PURPOSE:Adolescents with internalizing mental health (IMH) symptoms are more likely to use nicotine/tobacco products; however, the association with gender identity remains unclear. We examined differences in the relationship between IMH symptoms and nicotine/tobacco use by gender identity. METHODS:Data came from the U.S. arm of the International Tobacco Control Youth Tobacco and Vaping Survey, an online cross-sectional survey of adolescents aged 16-19, conducted from 2020 to 2023 (n = 28,959). Current nicotine/tobacco use was categorized as: (1) no use, (2) exclusive combustible product use, (3) exclusive noncombustible product use, and (4) use of both product types. Current depression and anxiety symptoms were aggregated into an IMH symptoms variable (yes/no). Gender identity was determined based on responses to questions regarding current gender identity and sex assigned at birth. Analyses examined differences in IMH symptoms and nicotine/tobacco use by gender identity and the potential moderating role of gender identity in the relation between IMH symptoms and nicotine/tobacco use. RESULTS:Risk for nicotine/tobacco use and IMH symptoms varied across gender identities. Transgender women reported the highest prevalence of any product use (29%) followed by transgender men (24%), cisgender men (22%), cisgender women (19%), and gender nonconforming (GNC) adolescents (14%). GNC adolescents reported the highest prevalence of IMH symptoms (85%), followed by transgender men (80%), cisgender women (67%), transgender women (65%), and cisgender men (45%). We found significant interactions between IMH symptoms and gender identity (p < 0.0001). CONCLUSION:This study revealed the importance of disaggregating GNC and transgender identities in research related to nicotine/tobacco use and mental health among adolescents.

INTRODUCTION:There is a well-established bidirectional relationship between cigarette smoking and internalizing mental health (IMH) symptoms (eg, symptoms of depression, symptoms of anxiety). However, it is unclear whether IMH symptoms are associated with using different types or combinations of nicotine products (eg, combustible, noncombustible, exclusive product use, or multi-product use). The purpose of this study is to improve our understanding of the relationship between adolescent IMH symptoms and use of a wide variety of nicotine products by examining the association between IMH symptoms and current nicotine use from 2020 to 2023. AIMS AND METHODS:Data come from the 2020 to 2023 waves of the International Tobacco Control (ITC) Adolescents Tobacco and Vaping Survey, an online repeat cross-sectional survey of adolescents aged 16-19 in Canada, England, and the United States (n = 80,427). Current nicotine use was examined in four categories: (1) no use, (2) exclusive noncombustible product use, (3) exclusive combustible product use, and (4) use of both product types. Respondents reported current symptoms of depression or anxiety, and we generated a dichotomous IMH symptoms variable (yes vs. no). We examined the association between IMH symptoms and current nicotine use using multinomial logistic regression models that adjusted for covariates. RESULTS:IMH symptoms were most strongly associated with use of both product types (adjusted relative risk ratio [ARRR]: 1.91, 95% confidence interval [CI] 1.80 to 2.03), followed by exclusive noncombustible use (ARRR: 1.70, 95% CI = 1.61 to 1.80), and then exclusive combustible use (ARRR: 1.29, 95% CI = 1.21 to 1.37). CONCLUSIONS:Adolescents with IMH symptoms are more likely to use nicotine products in general than adolescents without IMH symptoms. Specifically, noncombustible product use may have a particularly strong relationship with poor mental health among adolescents. Longitudinal research is needed to better understand directionality. IMPLICATIONS:This study provides an up-to-date understanding of how mental health and nicotine use are related among adolescents, particularly during the COVID-19 pandemic and its aftermath. Results indicate that youth mental health may be related to nicotine use, particularly noncombustible use, which is largely driven by e-cigarette use. Efforts to reduce youth e-cigarette use may consider emphasizing its relationship with mental health. Efforts to promote e-cigarette use as a less harmful alternative to cigarette smoking should be aware of the association between vaping and youth mental health.

