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Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to “normalize” what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve “normalization.”

Background This study examined the psychometric properties of novel multi-item measures of exposure to opportunities for alcohol use, cannabis use, and simultaneous use (SAM) among youth. Methods Surveys were administered to 1,082 15- to 20-year-olds in 40 California cities in 2023-24. The surveys included questions about how often respondents had an opportunity to engage in alcohol use, cannabis use, and SAM in different contexts/situations in the past year (e.g., at home), beliefs related to these substance use behaviors, and demographic characteristics. A second-order confirmatory factor analysis (CFA) and correlation and regression analyses were conducted to assess the psychometric properties of the exposure to substance use opportunities measures. Results The CFA indicated that survey items loaded on three primary factors (five items per factor) corresponding to opportunities for alcohol use, cannabis use, and SAM. Factor loadings ranged from 0.61 to 0.90, and the model fit was acceptable [NFI = 0.91; CFI = 0.94; RMSEA = 0.043 (95% CI = 0.036, 0.049), and SRMR u = 0.085]. The internal reliabilities (ω) of the substance-specific latent variables ranged from 0.82 to 0.89. The three substance specific factors, in turn, loaded significantly on an overall opportunities factor (λs = 0.78 − 0.89). The internal reliability (ω) for the overall opportunities latent variable was 0.85. Correlation analyses indicated moderate to strong associations in the expected directions between the exposure to opportunities measures and normative beliefs, perceived availability and perceived harm of alcohol, cannabis, and simultaneous use and corresponding substance use behaviors. Regression analyses indicated significant unique associations between exposure to opportunities measures and substance use behaviors when controlling related beliefs and demographic characteristics. Conclusions This study provides support for the validity and internal reliability of novel exposure to substance use opportunities measures. Measures for exposure to opportunities for alcohol and cannabis use and SAM will be useful for research on the etiology and prevention of the substance use behaviors and related problems among youth.

Background This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI. Methods Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics. Results Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil. Conclusion Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI.

BackgroundFrom 2005 to 2014, the asphyxiation suicide rate in the United States (U.S.) increased by 45.7% from 2.45 to 3.57 per 100,000 population. The primary purpose of this cross-sectional study was to describe decedent and incident characteristics of asphyxiation suicides in the U.S. from 2005 to 2014. The secondary purpose of this study was to explore whether any demographic characteristics of asphyxia suicide decedents were associated with type of suicide incident.MethodsData from the National Violent Death Reporting System (NVDRS) were used to describe asphyxiation suicide mechanisms and means in 16 states. Anchor points of hanging suicides were also described. Mechanisms, means, and anchor points were determined through a text search of cause of death, coroner/medical examiner narrative, and law enforcement narrative. Multivariable logistic regression was conducted separately for females and males to estimate beta coefficients to obtain adjusted odds ratios (AORs) and 95% confidence intervals (CIs) to compare hanging-related asphyxiation and other types of asphyxiation.ResultsFrom 2005 to 2014, there were 25,270 asphyxiation suicides. Most decedents were male (79.9%) and white, non-Hispanic (76.8%). Most asphyxiation suicides involved hanging (90.7%, N = 22,931); 1717 (6.8%) involved smothering; 968 (3.8%) involved chemicals or gasses; and 145 (0.6%) involved strangulation. For hanging suicides, the three most commonly used means were power or extension cords (N = 1834), bedding (N = 873), and animal ropes (N = 578). The three most common anchor points for hanging suicides were trees (N = 2215), beams (N = 2014), and closets (N = 2009). Among females and males, odds of asphyxiation suicide were highest among those of Other, non-Hispanic race and black, non-Hispanic race, respectively [AOR (95% CI) = 3.73 (1.59, 8.79) and 2.72 (1.34, 5.50), respectively].ConclusionsCommonly available objects are used in asphyxiation suicides. Modification of anchor points represents a potential solution for reducing hanging suicides. Changes in design and availability of grocery bags could help reduce smothering suicides. Strategies to reduce asphyxiation suicides need to be identified. Improving access to and utilization of mental health services can also reduce asphyxiation suicides. Future research should be conducted to better describe characteristics of asphyxiation suicide so that prevention efforts targeted by demographic subgroups can be implemented.

ObjectiveA California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents’ use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups.MethodsSecondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010–11 to 2017–2018.ResultsMultilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups.ConclusionsOur findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.

Objective: In the current study, the authors assessed whether a new online alcohol-misuse prevention course (College Alc) is more effective at reducing alcohol use and related consequences among drinkers and nondrinkers. Participants: The authors compared incoming college freshmen who reported any past 30-day alcohol use before the beginning of the semester with those who did not. Method Summary: The authors randomly assigned students who completed a precollege baseline survey to either complete a 3-hour noncredit version of College Alc or serve as members of a control group. The authors conducted a follow-up survey 3 months later. Results: Findings indicated that among freshmen who were regular drinkers before college, College Alc appeared to reduce the frequency of heavy drinking, drunkenness, and negative alcohol-related consequences. Among freshmen who did not report any past-30-day alcohol use before college, College Alc did not appear to have any beneficial effects. Conclusions: Results suggest that College Alc may be an effective program for students with a history of alcohol use.

Purpose of Review This narrative review summarizes research-to-date on strategies to prevent problematic cannabis use. Recent Findings Ten meta-analytic reviews of cannabis use prevention strategies published after 2010 were identified for this review. The meta-analytic reviews were based on studies evaluating the effectiveness of school-based programs, online/digital interventions, mass-media approaches, culturally specific interventions, and brief interventions. Results indicate that school-based programs, online/digital interventions, and culturally specific interventions may help to prevent or reduce cannabis use, though effect sizes were modest. Brief interventions were found to have no effect on cannabis use frequency, but had small beneficial effects on cannabis use disorder, consequences, and abstinence. Mass media approaches were not effective in preventing cannabis use. Summary School-based programs, online/digital interventions, culturally specific interventions, and brief interventions can have modest effects on problematic cannabis use. Research is needed to evaluate environmental strategies to prevent problematic cannabis use at the population level.

This study investigated the relevance of college drinking settings on the likelihood of students having sexual intercourse with a stranger. A random sample of 7,414 undergraduates at 14 public California universities responded to questions regarding frequency of attendance at six different setting types since the beginning of the semester (e.g., Greek, residence-hall parties, and bars or restaurants), drinking behavior, and sexual activity. Multi-level modeling examined the association between each setting type and the occurrence of alcohol-related sexual intercourse with a stranger. Findings indicated strong, positive associations between frequency of attendance at Greek parties, residence-hall parties, off-campus parties, and the occurrence of alcohol-related sex with a stranger. Frequency of attending the six settings and proportion of times drunk at the settings were also positively associated with alcohol-related sex with a stranger. Efforts aimed at preventing outcomes associated with casual sex (e.g., pregnancy, sexually transmitted infections, or mental health) should target specific drinking settings where students might be at high risk for risky alcohol use and unsafe sex behaviors.

Background We pursue two primary goals in this article: (1) to test a methodology and develop a dataset on U.S. local-level alcohol policy ordinances, and (2) to evaluate the presence, comprehensiveness, and stringency of eight local alcohol policies in 50 diverse California cities in relationship to recommended best practices in both public health literature and governmental recommendations to reduce underage drinking. Methods Following best practice recommendations from a wide array of authoritative sources, we selected eight local alcohol policy topics (e.g., conditional use permits, responsible beverage service training, social host ordinances, window/billboard advertising ordinances), and determined the presence or absence as well as the stringency (restrictiveness) and comprehensiveness (number of provisions) of each ordinance in each of the 50 cities in 2009. Following the alcohol policy literature, we created scores for each city on each type of ordinance and its associated components. We used these data to evaluate the extent to which recommendations for best practices to reduce underage alcohol use are being followed. Results (1) Compiling datasets of local-level alcohol policy laws and their comprehensiveness and stringency is achievable, even absent comprehensive, on-line, or other legal research tools. (2) We find that, with some exceptions, most of the 50 cities do not have high scores for presence, comprehensiveness, or stringency across the eight key policies. Critical policies such as responsible beverage service and deemed approved ordinances are uncommon, and, when present, they are generally neither comprehensive nor stringent. Even within policies that have higher adoption rates, central elements are missing across many or most cities’ ordinances. Conclusion This study demonstrates the viability of original legal data collection in the U.S. pertaining to local ordinances and of creating quantitative scores for each policy type to reflect comprehensiveness and stringency. Analysis of the resulting dataset reveals that, although the 50 cities have taken important steps to improve public health with regard to underage alcohol use and abuse, there is a great deal more that needs to be done to bring these cities into compliance with best practice recommendations.

Despite high rates of youth drinking in Mexico, little is known about the availability and consumption of specific types of alcoholic beverages within this population or the contexts in which alcohol is consumed.Objectives: This descriptive study examined alcohol consumption, perceived availability, and purchase of different types of alcoholic beverages (i.e., beer, wine, tequila, other spirits, pre-mixed cocktails, alcohol energy drinks, homemade alcohol), and drinking contexts.Methods: The sample comprised 594 students aged 12–17 in three cities in central Northeastern Mexico, where the legal drinking age is 18.Results: Over half had consumed alcohol in the past year. Of past-year drinkers, almost 57% had consumed alcohol in the past 30 days. Over half of these students reported that they or their friends had purchased alcohol at an off-premise establishment for their personal consumption, and 40% had consumed it at an on-premise establishment. Beer, which almost 60% of the study’s adolescents thought was either fairly or very easy to get, was the most commonly consumed type of alcoholic beverage in the past 30 days. The majority of youth (70%) reported that their last drinking location was at home, someone else’s home, or a public place. Importantly, however, 39% of young drinkers reported that the last time they consumed alcohol was at an on-premise establishment, and most of these youth (90%) did so in the absence of their parents.Conclusions/Importance: The findings suggest the need to implement and enforce measures to decrease retail and social alcohol availability to Mexican youth.