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The objective of this study was to examine the prevalence and patterns of alcohol use among U.S. Hispanic/Latino adults of diverse backgrounds. The population-based Hispanic Community Health Study/ Study of Latinos (HCHS/SOL) enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18-74 years at time of recruitment, from four US metropolitan areas between 2008-11. Drinking patterns and socio-demographics questionnaires were administered as part of the baseline examination. The relationship between age, sex, socio-demographics, acculturation, current alcohol use, and alcohol risk disorder, defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [no risk (i.e., never drinker), low risk (i.e., women<7 drinks/week; men<14 drinks/week), and at-risk (i.e., women>7 drinks/week; men>14 drinks/week)] were assessed in unadjusted and adjusted multinomial logistic regression analyses. Men reported a higher prevalence than women of at-risk drinking. For women, increased odds of at-risk alcohol use was associated with: a younger age, greater education, full-time employment, and acculturation after adjustment. For men, having a lower income (vs. higher income) or a higher income (vs. not reported) and being employed fulltime (vs. retired) was associated with at-risk alcohol use. For both men and women, there were variations in odds of at-risk drinking across Hispanic/Latino heritage backgrounds, after adjustment. Exact values, odds ratios and p-values are reported within the text. Common factors across sex associated with at-risk drinking included being of Mexican background and being employed full-time. Intervention strategies should consider diversity within the Hispanic/Latino community when designing alcohol abuse prevention programs.

Background Anxious-depression is a constellation of symptoms, frequently encountered among patients in primary care centers. There is a need to study how anxious-depression presents among Hispanic/Latinos of different backgrounds. Objective To study the construct of anxious-depression among 16,064 Hispanic/Latinos of different backgrounds participating in the Hispanic Community Health Study/Study of Latinos. We hypothesized that Hispanic/Latinos will cluster in 3 classes: low anxiety/high depression, high anxiety/low depression and a combined anxious-depression construct. Methods Using latent profile analysis, symptoms of depression and anxiety measured by the 10-item Center for Epidemiologic Studies Depression Scale and 10-item State-Trait Anxiety Inventory were evaluated to determine if an anxious-depression typology would result. A multinomial logistic regression analysis explored the association of the 3-class solution with different Hispanic/Latino backgrounds controlling for age, gender, language, education and income. Results A 3-class mixed anxious-depression structure emerged with 10 % of Hispanic/Latinos in the high, 30 % in the moderate and 60 % in the low anxious-depression category. After adjusting for age, gender, language preference, income and education, individuals of Puerto Rican background were more likely to experience high (OR = 1.79, p  < 0.05) and moderate (OR = 1.36, p  < 0.05) (vs. low) anxious-depression symptomatology compared to those of Mexican background. Individuals of Central American and South American background were less likely to experience high (OR = 0.68, p  < 0.05) and moderate (OR = 0.8, p  < 0.05) (vs. low) anxious-depression compared to those of Mexican background. Conclusion Anxious-depression symptomatology varied among this sample of Hispanic/Latino groups. These classes should be investigated as to their relationship with different health outcomes relevant to the Hispanic/Latino of different backgrounds.

Background Tobacco industry cigarette advertising is associated with increased adolescent smoking, while counter tobacco advertising is associated with reduced smoking. As these campaigns compete for influence, there is a need to understand their inter-relationship on youth smoking. Methods This study reports data from a national population of families (n=1036) with an oldest child aged 10–13 years, identified by random digit dialling. Parent and child dyads completed baseline questionnaires in 2003. Adolescents were resurveyed in 2007–2008 (response rate 74%). Adjusted logistic regression explores associations between receptivity to cigarette and tobacco control advertising and adolescent smoking initiation. Results In 2007–2008, 57.9% of adolescents reported a favourite tobacco control advertisement and 43.3% reported being receptive to cigarette advertisements. Thirty per cent reported receptivity to cigarette and tobacco control advertisements. Among those receptive to cigarette advertising, having a favourite anti-smoking advertisement had a borderline significant association with a 30% lower smoking rate. Anti-industry tobacco control messages were three times more likely to be favourites of those who were receptive to cigarette advertising than other tobacco control advertising. Conclusions Receptivity to tobacco control advertising appeared to ameliorate the promotion of initiation from cigarette advertising. Anti-industry advertising appears to be the most effective counter for tobacco control and should be considered for wider use. A larger longitudinal study is needed to confirm these findings.

