Introduction: Discussions on space and place often overlook the centrality of race in organizing social life. In our study, we focus on sub-communities across the United States, and delve into the nuanced impact of discrimination within micro spaces – both physical and socially-constructed – including academia, the workplace, and within the family. Despite being perceived as ‘safe spaces’, we unveil these spaces as manifestations of racial bias, rooted deeply in racism. The “Racialized Social Systems” theory extends the application of racial concepts from groups and individuals to include spaces. Our research aims to unravel the experiences of our focus group participants by examining instances of discrimination within these spaces, resulting in cognitive dissonance, substance co-use (nicotine, alcohol, and cannabis), and reproduction of racialized spaces. Methods: We recruited 43 participants between the ages 21 and 45 who were fluent in English and used at least two substances over the past month (cannabis, alcohol, and tobacco).We conducted 7 focus groups stratified by race/ethnicity and gender. We explored themes of acute perceived discrimination, poly-substance use, and coping strategies. Data analysis involved a thematic approach, incorporating independent open coding and team-based deliberation. Results: Our focus groups revealed people reported experiences of discrimination within specific spaces and microspaces. Several of these spaces include what would be conventionally referred to as ‘safe spaces’, ranging from generic workplace to street-level encounters, shaping the participants’ perceptions of racial dynamics. For some participants, the linkage of specific locations to instances of discrimination influenced substance use patterns where substance use served as behavioral responses to spatial racialization. Conclusion: Discussions during our focus groups reveal the interplay between the physical, mental, and social constructs of space in the context of race and the mechanism in which space moderates the production and sustainment of spatial racialization. The fluctuation of permanence and ambiguity of safe spaces for these communities suggest that substance usage in response to these negative experiences may be forms of protected spaces free from hostility. The immediate reprieve that substance use provides in the face of discrimination offers stability especially given the unpredictable nature of prejudice.

Dihydromyricetin (DHM), a polyphenolic secondary phytochemical-metabolite, is derived from various plants including Hovenia dulcis. DHM has been esteemed as a medicinal herb for its therapeutic benefits for hundreds of years in Traditional Chinese Medicine, addressing a wide range of ailments including hepatitis, chronic nephritis, and veisalgia-related symptoms. It is acclaimed for its robust anti-alcohol, antioxidant, anti-inflammatory, and metabolic-enhancing properties. The therapeutic potential of DHM has implications for liver disease, diabetes, anxiety, and more recently, Alzheimer’s Disease (AD)- for its ability to inhibit tau prionogenic seeding in in vitro studies. Currently, most in vivo studies focusing on DHM rely on invasive delivery methods such as intraperitoneal injection and/or oral gavage. The need for these methods of administration stems from the molecular structure and physicochemical properties of DHM, making it highly insoluble in aqueous solutions, resulting in poor oral bioavailability. In the clinic, this challenge complicates effective dosing strategies and, thus, therapeutic use. Therefore, our study aimed to overcome these barriers by developing water-soluble formulations that allow for oral delivery of DHM that are both stable and suitable for use in animal models and clinical applications. We focused on enhancing the aqueous solubility of DHM by crystallization techniques, pairing pharmaceutically relevant counterions (that are generally regarded as safe (GRAS) by the FDA) with DHM, to produce novel crystal formulation(s) of DHM. Characterization of DHM crystals by differential scanning calorimetry (DSC), X-ray powder diffraction (XRPD), and CryoEM Method MicroED confirmed that crystal structures were formed. To further elucidate the enhanced solubility and improved bioavailability of DHM, we will test two DHM crystal formulations against free DHM in mice, rats, and humans. We will then quantify various pharmacokinetic (PK) parameters, as well as brain and liver penetration in the preclinical models. This innovation of DHM crystal formulation offers promising potential as a tool to investigate the therapeutic benefits of oral DHM for an array of health conditions, particularly when implementing animal-based studies.

Background: Sorority women are a particularly high-risk college population in terms of alcohol use, binge-drinking, and alcohol-related consequences. Individuals within sororities have consistently been found to consume more alcohol than those uninvolved in Greek life. Similarly, studies have pointed to sexual minority (SM) women as a vulnerable population for risky drinking behaviors and consequences, and this holds true within the college population; namely, bisexual women and lesbian women often report higher rates of alcohol use when compared to their heterosexual counterparts. However, there is at present very little research investigating the alcohol use behaviors of SM sorority members, who can be assumed to be an especially at-risk group. Moreover, research often lumps SM women into a broad category, neglecting to examine specific sexual orientations within this group (e.g., bisexual, lesbian). Methods: The present study investigated the drinking behaviors of undergraduate women of different sexual orientations and sorority membership, and whether sorority membership moderates any differences in drinking behaviors that may exist between these groups. Participants included 30,036 (20.7% SM) cisgender woman undergraduate students aged 18 to 23, with data extracted from the 2018 Healthy Minds Study. Results: Logistic regression models controlling for age and race/ethnicity revealed that sorority affiliation significantly predicted any drinking and any binge drinking in the past two weeks. Additionally, bisexual students were more likely to report any drinking and binge drinking than heterosexual students, lesbian students, and students of other sexual orientations. Sorority affiliation was a moderator of the association between sexual orientation and binge drinking such that, while binge drinking was similar regardless of sorority affiliation for bisexual women, heterosexual women were most likely to binge drink if they were sorority members. Conclusion: Future research is needed to understand the drinking-related behaviors and experiences of both sorority-affiliated and non-sorority-affiliated SM women.