INTRODUCTION:While there is a bi-directional relationship between internalizing mental health (IMH) symptoms (i.e., symptoms of depression, symptoms of anxiety) and nicotine use, it is unclear how IMH relates to patterns of use. The purpose of this study is to quantitatively examine the relationship between IMH symptoms and indicators of nicotine dependence, quit intentions, and quit attempts among adolescents who use cigarettes and/or e-cigarettes. METHODS:Data come from the 2020-2023 waves of the International Tobacco Control (ITC) Adolescents Tobacco and Vaping Survey. The analytic sample for this study includes those reporting past 30-day use of cigarettes and/or e-cigarettes (n = 18,800). We measured indicators of nicotine dependence (i.e., frequency of use, time to first use, and perceived addiction), quit intention, and quit attempt history separately for cigarettes and e-cigarettes. Respondents reported current IMH symptoms (any vs. none). We examined associations between IMH symptoms and all outcomes using regression models, adjusting for dual use, and examining moderation by dual use. RESULTS:IMH symptoms were positively associated with e-cigarette nicotine dependence indicators and intention to quit e-cigarettes. IMH symptoms were positively associated with cigarette nicotine dependence indicators and intention to quit for those reporting dual use of e-cigarettes and cigarettes, but not exclusive cigarette use. IMH symptoms were positively associated with ever having a quit attempt for both products. CONCLUSIONS:Findings indicate that IMH symptoms were comorbid with greater dependence on nicotine products, particularly e-cigarettes. Smoking and e-cigarette cessation interventions should consider mental health, though research is needed to understand the directionality of the relationship between IMH symptoms and e-cigarette use.

Background In 2021, the United States experienced a 14% rise in fatal drug overdoses totaling 106,699 deaths, driven by harmful opioid use, particularly among individuals in the perinatal period who face increased risks associated with opioid use disorders (OUDs). Increased concerns about the impacts of escalating harmful opioid use among pregnant and postpartum persons are rising. Most of the current limited perinatal OUD studies were conducted using traditional methods, such as interviews and randomized controlled trials to understand OUD treatment, risk factors, and associated adverse effects. However, little is known about how social media data, such as X, formerly known as Twitter, can be leveraged to explore and identify broad perinatal OUD trends, disclosure and communication patterns, and public health surveillance about OUD in the perinatal period. Objective The objective is 3-fold: first, we aim to identify key themes and trends in perinatal OUD discussions on platform X. Second, we explore user engagement patterns, including replying and retweeting behaviors. Third, we investigate computational methods that could potentially streamline and scale the labor-intensive manual annotation effort. Methods We extracted 6 million raw perinatal-themed tweets posted by global X users during the opioid epidemic from May 2019 to October 2021. After data cleaning and sampling, we used 500 tweets related to OUD in the perinatal period by US X users for a thematic analysis using NVivo (Lumivero) software. Results Seven major themes emerged from our thematic analysis: (1) political views related to harmful opioid and other substance use, (2) perceptions of others’ substance use, (3) lived experiences of opioid and other substance use, (4) news reports or papers related to opioid and other substance use, (5) health care initiatives, (6) adverse effects on children’s health due to parental substance use, and (7) topics related to nonopioid substance use. Among these 7 themes, our user engagement analysis revealed that themes 4 and 5 received the highest average retweet counts, and theme 3 received the highest average tweet reply count. We further found that different computational methods excel in analyzing different themes. Conclusions Social media platforms such as X can serve as a valuable tool for analyzing real-time discourse and exploring public perceptions, opinions, and behaviors related to maternal substance use, particularly, harmful opioid use in the perinatal period. More health promotion strategies can be carried out on social media platforms to provide educational support for the OUD perinatal population.

