Introduction: Prevalence of alcohol and marijuana use is highest in young adulthood and an increasing number of young adults report simultaneous alcohol and marijuana (SAM) use, which is consistently linked with numerous negative consequences. To better understand reasons for engaging in SAM use and to refine measurement of subjective effects of SAM use, this study aimed to identify (1) how young adults describe subjective experiences during a SAM use occasion and (2) how language describing subjective effects changes as a function of level of alcohol and marijuana use. Methods: Using Amazon's Mechanical Turk (MTurk), 323 participants (53.6% women, 68.4% White, M age = 23.0 years) who reported past-month heavy episodic drinking and past-month SAM use were asked to list words to describe how they feel when using only alcohol, only marijuana, and various combinations of alcohol and marijuana. Results: SAM use language varied as a function of age and substance use behavior but was not associated with sex or race. Large differences in the terms used to describe subjective effects were observed when comparing different combinations of alcohol and marijuana use; most notably the term "cross-faded" appeared primarily when engaging at the heaviest combinations of alcohol and marijuana. Conclusion: Young adults have a wide range of vocabulary for describing subjective effects of SAM use, and subjective effects vary as a function of the level of each substance used. Future research should consider integrating such contemporary language when measuring subjective effects of SAM use.

Objective: To estimate the total number of alcohol-related consequences students experience during 4 years of college and examine early college indicators that result in higher rates of consequences. Method: Undergraduate drinkers (N = 1,744; 58% female; 87% White; 5% Hispanic) at a large northeastern university completed an online survey at the end of the fall and spring semesters during their first (T1, T2), second (T3, T4), third (T5, T6), and fourth (T7, T8) years of college (87% retention across the study). First, descriptive statistics were calculated to estimate the total number of alcohol-related consequences students experienced across all 4 years of college. Second, a structural equation model was examined to identify early college indicators that influence individuals experiencing more cumulative consequences. Results: Students experienced an average of 102 (SD = 89.91) alcohol-related consequences during 4 years of college. Next, early parental approval of consequences, but not peer drinking norms, were positively associated with students' willingness to experience consequences, which in turn, were positively associated with higher alcohol consumption and greater total consequences. Conclusions: Results estimated that, on average, students experienced 102 alcohol-related consequences across all 4 years of college. Parental approval of consequences influenced students' total consequences through their willingness to experience consequences and drinking behaviors. Findings from the current study have several important implications for interventions.

OBJECTIVE Research has shown that students who were more willing to experience consequences reported higher rates of alcohol consumption and negative consequences. The present study used a longitudinal design to examine intra- and interpersonal consequence-specific predictors of willingness to experience negative consequences. METHOD Students (N = 2,024) were assessed in the fall (Time [T] 1) and spring (T2) semesters of their first year in college. Intrapersonal constructs (i.e., expectancies, subjective evaluations, self-efficacy), interpersonal constructs (i.e., peer descriptive, injunctive norms), and personality constructs (i.e., self-regulation, impulsivity, sensation seeking) were assessed at T1 and willingness to experience negative alcohol-related consequences was assessed 6 months later. A structural path model examined the relationship between T1 predictors and T2 willingness. T1 drinking and sex were included as covariates. RESULTS These results demonstrated significant positive relationships between T1 participants' subjective evaluations of consequences, expectancies of experiencing consequences, and T2 willingness to experience negative consequences. Further, impulsivity, sensation seeking, and T1 drinking showed significant, positive associations with willingness, whereas higher self-regulation was significantly associated with lower willingness. Men were significantly more willing to experience negative consequences than women. No significant associations were observed between normative perceptions and willingness. CONCLUSIONS Intrapersonal and personality constructs, as well as previous drinking, were significantly associated with willingness to experience consequences whereas interpersonal constructs were not. Men were significantly more willing to experience negative consequences. College student interventions may benefit from focusing on significant constructs identified in the current study (e.g., enhancing self-regulation) and focusing on students with higher willingness to experience negative consequences.

Since approximately 12% of melanoma survivors will develop another melanoma, skin self-examination (SSE) is relevant.1,2 Structured SSE training with a partner may overcome challenges including a) motivation to undertake SSE; b) competence to recognize concerning lesions, and c) difficulty with long-term maintenance (≥1 year).3,4 Partner-assisted SSE and subsequent clinical presentation to a dermatologist for concerning moles rely on self-management, adoption of decision rules, and taking appropriate action.