Depressive symptoms and disordered eating behaviors (e.g., restrictive eating and dieting, binge eating, purging) have been identified as risk factors for cannabis consequences. Greater use of cannabis protective behavioral strategies (CPBS) has been concretely associated with experiencing fewer cannabis consequences among college students. Several studies have found that CPBS moderates the relationship between depressive symptoms and consequences, such that individuals with depressive symptoms use less CPBS and experience more consequences. Few studies have examined disordered eating and CPBS; the available studies did not find a relationship between CPBS and disordered eating. Although depression and eating disorders (ED) frequently co-occur in individuals, studies to date have examined depression and ED’s separately in models with CPBS use. A recent study examined ED symptoms, depression symptoms, and cannabis consequences; the study did not find a significant interaction between the three constructs, but the sample was restricted to participants engaging in binge eating behaviors. It is unknown if depressive symptoms working in conjunction with a wide range of disordered eating behaviors associate with cannabis consequences and how CPBS might moderate this relationship. The present study investigated the moderating effect of CPBS use on cannabis consequences among participants who screened positive for both depression and a possible ED. The sample consisted of 355 college student cannabis users with 11.7% (n=58) meeting screening criteria for depression and a possible ED. All participants completed measures of CPBS and cannabis consequences. Regression analyses were conducted controlling for generalized anxiety (i.e., a correlate of depression), sex, and frequency of cannabis use. Results show that participants who screened positive for both depression and a possible ED experienced significantly more cannabis consequences than participants who did not screen positive for both. CPBS moderated the association between screener status and cannabis consequences, so that those who screened positive for depression and a possible ED used less CPBS and experienced significantly more consequences. This study adds to existing literature examining risk factors for cannabis consequences and the moderating role of CPBS, while highlighting the importance of considering depression when investigating disordered eating in the context of CPBS and cannabis consequences.

Introduction Fentanyl is the leading cause of opioid-related overdose deaths in the U.S. In a changing drug market, our research sought to identify the experiences of people who use opioids (PWUO) within the context of social networks. Methods We conducted qualitative interviews with 30 PWUO (n=30) in Los Angeles, CA from July 2021 to April 2022. To be eligible for this study, participants had to report being 18 years of age or older and any opioid use and self-reported injection drug use within the past 30 days. We used grounded theory methods to analyze the contexts that contribute to lived experiences surrounding opioid use behavior within social networks. Results Within an unpredictable drug market contaminated by fentanyl, participants reported: 1) avoiding opioid withdrawal symptoms by sharing finances within social networks, 2) using known and predictable social ties to prioritize safe supply of opioids, and 3) avoiding overdose fatality by using opioids with peer groups. Conclusions Our findings emphasize that while peer support plays a critical role in safety for PWUO, structural changes are warranted to ease the moral burden of their efforts. Harm reduction interventions such as fentanyl test strip and overdose reversal agent distribution, safe consumption sites, and medication assisted treatment for OUDs may improve safety. However, with a fentanyl-contaminated drug supply increasing risk for PWUO, safer opioid distribution of pharmaceutical-grade products is warranted to effectively address withdrawal, overdose, and fatality.

Background: Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations. However, there is a need for evidence on tailored treatments that meet the complex needs of people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper presents preliminary results of a randomized control trial testing the efficacy of NRT and an SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia Methods: We set out to recruit 800 adult PLWH who use tobacco from HIV treatment centers in Uganda and Zambia by the end of the study. Participants are randomized to the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. The main outcome of interest is cessation of tobacco use by study participants at 6 months post-enrollment. Results: 3,815 participants have been screened within 6 months of trial initiation. 305 of the screened participants have been enrolled and randomized to a study arm, 147 in Uganda and 158 in Zambia. 16 participants have completed 6 months of follow-up, 11 of which have negative Cotinine dipstick results, indicating tobacco use cessation at 6 months post-enrollment among 69% of study participants. Conclusions: Initial program efficacy, feasibility and applicability suggest promise in delivering tobacco cessation interventions through health care professionals combined with cessation SMS messaging in Uganda and Zambia. These results offer valuable insights for providers and policymakers seeking cost-effective tobacco cessation strategies in low and middle-income countries worldwide.