Despite burgeoning evidence of the negative effects of service experiences on service members' spouses/partners, limited research has examined these effects in the context of substance use. Additionally, a strong literature demonstrates the protective role relationship satisfaction can play for health-related outcomes. The goal of the present research is to examine relations between service experiences (i.e., deployment, combat exposure) and partner substance use, as well as how relationship satisfaction may buffer these effects. Data from 275 civilian partners were drawn from Operation: SAFETY (Soldiers And Families Excelling Through the Years), a longitudinal study examining health among US Army Reserve/National Guard (USAR/NG) soldiers and partners. Analyses examined relations between soldier service history (baseline) and civilian partner alcohol/ drug use (two-year follow-up), as well as interactions with relationship satisfaction. Models controlled for civilian partner sex and age, and soldiers' self-reported PTSD symptoms and substance use. Results revealed interactions between service experiences and partner satisfaction for models predicting alcohol consumption and heavy drinking. Higher relationship satisfaction mitigated overall alcohol consumption and heavy drinking frequency among partners of soldiers with two or more deployments, and among partners of soldiers with higher combat exposure. Soldier service experiences were unrelated to civilian partner drug use. The effects of deployment and combat exposure extend beyond the service member to negatively influence civilian partner alcohol consumption and heavy drinking, with relationship satisfaction buffering these risks. Interventions that assist USAR/NG soldiers and spouses in strengthening their relationships may also help protect against spouse substance use related to soldier service experiences.

BACKGROUND:Military sexual trauma (MST) is linked to a range of deleterious health outcomes. Extant literature has focused disproportionately on mental health sequelae of MST. Research is needed to better understand the extent to which MST contributes to alcohol misuse and related problems - key issues facing service members. Additionally, sex differences in the nature and prevalence of MST may impact sequelae. The present research examined (a) the prevalence of an MST history among female and male service members, (b) relations between MST history and risk for alcohol misuse and related problems, and (c) potential sex differences in these experiences and outcomes.METHODS:Data from current and previous service members (334 males and 70 females) were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of U.S. Army Reserve and National Guard (USAR/NG) soldiers and their partners. Analyses examined the prevalence and types of MST experienced, relations between MST history and three alcohol-related variables (total consumption, heavy drinking frequency, and alcohol-related problems), and differences by sex.RESULTS:Approximately one-third (33.7%) of service members reported an MST history. Females (61.4%) reported an MST history at more than twice the rate of males (27.8%). Interactions between MST and sex were significant for all alcohol-related variables. Among males, an MST history was related to 70% higher alcohol consumption, 86% higher heavy drinking frequency, and 45% higher alcohol problem scores. An MST history was unrelated to alcohol-related variables among females.CONCLUSION:Findings suggest a higher prevalence of MST among USAR/NG service members than is often reported in the literature, particularly among males. An MST history was associated with higher and more hazardous/harmful current alcohol consumption among male service members, highlighting the need for greater screening, prevention, and intervention among a population already at high risk for problematic alcohol use. Results underscore that MST is an important and prevalent experience requiring greater study alongside more traditional notions of service-connected trauma.

OBJECTIVE:Sleep problems are common among military members and may increase substance use risk. This study examines longitudinal associations between sleep problems and substance use among U.S. Army Reserve and National Guard (USAR/NG) soldiers as well as differences between current and former soldiers.METHOD:Data are drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing prospective study of the health and well-being of USAR/NG soldiers and their spouses. We used generalized estimating equation models (N = 485 soldiers; 79.8% male) to examine residual change in substance use (alcohol problems, heavy drinking, current use of any drug, nonmedical use of prescription drugs [NMUPD], and illicit drugs) associated with sleep problems (globally and particular dimensions) over 3 years, controlling for probable post-traumatic stress disorder, age, sex, and substance use at the prior time point. Interaction models examined differences by military status (current vs. former soldier).RESULTS:Sleep problems were associated with increased risk of heavy drinking (p < .05), any current drug use (p < .05), current NMUPD (p < .01), and current illicit use (p < .05). There were significant interactions between sleep quality and military status on any current drug use (p < .01) and current illicit use (p < .05) and between sleep duration and military status on current NMUPD (p < .05), such that the risk of substance use was greater for former compared with current soldiers.CONCLUSIONS:Sleep problems are prevalent among USAR/NG soldiers and are longitudinally associated with alcohol and drug use. This risk may increase for soldiers who have separated from the military. These findings support routine screening for sleep problems among soldiers and predischarge education around substance use risks related to unaddressed sleep problems.