Adolescent drinking continues to be a significant concern in the U.S. national epidemiological studies, which suggest that there are substantial increases among 16- to 17-year-olds for the past 30-day use (22.7%), heavy episodic drinking (HED; ≥5 drinks, 13.1%), and heavy use (>5 HED occasions, 2.7%) [[1]Substance Abuse and Mental Health Services AdministrationResults from the 2013 National Survey on Drug Use and Health: Summary of national findings.http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdfDate: 2014Date accessed: June 3, 2020Google Scholar]. This is concerning, as the consequences for adolescents, the people around them, and society as a whole have been well documented [[2]National Center for Education StatisticsFast facts: Back to school statistics.2016http://nces.ed.gov/fastfacts/display.asp?id=372Date accessed: June 3, 2020Google Scholar]. Research has shown that parent-based interventions (PBIs) have a potentially powerful role to play in reducing the scope of the adolescent drinking problem [[3]Spoth R. Greenberg M. Turrisi R. Preventive interventions addressing underage drinking: State of the evidence and steps toward public health impact.Pediatrics. 2008; 121: S311-S336Crossref PubMed Scopus (159) Google Scholar]. Despite the utility of PBIs, efficacy studies examining programs, such as Strengthening Families, Project STAR, and Raising Healthy Children, reveal that their content focuses primarily on parenting behaviors (e.g., communication, monitoring) of two-parent households. We could not identify any articles examining the effects of these programs on single-parent (SP) families raising teenagers. As such, their content does not fully address the specific unique needs of SPs (widowed, divorced, separated, or never married; and not currently married or living with a partner). This is concerning because SPs make up approximately one third of U.S. households [[4]Duffin E. Number of U.S. children living in a single parent family 1970-2019.https://www.statista.com/statistics/252847/number-of-children-living-with-a-single-mother-or-single-father/Date: 2020Date accessed: June 3, 2020Google Scholar]. Furthermore, approximately one in four U.S. children (∼20 million per year) have been raised by an SP and no other adult (80.4% of custodial SPs are mothers) [[4]Duffin E. Number of U.S. children living in a single parent family 1970-2019.https://www.statista.com/statistics/252847/number-of-children-living-with-a-single-mother-or-single-father/Date: 2020Date accessed: June 3, 2020Google Scholar]. Numerous studies have provided evidence showing teens raised in SP homes are more likely to engage in delinquent behaviors that include alcohol and other substance use [5Amato P.R. Children of divorce in the 1990s: An update of the Amato and Keith (1991) meta-analysis.J Fam Psychol. 2001; 15: 355-370Crossref PubMed Scopus (797) Google Scholar, 6Tomčíková Z. Veselská Z.D. Madarasova Gecková A. et al.Adolescents’ drinking and drunkenness more likely in one-parent families and due to poor communication with mother.Cent Eur J Public Health. 2015; 23: 54-58Crossref PubMed Scopus (15) Google Scholar, 7Ruutel E. Sisask M. Varnik A. et al.Alcohol consumption patterns among adolescents are related to family structure and exposure to drunkenness within the family: Results from the SEYLE Project.Int J Environ Res Public Health. 2014; 11: 12700-12715Crossref PubMed Scopus (20) Google Scholar, 8Tomčíková Z. Madarasova Gecková A. Orosova O. et al.Parental divorce and adolescent drunkenness: Role of socioeconomic position, psychological well-being and social support.Eur Addict Res. 2009; 15: 202-208Crossref PubMed Scopus (16) Google Scholar]. Although there are exceptions, the overwhelming majority of studies have provided evidence of increased risk for early alcohol initiation, drinking more frequently, and consuming alcohol in greater quantities, warranting intervention efforts specifically tailored or adapted for SPs and their adolescent children [6Tomčíková Z. Veselská Z.D. Madarasova Gecková A. et al.Adolescents’ drinking and drunkenness more likely in one-parent families and due to poor communication with mother.Cent Eur J Public Health. 2015; 23: 54-58Crossref PubMed Scopus (15) Google Scholar, 7Ruutel E. Sisask M. Varnik A. et al.Alcohol consumption patterns among adolescents are related to family structure and exposure to drunkenness within the family: Results from the SEYLE Project.Int J Environ Res Public Health. 2014; 11: 12700-12715Crossref PubMed Scopus (20) Google Scholar, 8Tomčíková Z. Madarasova Gecková A. Orosova O. et al.Parental divorce and adolescent drunkenness: Role of socioeconomic position, psychological well-being and social support.Eur Addict Res. 2009; 15: 202-208Crossref PubMed Scopus (16) Google Scholar]. We use the remainder of this commentary to address the issues and potential solutions. First, PBIs tend not to take into consideration the specific needs of SPs. We examined the content of the PBIs for adolescents that the Spoth et al.’s [[3]Spoth R. Greenberg M. Turrisi R. Preventive interventions addressing underage drinking: State of the evidence and steps toward public health impact.Pediatrics. 2008; 121: S311-S336Crossref PubMed Scopus (159) Google Scholar] review identified as having the most rigorous evidence of efficacy for reducing underage drinking, mentioned previously. Their content focused primarily on parenting behaviors and rarely addressed parental risk and protective factors (e.g., emotional distress [re: anxiety, depressed mood, and stress]; support [social, money, and time]; self-care [re: sleep, healthy eating, exercise, and mindfulness]; conflict with other parent; and coping [re: adaptive and maladaptive]). SP families are diverse, and while networks of extended family and friends are available to some, other families lack the additional support resulting in overtaxed resources. This is even more concerning during the COVID-19 pandemic, as parents are experiencing new or enhanced risk factors, as they are juggling work issues, health concerns, parenting, relationships, and in-home schooling, often without childcare. For SPs, this often means having to make choices about working to support their families versus providing their children with adult supervision or education. The content of PBIs must be enhanced to meet the needs of SPs; therefore, research is needed to identify content that informs adaptations targeting PBIs for SPs. Second, little is known about how SP parenting behaviors and SP risk and protective factors are interrelated. For the purposes of identifying the content to inform adaptations to PBIs for SPs, we conducted a review of etiological studies on SPs' parenting behaviors and risk and protective factors and observed several trends. First, most studies examined either parenting behaviors or parental risk and protective factors, but not both at the same time [[7]Ruutel E. Sisask M. Varnik A. et al.Alcohol consumption patterns among adolescents are related to family structure and exposure to drunkenness within the family: Results from the SEYLE Project.Int J Environ Res Public Health. 2014; 11: 12700-12715Crossref PubMed Scopus (20) Google Scholar,[8]Tomčíková Z. Madarasova Gecková A. Orosova O. et al.Parental divorce and adolescent drunkenness: Role of socioeconomic position, psychological well-being and social support.Eur Addict Res. 2009; 15: 202-208Crossref PubMed Scopus (16) Google Scholar]. Second, among the few reports that studied both parenting behaviors and parental risk and protective factors concurrently, only a small number of constructs were included (e.g., communication or stress) and used poor methodologies that limited conclusions and generalizability [[8]Tomčíková Z. Madarasova Gecková A. Orosova O. et al.Parental divorce and adolescent drunkenness: Role of socioeconomic position, psychological well-being and social support.Eur Addict Res. 2009; 15: 202-208Crossref PubMed Scopus (16) Google Scholar]. Research that broadly examines both parenting behaviors and parental risk and protective factors of SPs (and their interrelationships) using rigorous methods is needed. Third, longitudinal research on SPs is needed. There is evidence of increases and changes in drinking throughout adolescence (e.g., transitioning to high school and driving). According to Monitoring the Future 2019, the rates of past-year alcohol use nearly doubles from eighth grade (19.3%) to 10th grade (37.7%) and then again in the 12th grade (52.1%) [[9]Monitoring the FutureMonitoring the future 2019 survey results: Overall findings. Institute for Social Research, The University of Michigan, Ann Arbor, MI2019Google Scholar]. We could not locate any peer-reviewed articles that report exact figures for these changes in adolescents raised by SPs. Drawing on the findings that adolescents who live in SP homes are at increased risk for early initiation and problematic drinking [6Tomčíková Z. Veselská Z.D. Madarasova Gecková A. et al.Adolescents’ drinking and drunkenness more likely in one-parent families and due to poor communication with mother.Cent Eur J Public Health. 2015; 23: 54-58Crossref PubMed Scopus (15) Google Scholar, 7Ruutel E. Sisask M. Varnik A. et al.Alcohol consumption patterns among adolescents are related to family structure and exposure to drunkenness within the family: Results from the SEYLE Project.Int J Environ Res Public Health. 2014; 11: 12700-12715Crossref PubMed Scopus (20) Google Scholar, 8Tomčíková Z. Madarasova Gecková A. Orosova O. et al.Parental divorce and adolescent drunkenness: Role of socioeconomic position, psychological well-being and social support.Eur Addict Res. 2009; 15: 202-208Crossref PubMed Scopus (16) Google Scholar], it is likely that increases in drinking are even more dramatic in adolescents from SP homes, but, without data, this remains an important empirical question. Research is desperately needed to understand how a comprehensive examination of parenting factors influence adolescent psychosocial and developmental factors during different critical stages of development. Examples of research questions that would move the prevention field forward could include (1) Which SP parenting behaviors and parental risk and protective factors will have the most impact on their adolescents' psychosocial development at different time points? (2) What is the manner in which SP parenting behaviors and risk and protective factors result in the least and most adolescent drinking-related harm? and (3) What are the potential optimal points for PBIs for SPs of adolescents? Answers to these questions will provide necessary information to tailor the PBI content and optimal timing for SPs and their adolescent children. Furthermore, our review of research studies on SP families extended beyond adolescent drinking to smoking/vaping, marijuana use, age of first intercourse, externalizing behaviors, and self-harm. We could find very few empirical examinations of SP households and adolescent risky behaviors and even fewer that report more than sample demographics. A notable exception is in the area of sex communication [[10]Padilla-Walker L.M. Rogers A.A. McLean R.D. Is there more than one way to talk about sex? A longitudinal growth mixture model of parent–adolescent sex communication.J Adolesc Health. 2020; 67: 851-858Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar]. In sum, many adolescent children of SPs are at significant risk. To effectively address this, comprehensive research is needed to inform prevention efforts that examine the processes by which parenting behaviors and risk and protective factors (and their interrelationships) of SPs influence their adolescents' psychosocial/developmental variables and subsequent drinking outcomes. All who contributed significantly to the commentary are named as authors.

Introduction: Research on combining alcohol and nicotine (ALCNIC) has shown this risky behavior results in significantly more consequences than using either alcohol or nicotine alone. No measures currently exist to assess ALCNIC motives limiting intervention and prevention efforts. The present study developed a psychometrically sound and multidimensional measure of ALCNIC motives (the ANMS). Methods: An initial item pool of ALCNIC items was developed from literature on college student drinking, focus groups, and individual interviews. Study 1 involved students from a northeastern university who completed an online survey on the ALCNIC items (N = 55; 57.1% female; Mage = 20.3). Analysis focused on reliability (exploratory factor analysis). Study 2 involved a cross-validation national sample of college students (N = 336; 49.7% female; Mage = 21.2) completing the same survey items. Confirmatory factor analysis, criterion-related validity (ALCNIC/weekend drinking), and discriminant validity (social desirability) were assessed using structural equation modeling. Results: Results across two studies revealed three factors to engage in ALCNIC: antagonistic (party longer), synergistic (enhanced effects), and social (peer pressure); and one factor to avoid ALCNIC: negative effects (feeling anxious) (all alphas > 0.7). In study 2, criterion-related validity revealed that synergistic motives were significantly positively associated with ALCNIC use; and negative effects motives were significantly negatively associated with ALCNIC use. Discriminant validity showed ALCNIC subscales were not significantly associated with social desirability (except social). Conclusions: The study developed a reliable and valid measure of motives for ALCNIC use. Results were robust to cross-validation across two samples of college students. These measures provide targets for intervention and prevention efforts.

Abstract Background Compared with other cancers, melanoma has the longest delays measured as the median time to patient presentation for care from symptom onset. Time to presentation for care is a key determinant of outcomes, including disease stage, prognosis, and treatment. Methods Melanoma survivors with localized disease and their skin check partners enrolled in two sequential randomized control trials of skin self‐examination (SSE) training. In Phase 1, the pair read a workbook in the office and had quarterly total body skin examinations with a study dermatologist. In Phase 2, materials were mailed to pairs, whose surveillance was with a community physician. SSE knowledge, performance (frequency and extent), and identification of concerning moles were compared between phases. Results Among 341 patients, 197 received the workbook and the others were controls. Knowledge in performing SSE was higher for the workbook relative to controls in both phases. The SSE frequency ranged from 2.38 to 5.97 times in 9 months. Patients randomized to the workbook in both phases performed significantly more SSE than controls at 9 months (P < .05). In both phases, trained survivors performed significantly more SSEs on the scalp than controls at 9 and 18 months (P < .05). Phase 1 survivors performed significantly more SSEs on the abdomen, buttocks, and soles of the feet than controls, but this did not occur in Phase 2. Finally, in both phases, survivors trained with the workbook resulted in greater detection of suspicious lesions and melanomas. Conclusions These findings justify the benefits of remote SSE training for patients as an adjunct to provider‐administered screening.

BACKGROUND:Studies have shown that parents have a significant influence on emerging adult college students' drinking during the first year of college. Limited research has been conducted to address the question of whether parenting later in college continues to matter in a similar manner. The current study utilized a prospective design to identify associations between parental permissiveness toward alcohol use and monitoring behaviors and student drinking outcomes during the first and fourth years of college.METHODS:Participants (N = 1,429) at 3 large public universities completed surveys during the fall semesters of their first (T1) and fourth years (T2) (84.3% retention). The study employed a saturated autoregressive cross-lag model to examine associations between parental permissiveness of college student alcohol use, parental monitoring, student drinking, and consequences at T1 and T2, controlling for peer norms, sex, and campus.RESULTS:Examination of the association between parenting and student drinking outcomes revealed: (i) parental permissiveness was positively associated with drinking at T1 and again at T2; (ii) parental permissiveness had indirect effects on consequences via the effects on drinking at both times. Specifically, a 1-unit increase in parental permissiveness at T1 resulted in students experiencing 4 to 5 more consequences as a result of their drinking; (iii) parental permissiveness was not directly associated with monitoring at T1 or T2; and (iv) parental monitoring was significantly associated with drinking at T1 but not T2.CONCLUSIONS:The findings provide evidence for the continued importance of parenting in the fourth year of college and parents expressing low permissiveness toward student drinking may be beneficial to reducing risky drinking even as students turn 21.

OBJECTIVE:College student alcohol use remains a considerable concern. While many colleges provide universal interventions surrounding matriculation, trends indicate alcohol use increases over the college years. This study utilized a person-centered approach to examine changes in drinking across college and predictors (expectancies, attitudes, norms, and gender) of increases in risky drinking. Understanding transitions in drinking patterns and predictors of risky transitions can help identify risky students, periods of increased risk, and inform prevention efforts.METHOD:1429 first-year students were recruited from three universities across the USA. Students were assessed in the fall of each of the four years of college using a wide variety of drinking-related measures.RESULTS:Latent transition analysis (LTA) identified five classes of students (Non-Drinkers, Weekend Light Drinkers, Weekend Heavy Drinkers, Occasional Heavy Episodic Drinkers, Heavy Drinkers). Heavy-Drinkers were not likely to move out of their status during all four years of college. All psychosocial factors were shown to predict class membership during the first year (e.g., higher positive expectancies were associated with greater likelihood of being in a higher risk class). Increased psychosocial risk factors also predicted transitioning to higher risk drinking classes, mostly for Non-Drinkers. Differences by gender were observed.CONCLUSIONS:Results indicate many students maintain or increase risky drinking practices, rather than mature out, suggesting continued need for early prevention. Targeting positive attitudes during the first year may be particularly important for later transitions. Males may benefit more from targeted intervention during the transition between third and fourth years.

The current study examined two research aims: (1) Identify latent statuses of college students who share common patterns of single or repeated experiences with distinct types of negative alcohol-related consequences during the first two years of college; and (2) Examine how changes in students' living arrangements were associated with transitions in the consequence statuses. Using a sample of college student drinkers (N = 1706), four latent statuses were identified that distinguished among distinct combinations of single and repeated experiences across the multiple consequence subtypes: No Consequences, Physical Non-Repeaters, Multiple Consequences, and Multiple Consequences Repeaters. Students who remained in on-campus living spaces were most likely to belong to lower-risk statuses at T1, and remain in those statuses at T2. We found that moving into Greek housing had strongest effects among students who started in the No Consequences status, while students who moved to off-campus housing were most likely to remain in the Multiple Consequences status. Given that students who moved out of on-campus residences were more likely to transition into high-risk statuses, interventions that target students who intend to move to off-campus or fraternity housing should be implemented during the first year of college.