AIMS: Young adult cannabis use is at an all-time high and cannabis products are increasingly marketed to improve sleep and mental health. However, there is little evidence on the association between cannabis use and sleep among young adults, including whether associations differ by mental health status. METHODS: We evaluated the association of cannabis use frequency with subsequent sleep problems among 1,926 young adults ages 20-23 in Southern California using two waves of a prospective cohort study between 2020-2021, and examined whether associations differed by baseline sleep quality and mental health status. The exposure was cannabis use frequency at baseline. The outcome was sleep problems at a 6-month follow-up, calculated based on frequency of sleep issues (range=4-24, higher score indicates worse sleep). Models adjusted for sociodemographic factors, baseline sleep score, mental health symptoms (depression and/or anxiety vs. neither), and past 30-day nicotine or alcohol use. Models were additionally stratified by mental health symptoms and baseline sleep quality (excellent vs. imperfect sleep). FINDINGS: In unstratified models, there was no association between cannabis use frequency and sleep problems. Among participants without anxiety or depression symptoms at baseline, using cannabis ≥20 days/month (vs. never use) was associated with greater sleep problems at follow-up (mean difference [MD]=1.66, 95%CI: 0.59, 2.74). However, among participants with anxiety and/or depression at baseline, using cannabis ≥20 days/month (vs. never use) was associated with fewer sleep problems at follow-up (MD=-1.18, 95%CI: -2.18, -0.17), with stronger associations among participants with both mental health and sleep problems at baseline (MD=-1.42, 95%CI: -2.81, -0.02). CONCLUSIONS: Cannabis use was associated with improved sleep among young adults with depression and/or anxiety who have preexisting sleep problems, and was associated with worse sleep among young adults without depression or anxiety. Findings suggest functional complexities of cannabis use and sleep based on underlying mental health symptoms.

Prior correlational research has demonstrated an association between lower perceived economic mobility and greater preference for “hedonic” over “utilitarian” options (REF). Accordingly, individuals who believed they were likely to rise more in social standing reported less substance use (Ritterman Weintraub, Fernald, Adler, Bertozzi, & Syme, 2015). In the present study, we assessed whether these observed associations reflect a causal relationship. Participants (N = 397 individuals recruited from a Chinese online paid research platform) were randomly assigned to read either a persuasive argument highlighting stories and statistics that showed economic mobility in modern Chinese society was either 1) quite limited, or 2) quite extensive. A manipulation check indicated that participants views on economic mobility were strongly impacted by the persuasive text (t(332) = 17.5, p < .001, Cohen’s d 1.76 + .23). Participants randomly assigned to perceive lower economic mobility in their society indicated greater preference for hedonic over utilitarian purchases (t(372.3) = -4.75, p < .001, Cohen’s d = .48 + .20). Although the sample views were generally near ceiling for disapproval of drinking to intoxication and smoking, disapproval was significantly lower among those randomized to perceive less economic mobility (t(330.4) = 2.5, p = .01, Cohen’s d = .25 + .20). These data suggest that a sense of economic immobility may be a risk factor for increased substance use.

Background: Previous studies describe relationships between current health inequities and historical redlining-government-sponsored and racially discriminatory grading of neighborhoods’ deservingness of investments (i.e. home loans and credit) in the 1930s. Historical redlining is a mechanism of structural racism and government-sanctioned disinvestment, which maintained geographic segregation and has contributed to inequitable neighborhood conditions. To our knowledge, no study has examined the association between historical redlining grades (Best, Still Desirable, Declining, Hazardous) and current rates of fatal opioid-related overdose. Methods: We linked decedent data between 2015 – 2019 from the Massachusetts Registry of Vital Records and Statistics, census tract population estimates from the American Community Survey, and georeferenced historical redlining grades from the University of Richmond’s Digital Scholarship Lab. We conducted Analysis of Variance tests to determine differences between mean five-year annual opioid-related overdose death rates by historical redlining grade within Massachusetts census tracts. Results: 1,829 opioid-related overdose deaths occurred between 2015 – 2019 among residents of 326 census tracts that had 50% or more of their land area historically graded. Mean opioid-related overdose death rates in census tracts graded Hazardous (40.5/100,000) and Declining (34.3/100,000) were significantly higher than those graded Best (20.1/100,000) (p<0.05). Mean Hispanic and white rates within census tracts graded Hazardous (42.5/100,000; 81.7/100,000) were significantly higher than respective race/ethnicity categories in census tracts graded Best (Hispanic: 8.0/100,000; white: 24.7/100,000) and Still Desirable (Hispanic: 19.3/100,000; white: 45.1/100,000). We did not find differences in rates among Black residents, which may reflect the complexity of structural racism’s impacts on Black residents. Conclusions: We found historical redlining to be significantly associated with higher current overdose deaths, providing a starting point for further examination of structural racism’s impact on opioid-related overdose deaths. Further multilevel modeling and mediation analysis may support the implementation of interventions designed to help redress the impacts of structural racism, including neighborhood-level and race-explicit approaches to fatal opioid-related overdose prevention as well as changes in policy and fund distribution.

Introduction: Prescription drug monitoring programs (PDMPs) are state-run databases that track controlled substances to reduce drug misuse, abuse, and diversion. The accuracy of PDMPs for adolescents who receive postoperative opioid prescriptions is unknown. Methods: This prospective cohort study was conducted at a free-standing tertiary children’s hospital from 2019-2020. Adolescents 13-20y undergoing elective surgery commonly associated with an opioid prescription at discharge were enrolled. Prescription opioid fills and refills were measured through five data sources: (1) Electronic Medical Record (EMR) prescription orders (2) postoperative clinic notes, (3) California’s PDMP and (4) adolescent and (5) parent surveys. An UpSet plot was created to quantify data overlap between sources (Figure). Results: The majority of the 55 adolescents enrolled were Hispanic/Latino (52.7%), female (54.5%), and underwent posterior spinal fusion (41.8%). Of 42 adolescents with an opioid prescription in the EMR, the greatest overlap in data sources occurred between the EMR and parent surveys (81%) with only 20% of adolescents having their opioid prescription fill captured in all five data sources. Two patients (3.6%) who did not receive an opioid prescription based on EMR or survey data were identified in the PDMP. Survey data indicated that five adolescents (11.9%) refilled their opioid prescription. However, the PDMP only captured four (9.5%) refills. Conclusion: A notable discrepancy exists among EMR, PDMP, and survey, documentation of prescription opioid dispensing and refills for adolescents undergoing surgery. These findings highlight the need to capture multiple data sources when tracking prescription opioid dispensing. Additionally, there is opportunity for improved accuracy within prescription drug monitoring programs.

Burnout among undergraduate students is a well-documented phenomenon that has garnered increasing attention in recent years. Engaging in activities that elicit the flow state can help alleviate burnout; however, there is a notable gap in existing literature exploring this relationship. The present study utilized a survey to examine the potential role of flow-state activities in preventing burnout in undergraduate students. The study population included undergraduate students, irrespective of major and academic year, primarily from the University of Southern California and Fullerton College. Over one month (February 1 to February 27, 2024), participants (N = 235) were asked to complete a survey about their weekly flow-state engagement and burnout levels. Flow-state engagement was measured in terms of the number of different flow-state activities engaged and the time reportedly spent in flow. Burnout was measured with the Maslach Burnout Inventory – General Student Survey (MBI-GS [S]), which assessed levels of general exhaustion, cynicism, and professional efficacy. The study found a poor correlation between flow-state engagement and burnout levels. Neither an increased number of flow-state activities nor increased time spent in flow correlated with decreased levels of cynicism, general exhaustion, or increased levels of professional efficacy. Contrary to the existing literature, these results suggest that promoting flow-state engagement may not offer a promising strategy to combat undergraduate burnout. Further analyses are needed to determine if there are trends in the current data. Additionally, research into specific flow-state activities, interventions, and the impact of moderators like academic major and gender could provide valuable insights into the relationship between flow-state engagement and undergraduate burnout. Keywords: Flow State, Burnout, Undergraduate Burnout, Maslach Burnout Inventory

Alcohol use disorder (AUD) is a complex disease state characterized by excessive alcohol consumption, dependence, and tolerance that affects over 76 million people worldwide. Despite its prevalence, currently available FDA-approved therapeutics are largely ineffective at addressing maladaptive drinking behaviors, thereby illustrating the need for alternate interventions. One possible candidate is dihydromyricetin (DHM), a bioactive flavonoid with demonstrated anti-alcohol properties. Research conducted by our lab using a chronic alcohol consumption mouse model has shown that intraperitoneal DHM administration (5 mg/kg and 10 mg/kg) modulates consumption behavior and ethanol (EtOH) metabolism. Despite these promising findings, the compound’s suboptimal pharmacokinetic profile has been a major limitation to its clinical utility. Specifically, DHM’s poor water solubility limits intestinal absorption, contributing to low oral bioavailability. To address these issues, our lab is developing a novel chemical formulation of DHM intended to improve the compound’s solubility and allow for oral administration. