smoking) among older U.S. adults based on sexual orientation. Efforts to increase screening should take into account these differences.

Alcohol mixed with energy drink use during young adulthood

AIMS Alcohol mixed with energy drink (AmED) use is associated with negative consequences including hazardous alcohol use and driving under the influence. While many studies have focused on correlates of AmED use among college samples, very few have examined patterns of AmED use during adolescence and young adulthood within the general population. Accordingly, the purpose of this study is to assess age differences in AmED use among a national sample of respondents aged 18 to 30. METHODS The data for this study come from the Monitoring the Future panel study from 2012 to 2015. The sample consists of 2222 respondents between the ages of 18 and 30. Multiple logistic regression using generalized estimating equations (GEE) was used to model past-year AmED prevalence across age and other covariates. RESULTS Nearly half (45.0%) of respondents indicated past-year AmED use at some point during the study period. The lowest prevalence rates were found at age 18 (25.9%) and the highest prevalence rates at age 21/22 (43.5%). GEE analyses indicated a statistically significant positive linear and negative quadratic trend with respect to the association between age of respondent and past-year AmED use. Namely, peak use occurred in early young adulthood (age 21/22 and 23/24) and then declined, reaching 32.0% by age 29/30. College attendance and several substance use behaviors at age 18 moderated these linear and quadratic age trends. CONCLUSIONS AmED use peaked rapidly in early young adulthood and declined into later young adulthood. Substance use during adolescence was associated with a higher incidence of AmED use across all young adult ages and a slower decline of AmED use after age 21/22. Several sociodemographic factors were associated with AmED use, particularly college attendance at the age of 21/22.

Adolescent Sports Participation, E-cigarette Use, and Cigarette Smoking

INTRODUCTION Although sport participation among adolescents has been found to lower the risk of traditional cigarette smoking, no studies to date have assessed if this type of physical activity lowers the risk of e-cigarette use among adolescents. METHODS National data from the 2014 and 2015 Monitoring the Future study of 12th-grade students were used and analyses were conducted in 2016. Measures for past 30-day e-cigarette use and traditional cigarette smoking were used to assess differences between adolescents who participated in at least one competitive sport during the past year and adolescents who did not. Differences in e-cigarette use and traditional cigarette smoking were assessed between 13 different sports to determine which sports were associated with a greater or lower risk of these behaviors. RESULTS Adolescents who participated in at least one competitive sport were less likely to engage in past 30-day traditional cigarette smoking (AOR=0.73, 95% CI=0.538, 0.973) and past 30-day dual use of traditional cigarettes and e-cigarettes (AOR=0.66, 95% CI=0.438, 0.982) when compared with their nonparticipating peers. Adolescents who participated in baseball/softball and wrestling were at greatest risk of e-cigarette use. Of the 13 assessed sports, none were found to lower the odds of e-cigarette use. CONCLUSIONS No significant evidence was found that participation in a sport was a protective factor against e-cigarette use. Certain types of athletes are at an elevated risk of e-cigarette use, and prevention efforts targeted at these specific sports should be considered by school administrators.