ObjectiveParents represent a growing yet understudied population of people who use cannabis in the era of legalization. Studies examining how increasing availability of cannabis retail stores affects parental cannabis use, norms, and perceived harm are needed to guide interventions to support families. This longitudinal study examines whether perceived and objectively measured cannabis outlet availability are associated with parents' cannabis use frequency, acceptability, and perceived addictiveness in Washington State, where nonmedical cannabis retail stores opened in 2014.MethodParents (n = 471) in the Seattle Social Development Project - The Intergenerational Project were surveyed in 2015, 2016, and 2017. Multilevel models were used to estimate within- and between-person associations between (a) perceived cannabis outlet availability (self-reported number of outlets in one's neighborhood) and (b) objective cannabis outlet availability (number of outlets within a 10-minute drive time from home) with past-year cannabis use frequencies, acceptability of parental cannabis use, and perceived addictiveness.ResultsLocal retail outlet availability was higher in later waves. There were significant between-person associations, such that parents residing in neighborhoods with greater cannabis outlet availability (both perceived and objectively measured) over the course of the study had greater cannabis use frequency, higher acceptability of use, and lower perceived addictiveness. When comparing the same parents over time, the association between objectively measured outlet availability and acceptability of use was replicated in the within-person analysis, such that parents had greater acceptability of parental cannabis use in years when they lived in neighborhoods with higher objective outlet availability.ConclusionsLegal cannabis retail stores are increasingly common within neighborhoods. Prevention programming to support families residing in neighborhoods with greater outlet availability may reduce permissive cannabis norms and use among parents, which can have strong implications for youth substance use prevention and positive youth development.

U.S. schools have changed dramatically from before the pandemic (AY 2018–2019) to after school campus reopening (AY 2021–2022). These changes are most visible through the sharp increase in chronic absenteeism and decrease in enrollment in K-12 public schools. This study specifically focuses on California and two outcomes of interest, changes in chronic absenteeism rates and changes in school enrollment. We examined the associations of each outcome in separate models with indicators of structural inequality (school racial composition, school free and reduced priced meals [FRPM], county unemployment rates) and pandemic factors (county-level COVID-19 incidence rates, learning modality). Findings describe how increases in FRPM and school racial composition, two indicators of structural inequality, were directly associated with chronic absenteeism. In addition, although learning modality (e.g., in-person, remote) was not a significant predictor, higher COVID-19 incidence rates were associated with lower chronic absenteeism. Urbanicity and community unemployment predicted declines in enrollment, but not school racial composition, FRPM, community level COVID-19 incidence or learning mode. Findings can support school psychologists in investigations of the root causes of chronic absenteeism, changes in school enrollment, and inform the development of appropriately targeted interventions that consider the structure contexts of systemic inequities and the long-lasting effects of the pandemic.

School suspension in adolescence has been shown to predict homelessness in young adulthood, suggesting that it may be a point of intervention to reduce young adult homelessness. Under zero tolerance policies, school suspension is more common in the United States relative to Australia. Multilevel modeling of cross-national longitudinal data from the International Youth Development Study tested prospective associations between adolescent problem behaviors, student-perceived likelihood of suspension/expulsion, school-level behavior management policy, and young adult homelessness. Population-based samples of participants from Washington State (United States) and Victoria (Australia) were surveyed at ages 13, 14, 15 (2002-2004), and 25 years (2014-15; n = 1945; 51% female). Over half of the young adults who reported homelessness within the previous year at age 25 had experienced school suspension. Individual-level school suspension in middle school predicted young adult homelessness. Higher levels of adolescent rebelliousness, non-violent and violent antisocial behavior, and substance use predicted a higher likelihood of school suspension at the person-level and were indirectly related to increased risk for homelessness at age 25. School behavior management policy was not related to a history of school suspension at either the person- or school-level once individual factors were controlled. Findings demonstrate the importance of school suspension as a risk factor for future homelessness and suggest that prevention programming that aims to mitigate substance use, antisocial behaviors, and school suspension may help to reduce young adult homelessness.