The United States’ initiative to End the HIV Epidemic by 2030 includes a primary goal to reduce new HIV infections by 90 percent. One key contributor to this plan is HIV pre-exposure prophylaxis (PrEP). While knowledge and acceptance of PrEP among clinicians is growing, few studies have assessed knowledge and awareness among future healthcare professionals in academic training programs. The present study aimed to assess and compare healthcare trainees’ awareness, knowledge, and familiarity with PrEP prescribing guidelines to better understand and prevent gaps in academic training regarding PrEP. A cross-sectional web-based survey of medical, nurse practitioner, and pharmacy students enrolled at two universities was conducted between October 2017 and January 2018. The study assessed participants’ awareness, knowledge, and familiarity with PrEP prescribing guidelines and willingness to prescribe PrEP and refer to another healthcare provider. The survey was completed by 744 participants (response rate = 36.2%). Overall, PrEP awareness was high though PrEP knowledge was low. There were significant differences among student groups in domains of interest. Pharmacy students had the greatest PrEP knowledge, awareness, and familiarity with prescribing guidelines. However, medical students reported the greatest comfort with performing PrEP-related clinical activities and willingness to refer a candidate to another provider. Study findings enhance our understanding of healthcare professional students’ perspectives of PrEP as a biomedical prevention strategy for HIV. The gaps in students’ knowledge offer opportunities for the development of educational strategies to support HIV prevention among future healthcare professionals.

In the United States, turning 21 often involves heavy drinking and high rates of alcohol-related consequences. Friends are an important source of social influence on young adult drinking, including during 21st birthdays. However, research is needed to investigate the specific pathways through which this interpersonal influence occurs. Data were drawn from a larger intervention study focused on reducing 21st birthday drinking. Using data from 166 celebrant and friend dyads (N = 332 individuals), we prospectively examined relations among each person's beliefs about 21st birthday celebrations, drinking intentions for the celebrant, and celebrants' estimated blood alcohol concentration (eBAC) on their 21st birthdays. Path analyses evaluated the impact of celebrant and friend beliefs on their own report of celebrant intentions, each other's report of celebrant intentions, and celebrant eBAC, as well as the mediating role of each individual's report of celebrant intentions. Results revealed significant indirect effects of each individual's beliefs on celebrant eBAC via their own report of celebrant 21st birthday drinking intentions. Friend beliefs also predicted celebrant eBAC via celebrant drinking intentions, beyond the effect of celebrant beliefs. Importantly, celebrant eBAC was as strongly predicted by friend 21st birthday celebration beliefs as they were by their own beliefs. Results highlight multiple pathways through which friends influence 21st birthday drinking and reveal that friend influence is not constrained to the celebration, but begins in advance of the event by shaping celebrants' drinking intentions. Findings highlight key directions for future work leveraging friends as intervention agents to reduce drinking related to this high-risk event.

Background: Many women continue to smoke during pregnancy, despite known risks, often in response to negative affect. Recent scholarship has begun to examine factors that decrease the success of behavioral treatments for smoking cessation in pregnancy, which are the preferred interventions. Alexithymia is one factor that may interfere with smoking cessation interventions. Alexithymia restricts access to emotional information and increases propensity toward maladaptive behaviors, including smoking. However, mechanisms underlying such effects are largely unknown. Objectives: Using data from a longitudinal treatment study, the present research examined difficulties with emotion regulation as a potential mechanism linking alexithymia and smoking. Pregnant smokers (n = 73; mean age = 24.78; SD = 4.50) completed measures related to alexithymia, smoking, emotion regulation, depression, anxiety, and anger at baseline and then again following eight sessions of Cognitive-Behavioral Smoking Cessation Treatment. Results: Nearly 40% of the sample met the criteria for alexithymia. The alexithymia group reported higher depression, anxiety, and anger. They also reported more difficulties with emotion regulation. In a path analysis, baseline alexithymia had a significant positive indirect effect on number of cigarettes smoked at the end of treatment through difficulties with emotion regulation. Conclusions/Importance: Similar to other studies, alexithymia limits the understanding of emotional information necessary for selection and implementation of adaptive coping responses. Our results extend the literature by suggesting that smoking may be an attempt to manage undifferentiated and unpleasant sensations created by alexithymia.