Emerging evidence suggests bisexual populations are at increased risk for a variety of negative health outcomes, including tobacco use. Lesbian, gay, and bisexual (LGB) populations are at increased risk for cigarette smoking, but research on LGB subpopulations' use of tobacco products beyond cigarettes and tobacco use differences across LGB subgroups is in its infancy. This study explores differences in use of tobacco products across LGB subgroups, including gender differences among bisexuals. This study reports results from a 2013 nationally-representative cross-sectional online survey of US adults (N = 17 087). Weighted tobacco use prevalence and adjusted logistic regression results are reported. LGB populations reported higher current use of any tobacco product (35.7%) and current use of cigarettes (32.0%), e-cigarettes (8.9%), regular (5.5%) and small cigars (11.6%), compared with non-LGB. Bisexual (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 1.7-3.9) and lesbian (OR = 1.7, 95% CI: 1.0-2.7) women have higher odds of any tobacco use than heterosexual women; including greater odds of regular (OR = 2.9, 95% CI: 1.2-7.0 and OR = 2.2, 95% CI: 1.3-3.9; respectively) and small cigar use (OR = 2.4, 95% CI: 1.4-4.1 and OR = 3.2, 95% CI: 2.0-5.1; respectively). Gay men had lower odds of cigar use (OR = 0.4, 95% CI: 0.2-0.8) than heterosexual men. This is the first US adult population study to assess differences in use of various tobacco products across adult LGB subpopulations and by gender, confirming their increased risk of use and illuminating differences by subgroup and gender. Exploring LGB as a unified population appears inadequate to accurately characterize LGB tobacco use risk. Tobacco-related LGB health inequities, particularly among bisexual and lesbian women, may be greater than previously indicated. This manuscript provides important contributions to the field of tobacco control and prevention, and more specifically to LGB tobacco-related health disparities research. This is among the first population level studies to explore various tobacco use across LGB populations and across genders, comparing results to non-LGB populations in a national study. We provide novel evidence that bisexual women in particular, have a higher risk for use of various tobacco products, compared with other LGB subpopulations. In order to address this disparity, tobacco control professionals need to be made aware of these important differences in tobacco use behavior.

Abstract Background LGBT populations use tobacco at disparately higher rates nationwide, compared to national averages. The tobacco industry has a history targeting LGBT with marketing efforts, likely contributing to this disparity. This study explores whether exposure to tobacco content on traditional and social media is associated with tobacco use among LGBT and non-LGBT. Methods This study reports results from LGBT (N = 1092) and non-LGBT (N = 16430) respondents to a 2013 nationally representative cross-sectional online survey of US adults (N = 17522). Frequency and weighted prevalence were estimated and adjusted logistic regression analyses were conducted. Results LGBT reported significantly higher rates of past 30-day tobacco media exposure compared to non-LGBT, this effect was strongest among LGBT who were smokers (p < .05). LGBT more frequently reported exposure to, searching for, or sharing messages related to tobacco couponing, e-cigarettes, and anti-tobacco on new or social media (eg, Twitter, Facebook, etc.) than did non-LGBT (p < .05). Non-LGBT reported more exposure from traditional media sources such as television, most notably anti-tobacco messages (p = .0088). LGBT had higher odds of past 30-day use of cigarettes, e-cigarettes, and cigars compared to non-LGBT, adjusting for past 30-day media exposure and covariates (p ≤ .0001). Conclusions LGBT (particularly LGBT smokers) are more likely to be exposed to and interact with tobacco-related messages on new and social media than their non-LGBT counterparts. Higher levels of tobacco media exposure were significantly associated with higher likelihood of tobacco use. This suggests tobacco control must work toward reaching LGBT across a variety of media platforms, particularly new and social media outlets. Implications This study provides important information about LGBT communities tobacco-related disparities in increased exposure to pro-tobacco messages via social media, where the tobacco industry has moved since the MSA. Further, LGBT when assessed as a single population appear to identify having decreased exposure to anti-tobacco messages via traditional media, where we know a large portion of tobacco control and prevention messages are placed. The study points to the need for targeted and tailored approaches by tobacco control to market to LGBT using on-line resources and tools in order to help reduce LGBT tobacco-related health disparities. Although there have been localized campaigns, only just recently have such LGBT-tailored national campaigns been developed by the CDC, FDA, and Legacy, assessment of the content, effectiveness, and reach of both local and national campaigns will be important next steps.

Neuropsychological disturbances have been reported in association with use of the recreational drug “ecstasy,” or 3,4-methylenedioxymethamphetamine (MDMA), but findings have been inconsistent. We performed comprehensive neuropsychological testing examining seven ability domains in 21 MDMA users (MDMA+) and 21 matched control participants (MDMA−). Among MDMA+ participants, median [interquartile range] lifetime MDMA use was 186 [111, 516] doses, with 120 [35–365] days of abstinence. There were no significant group differences in neuropsychological performance, with the exception of the motor speed/dexterity domain in which 43% of MDMA+ were impaired compared with 5% of MDMA− participants (p = .004). Motor impairment differences were not explained by use of other substances and were unrelated to length of abstinence or lifetime number of MDMA doses. Findings provide limited evidence for neuropsychological differences between MDMA+ and MDMA− participants with the exception of motor impairments observed in the MDMA+ group. However, replication of this finding in a larger sample is warranted. (JINS, 2010, 16, 1047–1055.)

The prevalence of e-cigarette use (vaping) in young adults is concerning, particularly because the initiation of combustible tobacco use is higher in e-cigarette vapers. It is unclear why young, never-smoker vapers decide to start smoking cigarettes, but they may be influenced by perceptions of health risks and accessibility. We designed a social media questionnaire to assess factors driving the initiation of combustible tobacco use by e-cigarette vapers (multi-inhalant use) and switches between inhalant types. Respondents reported an earlier initiation of combustible tobacco versus vaping (18 vs. 19, respectively, p < 0.0001), greater ease of obtaining combustibles versus vaping products (p < 0.01), and pleasure of vaping being equivalent to that of smoking. The majority of subjects (57%) reported smoking first prior to adding vaping devices, 32% reported initiating both smoking and vaping within 12 months of one another, and 11% reported initiating vaping first. Among respondents (n = 864) who switched from vaping to smoking (n = 104), the primary reasons included 1. the perception that smoking was healthier (44%) and 2. greater accessibility of cigarettes (40%). For those who switched from smoking to vaping (n = 178), the predominant motivations included 1. having friends or family who vape (40%) and 2. the perception that vaping was healthier (36%). Among multi-inhalant users (n = 223), key factors driving this behavior included 1. increased enjoyment (47%) and 2. greater variety (42%). Our findings imply that there is no single, dominant reason driving the initiation of combustible use or switching from one inhalant to another. Further, tobacco users are receiving mixed messaging, leading many to believe that combustible tobacco is the healthier option. Public health interventions are needed to prevent the initiation of e-cigarette vaping by youth and to educate the public about the health effects of tobacco products.

Objective: This three-study dissertation project explores the impact of tobacco-specific socialization on youth smoking initiation. The primary aims of this research were to investigate the influences of parent and child agreement that their home was smoke-free home, parent and child agreement about youth risk for smoking, and child report of favorite pro- and anti- tobacco advertisements on youth smoking initiation. Methods: In 2003, parents with an oldest child aged 10-13 were enrolled into a study exploring the influence of parenting on youth risk behaviors (N=1036). Parent and child baseline surveys were completed in 2003-04, 960 youth reported being never smokers. Follow-up for baseline never smoking youth was completed in 2007-08 (N=704, 73.3%). For each study, participants with missing data were excluded (≤5%). Studies employed descriptive statistics, chi-square analysis, and simple and multivariate logistic regression. Results: Approximately 25% of youth reported smoking initiation in 2007-08. The majority of dyads agreed their home was smoke-free. Overall, adolescents in dyads who did not agree their home was smoke free were 60% more likely to initiate smoking (OR=1.6, 95%C.I.:1.0-2.4). The effect was only significant in non-smoking households (OR=1.8, 95%C.I.: 1.1-3.2). Adolescents reported youth smoking risk more frequently than did parents, both assessments were independent predictors of future smoking initiation (parent: OR=2.3, 95%C.I.:1.3-3.9; child: OR=2.0, 95%C.I.:1.3-3.0). Concordance that the child was at risk increased later initiation fourfold over concordance that the child was not at risk (OR=4.1, 95%C.I.: 2.0-8.5), however, any report of risk was predictive of future initiation. Evidence is provided for a youth anti-tobacco belief scale to predict dyad agreement. Adolescents reported favorite tobacco industry (43%) and tobacco control (58%) advertisements, of these 30% reported both. Compared to having a favorite tobacco industry advertisement, having only a favorite tobacco control advertisement reduced initiation by 63% (OR: 0.37, 95%C.I.: 0.20-0.69). Those with a favorite advertisement from both sides appeared to have an initiation rate midway between. Conclusions: The study results indicate that tobacco-related socialization occurring in pre- and early- adolescence may reduce the probability that youth will initiate smoking.

ObjectiveTo review the available evidence for home smoking restrictions as a useful tool in the prevention of youth smoking and to make recommendations for further research.MethodsA PubMed search (1 January 1990 to 26 January 2010) identified studies involving youth ≤18 years using extensive criteria. In all, 17 studies relating home smoking restrictions to youth smoking behaviour were identified from titles, abstracts or the full text, as required. Two additional articles were identified by other means. KE, NS and EG reviewed the studies. Differences in interpretation were resolved by discussion, with EG making final decisions.ResultsOf the 19 studies, 16 (including the only 2 longitudinal studies) showed at least marginal evidence of an association of home smoking restrictions with reduced adolescent smoking behaviours. Associations were more numerous and stronger in homes without adult smokers, suggesting that even in such homes, lack of a smoke-free home may undermine the parental value of not smoking. Definitions of home smoking rules, adolescent smoking behaviour and treatment of parental smoking varied widely among studies. It is recommend that future research: (1) contrast smoke-free homes for everyone against all others, (2) included an interaction term for parental smoking and having a smoke-free home, or conduct separate analyses for homes with and without parental or other adults smokers and (3) examine early and later stages of the smoking uptake continuum.ConclusionsWhile the evidence is suggestive for an effect, further research is required to establish causality using longitudinal designs.