Social and emotional learning (SEL) practices in schools endeavor to support wellbeing and emotional intelligence in young people; they work best when implemented well. Educational leaders in K-12 settings need to have capacities to provide SEL implementation support. Surveying SEL implementation capacity can identify specific strengths and areas for improvement and monitor progress. The current study assesses the validity and reliability of a 15-item self-report scale of capacities to support SEL implementation. A sample of 507 county-, district-, and school-level K-12 educational SEL leaders completed the scale in Fall 2023. Confirmatory factor analysis was used. The SEL capacities scale contains four unique dimensions with high internal reliability: mindsets (5 items), knowledge (3 items), skills (6 items), and efficacy (1 item). The SEL capacities scale also showed consistency (e.g., factor structure invariance) across school seasons, different educational settings, roles in the education system, years of experience among leaders, and recent levels of SEL supports received. Data generated by the SEL capacities scale can be used to inform practice decisions, make comparisons across people and over time, and unearth specific mechanisms of change related to developing adult SEL capacities to provide SEL implementation support.

PURPOSE:Economic factors are an important social determinant of health. Financial hardship in young adulthood is particularly concerning, given current inflation rates, high housing prices, and rising cost of living. Yet, we know remarkably little about the socioecological factors in adolescence that influence later risk for financial hardship in young adulthood above and beyond family socioeconomic circumstances. METHODS:Multivariable ordered logistic regression analyses using cross-national longitudinal data from the International Youth Development Study explored associations between a range of socioecological factors in adolescence and financial hardship in young adults. Participants from Washington State (the United States) and Victoria (Australia) were surveyed at ages 13, 14, 15 (2002-2004), and 25 years (2014-2015; N = 1,945; 51% female). RESULTS:At least two indicators of financial hardship were reported by 25% of young adults. Multivariable predictors of financial hardship in young adulthood included higher levels of family conflict, a history of school suspension, and academic underperformance. Early family economic disadvantage was no longer significant after adjustment for adolescent influences. DISCUSSION:Findings suggest that there are modifiable adolescent socioecological factors that influence young adult financial hardship beyond the economic position of the family unit. Exploring when these factors emerge from childhood to adolescence is recommended as this could inform the development of prevention and intervention strategies that respond to these risks at the earliest point in the life course, with the goal of shifting the rate of financial hardship in young adults, and ultimately improving their health and well-being.

The objective of this study is to examine cross-over effects of the Raising Healthy Children universal childhood preventive intervention on adult suicide behaviors and related mental health. A nonrandomized controlled trial was conducted in elementary schools serving higher-risk areas in Seattle, Washington (during ages 6–13, grades 1–6) and followed up at ages 21–39. The panel originated in Seattle but was followed in and out of state. This study examines participants who had been in the intervention (n = 156) vs. control (n = 220) conditions in grades 1–6. The intervention provided teachers with methods of classroom management, parents with family management skills, and children with social-emotional skills training. Outcomes examined were ever suicide ideation, attempt, or completion, and DSM-IV-based criterion counts for depression, generalized anxiety disorder, PTSD, and social phobia across 6 waves, ages 21–39. At follow-up, the intervention group showed significantly lower suicide ideation and behavior, depression, generalized anxiety disorder, PTSD, and social phobia than the control group. Universal childhood preventive intervention can reduce suicide ideation and behaviors and related mental health problems in adulthood. Clinical Trials.gov ID: NCT04075019.

Objective: The purpose of this study was to examine how alcohol availability, overserving, and enforcement in recreational and social settings are related to alcohol misuse and alcohol-impaired driving among young adults in Victoria, Australia, and Washington State, United States. Method: Longitudinal data came from 1,430 participants in Victoria (n = 757; 52% female) and Washington (n = 673; 53% female), surveyed in 2014 (age 25 years) and 2018 (age 29 years) from the International Youth Development Study, a population-based, cross-national study to examine factors influencing substance use. Path modeling tested associations between age 25 perceptions of the alcohol environment, age 25 social alcohol consumption, and age 29 alcohol-related harms. Multiple-group modeling examined differences in parameter estimates across both states. Results: Age 25 perceptions of the alcohol environment (alcohol availability, overservice in evening social venues, legal enforcement) and alcohol consumption in evening social settings were similar between the two states. Higher alcohol availability and perceived tendency of evening social venues to overserve were associated with higher alcohol consumption in these contexts. In turn, higher alcohol consumption in these settings was associated with more problematic alcohol use and an increased likelihood of alcohol-impaired driving 4 years later. The perceived likelihood of legal enforcement in evening social settings was not related to alcohol consumption in these contexts. Conclusions: The recreational and social settings commonly frequented by young adults can influence drinking behaviors and alcohol-related harms. Reducing alcohol availability and overservicing in settings where young adults often congregate and socialize could reduce problematic alcohol use and alcohol-impaired driving.

This study offers a model for using multidimensional growth mixture models to identify polysubstance use trajectories by examining transitions among conjoint substance use trajectories from adolescence to young adulthood and exploring potential moderators that may facilitate transitions towards healthier substance use trajectories in young adulthood. Longitudinal mixture modeling was used to examine six waves of data collected during adolescence (ages 13, 14, 15) and young adulthood (ages 25, 29, 31) in Seattle, Washington. Data were drawn from the International Youth Development Study, a longitudinal, cross-national study examining the life course patterns of substance use and development among youth. Participants (N = 961) completed questionnaires on six occasions that assessed demographics (sex, race, highest parent education), suspension and expulsion, individual substance use, partner substance use, and social role transitions (education, marriage, childbearing, employment). Four substance use classes were identified in adolescence and included low use (n = 572, 59.6%), alcohol dominant (n = 177, 18.4%), increasing use (n = 103, 10.7%), and poly-use (n = 109, 11.3%). Five substance use classes were identified in young adulthood and included low use (n = 134, 15.3%), alcohol only (n = 349, 39.8%), alcohol and tobacco (n = 97, 11.0%), alcohol and cannabis (n = 162, 18.5%), and poly-use (n = 135, 15.4%). The transition from adolescence to young adulthood showed the strongest continuity in the poly-use class and the weakest in the low use class, with a general trend toward adding substances rather than reducing them. College graduation moderated the transition in substance use patterns from adolescence to young adulthood for low use and alcohol dominant adolescent classes but not for the poly-use class. Delays in adult role assumptions were not consistently associated with substance use classes during this transition. However, where significant, delayed marriage and parenthood acted as protective factors against the progression of substance use leading into young adulthood. The findings underscore the need for early detection and tailored prevention efforts among adolescents. By identifying pivotal periods and specific substance use patterns, these findings inform the timing and focus of targeted interventions designed to reduce the escalation of substance use leading into young adulthood.

ObjectiveIntergenerational studies have identified relations between adolescents' and their future offspring's cannabis and alcohol use, but rarely have examined the association for other illicit drug use. Given the low prevalence of such use in community populations, we pooled data from three prospective intergenerational studies to test this link.MethodParticipants were 1,060 children of 937 parents who had been repeatedly assessed since early adolescence. Children and parents reported on their use of cocaine, stimulants, hallucinogens, sedatives/tranquilizers, and opiates/narcotics from ages 10 to 18 years. Intergenerational similarities in any versus no use of these drugs were formally modeled using logistic regression. Patterns also were descriptively analyzed.ResultsParent illicit substance use was associated with significantly higher odds of child use (adjusted odds ratio [95% confidence interval] = 2.682 [1.328-5.416], p = 0.006). However, intergenerational continuity was modest; 87% of children whose parent used illicit drugs in adolescence did not use such drugs, and 77% of parents of children who used illicit drugs had not themselves used these drugs during adolescence.ConclusionsThe use of illicit substances by parents during their teenage years poses a risk for their offspring's similar behaviors. However, the discontinuity of these behaviors across generations implies children are largely resilient to or protected from this risk, and conversely that other aspects of parents' and children's experiences or characteristics may be more powerful risks for children's illicit drug use than this transgenerational influence. (a) Parents' use of illicit drugs during adolescence significantly increased risk that their adolescent children would use such drugs. (b) However, most parents who used illicit drugs did not have children who used illicit drugs, and conversely, the majority of adolescents who used illicit drugs did not have parents who had used such drugs in their adolescence. (c) Distinct prevention strategies may be needed to disrupt intergenerational continuities in illicit drug use via selective prevention, and also to avert drug use by offspring of parents who abstained in adolescence through universal approaches.

Prior studies suggest that adult supervised drinking in adolescence predicts greater adolescent alcohol misuse. Long-term follow up data examining how adult supervised drinking during adolescence relates to alcohol misuse in adulthood are lacking. Longitudinal data from the International Youth Development Study tested associations between adult supervised drinking during adolescence (ages 13 - 16 ; 2002 - 2004) and adult alcohol misuse (ages 25 - 31 ; 2014, 2018, 2020). Cross-nationally matched samples were compared in Washington State, USA (n = 961) and Victoria, Australia (n = 1,957; total N = 2,918, 55% female, 83% White), where adult-supervised adolescent alcohol use was more common. Multilevel analyses adjusted for state, sex, adolescent drinking, parent education, family management, family history of substance use problems, and parent alcohol-related norms. Adult supervised drinking in adolescence (at dinner or parties, on holidays) predicted more adult alcohol misuse (mean Alcohol Use Disorders Identification Test score; b[SE] 0.07[0.03]; p = 0.004) and higher rates of alcohol-impaired driving (Odds Ratio [OR] 1.501, p = 0.034) and riding with an alcohol-impaired driver (OR 1.669, p = 0.005), but not the use of strategies to moderate alcohol intake (e.g., counting drinks). Better family management (monitoring, clear rules) in adolescence predicted less adult alcohol misuse. Associations were similar in the two states. Reducing the frequency of adult supervised drinking and improving family management practices in adolescence may help to decrease alcohol misuse well into adulthood. Findings support the widespread implementation of substance use prevention and family management training programs.

ObjectiveFew studies of recreational cannabis legalization (RCL) have assessed adolescents both before and after RCL or considered moderators of RCL effects. The present study tested whether RCL was more strongly associated with cannabis use for girls and among youth whose parents had a history of cannabis use during adolescence.MethodData were pooled from 940 adolescents from three intergenerational studies that began in Washington (where RCL was enacted in 2012), Oregon (RCL year = 2015), and New York (RCL year = 2021). Youth were assessed repeatedly from ages 13 to 18 years (k = 3,650 person-years) from 1999 to 2020 (prior to RCL in New York). Parent cannabis use at or before age 18 years (yes/no) was assessed prospectively during the parent's adolescence. Multilevel models focused on the between-subjects effects of years of youth exposure to RCL on adolescents' mean cannabis use likelihood, and interactions with child sex and parent use history.ResultsChild exposure to RCL was associated with a higher likelihood of cannabis use if their parents had a history of adolescent use, (Estimate [SE] = 0.67 [0.25], p = 0.008), versus no such history (Estimate [SE] = -0.05 [0.28], p = 0.855). RCL effects were not moderated by child sex.ConclusionsThe effects of RCL on adolescents' cannabis use may depend on their parents' history of using the drug. Identifying other moderators of RCL effects, and understanding the mechanisms of these risks and the ways that parents and communities can offset them, are prevention priorities. (1) Adolescents' use of cannabis may have intergenerational consequences, making it more likely their future offspring will use cannabis. (2) Whether or not recreational cannabis legalization influences adolescents' cannabis use may depend on their parents' cannabis use history. (3) Parenting in a state with liberalized cannabis policies may present new challenges and require that novel prevention resources be developed.

BACKGROUND AND AIMS:Emerging data suggest neoadjuvant chemotherapy (NAC) for resectable pancreatic ductal adenocarcinoma (PDAC) is associated with improved survival. However, less than 40% of patients demonstrate a meaningful radiographic response to NAC. EUS-guided radiofrequency ablation (EUS-RFA) has emerged as a new modality to treat PDAC. We hypothesize that NAC plus EUS-RFA can be used in the management of resectable PDAC. METHODS:This was a prospective review of PDAC patients meeting the criteria of resectable tumor anatomy who underwent NAC chemotherapy plus EUS-RFA followed by pancreatic resection. Radiographic imaging and perioperative and short-term outcomes were recorded. Surgical pathology specimens were analyzed for treatment response. RESULTS:Three eligible patients with resectable PDAC received 4 months of NAC plus EUS-RFA. One month after completing NAC and EUS-RFA, all 3 patients underwent standard pancreaticoduodenectomy without adverse events. After a 6-week recovery, all patients completed 2 months of postoperative adjuvant chemotherapy. CONCLUSIONS:In our institutional experience, this treatment protocol appears to be safe as patients tolerated the combination of chemotherapy and ablation. Patients underwent pancreatic resection with uneventful recovery. This novel neoadjuvant approach may provide a more effective alternative to chemotherapy alone.

BACKGROUND AND AIMS:For young adults, the disruptions brought by the COVID-19 pandemic to work, social relationships and health-care probably impacted normative life stage transitions. Disaster research shows that negative effects of these events can persist for years after the acute crisis ends. Pandemic-related disruptions may have been especially consequential for young adults with a history of substance use disorder (SUD). The current work aimed to measure the broad impact of the COVID-19 pandemic on young adults with and without a history of SUD. DESIGN, SETTING AND PARTICIPANTS:Data were from a longitudinal panel of n = 4407 young adults across the United States surveyed repeatedly from 2014 to 2019 (aged 19-26 years, pre-pandemic) and again in 2021 (aged 28 years, mid-pandemic). MEASUREMENTS:We fitted multi-level models to understand the association between SUD history and pandemic outcomes, controlling for potential confounders (socio-demographic and health measures). Outcomes included overall life disruption; mental health, social and economic impacts; substance use; and physical health. FINDINGS:Young adults with a history of SUD reported greater life disruption (standardized β = 0.13-0.15, Ps < 0.015) and negative mental health impacts (standardized β = 0.12-0.14, Ps < 0.012), experienced approximately 20% more work-related stressors (relative risks = 1.18-1.22, Ps < 0.002) and 50% more home-related stressors (relative risks = 1.40-1.51, Ps < 0.001), and had two to three times the odds of increased substance use during the pandemic (odds ratios = 2.07-3.23, Ps < 0.001). Findings generally did not differ between those with a recent SUD diagnosis and those in recovery from SUD before the pandemic began. CONCLUSIONS:United States young adults with a history of substance use disorder (SUD) reported more life disruption and greater negative physical and mental health, social and economic impacts during the COVID mid-pandemic period than young adults with no history of SUD.

Housing insecurity is concerning at any age, but the prevalence and predictors of young adult housing insecurity are poorly described. Multivariable regression analyses using cross-national longitudinal data from a population-based sample tested prospective associations between various adolescent predictors and young adult housing insecurity. Participants from Washington State (United States) and Victoria (Australia) were surveyed at ages 13, 14 and 15 (2002-2004) and 25 and 29 years (2014-15, 2018-19; N = 1945; 46% female). The prevalence of housing insecurity was 9%. Multivariable predictors of housing insecurity included living in Washington State, antisocial behavior, a history of school suspension, and academic underachievement. School suspension was more strongly related to insecure housing in Washington State than in Victoria. Future analyses should explore state policy differences and risk and protective processes within social-ecological contexts to identify population-level modifiable upstream risk factors for housing insecurity that can be targeted earlier in the life course.

Abstract Background Chronic pain often clusters in families, where parents and their offspring both experience chronic pain conditions. Young children of parents with irritable bowel syndrome (IBS) represent an at-risk group for the development of abdominal pain, disability, and excess health care visits in later childhood. Parental solicitous responses to children’s expressions of discomfort and maternal modeling of their own illness behavior contribute to a greater focus on somatic sensations, leading to illness behaviors in children. This randomized controlled trial will test the effectiveness of an early preventive web-based psychosocial intervention (REACH)[TM] vs. an educational web-based safety comparison condition delivered to parents with IBS to alter parental responses and lead to improved child health and decreased health care costs. Methods Parents with IBS who have children ages 4–7 years are recruited via community-based approaches (e.g., social media advertisements, school electronic distribution, research networks) and health care providers. The target sample is 460 parents randomized to REACH, a web-based social learning and cognitive behavior therapy (SLCBT) intervention or an educational web-based safety comparison condition (EC). Participants will be assessed at baseline, 6-week (immediate post-intervention), 6-month, 12-month, and 18-month follow-up periods (months post-completion of intervention). The primary outcome is change in parental solicitous/protective behaviors. Secondary outcomes include parent risk and protective factors, child health and symptom outcomes, and health care utilization and cost savings. Discussion This study adapts a validated, parent-delivered intervention to treat chronic pain in children to a web-based application designed to prevent the development of chronic pain in very young, high-risk children. If successful, this strategy can both prevent adverse sequelae of this condition from developing as well as be widely accessible. Furthermore, the availability of a prevention model for parent training could result in significant short- and long-term health benefits across a broad spectrum of conditions. Trial registration ClinicalTrials.gov NCT05730491. Registered on February 15, 2023.

Some universal prevention programs, such as Raising Healthy Children (RHC), have shown persisting and wide-ranging benefits in adulthood, long after the intervention has ended. Recent studies suggest that benefits may continue into the next generation as well. This study examines whether the RHC intervention, delivered in childhood, may promote healthy family functioning among participants who now have families of their own. Participants were drawn from the Seattle Social Development Project (SSDP), a nonrandomized controlled trial of the RHC intervention prospectively following youths from 18 elementary schools in Seattle, Washington from 1985 to 2014. Participants who became parents were enrolled in an intergenerational study, along with their oldest biological child and an additional caregiver who shared responsibility for raising the child. Ten waves of data were collected between 2002 and 2018. The present analysis includes 298 SSDP parents, 258 caregivers who identified as a parent or partner of SSDP parent ("co-parent"), and 231 offspring. The SSDP parent sample was composed of 41.6% male, 21.1% Asian or Pacific Islander, 24.2% Black or African American, 6.4% Native American, and 48.3% white individuals. No significant intervention effects were found on adult romantic relationship quality; offspring bonding to co-parent; or co-parent past-month use of cannabis, cigarettes, or binge drinking. Findings highlight the continued need to understand how the benefits of theory-guided universal preventive interventions are sustained across the life course and how they may or may not shape family functioning for those who go on to have families and children of their own.ClinicalTrials.gov Identifier: NCT04075019.

PURPOSE:This study builds upon and extends previous longitudinal research on deliberate self-harm (DSH) among youth by investigating which risk and protective factors during adolescence predict DSH thoughts and behavior in young adulthood. METHODS:Self-report data came from 1,945 participants recruited as state-representative cohorts from Washington State and Victoria, Australia. Participants completed surveys in seventh grade (average age 13 years), as they transitioned through eighth and ninth grades and online at age 25 years. Retention of the original sample at age 25 years was 88%. A range of risk and protective factors in adolescence for DSH thoughts and behavior in young adulthood were examined using multivariable analyses. RESULTS:Across the sample, 9.55% (n = 162) and 2.83% (n = 48) of young adult participants reported DSH thoughts and behaviors, respectively. In the combined risk-protective factor multivariable model for young adulthood DSH thoughts, depressive symptoms in adolescence (adjusted odds ratio [AOR] = 1.05; confidence interval [CI] = 1.00-1.09) increased risk, while higher levels of adolescent adaptive coping strategies (AOR = 0.46; CI = 0.28-0.74), higher levels of adolescent community rewards for prosocial behavior (AOR = 0.73; CI = 0.57-0.93), and living in Washington State decreased risk. In the final multivariable model for DSH behavior in young adulthood, less positive family management strategies during adolescence remained the only significant predictor (AOR = 1.90; CI = 1.01-3.60). DISCUSSION:DSH prevention and intervention programs should not only focus on managing depression and building/enhancing family connections and support but also promote resilience through efforts to promote adaptive coping and connections to adults within one's community who recognize and reward prosocial behavior.

People who experience social marginalization and vulnerability have uniquely complex health needs and are at risk of poor health outcomes. Regression analyses using longitudinal data from a cross-national, population-based sample of young adults participating in the International Youth Development Study, tested associations between social marginalization and vulnerabilities and physical health, mental health, and substance use outcomes. Participants from Victoria, Australia, and Washington State in the US were surveyed at ages 25 (2014) and 29 years (2018; N = 1944; 46.7% male). A history of adverse childhood experiences (ACEs), LGBT identity, financial insecurity, and justice system involvement at age 25 predicted poor health outcomes at age 28, including lower perceived health status, risk for chronic illness, depression and anxiety symptoms, and diagnosed mental health/substance use disorders. Tests of model equivalence across states showed that a history of ACEs was more strongly related to health status and serious injury at age 28 and justice system involvement at age 25 was more strongly related to age 28 serious injury in Victoria than in Washington State. Findings strengthen the case for future population-based research identifying life-course interventions and state policies for reducing poor health and improving health equity among members of socially marginalized groups.

The workplace has been understudied as a setting for the prevention of young adult alcohol misuse. This study examined if alcohol-tolerant workplace environments are associated with greater risk for alcohol use and misuse on and off the job among young adults. Data were collected in 2014 from state-representative, sex-balanced samples (51% female) of 25-year-olds in Washington, U.S. (n = 751) and Victoria, Australia (n = 777). Logistic regressions indicated that availability of alcohol at work, absence of a written alcohol policy, and alcohol-tolerant workplace norms and attitudes were independently associated with a 1.5 to 3 times greater odds of on-the-job alcohol use or impairment. Alcohol-tolerant workplace norms were associated also with greater odds of high-risk drinking generally, independent of on-the-job alcohol use or impairment. Associations were mostly similar in Washington and Victoria, although young adults in Victoria perceived their workplaces to be more alcohol-tolerant and were more likely to use alcohol or be impaired at work and to misuse alcohol generally than young adults in Washington. Cross-nationally, workplace interventions that restrict the availability of alcohol, ban alcohol at work, and reduce alcohol-tolerant norms have the potential to prevent and reduce young adults’ alcohol use and misuse on and off the job.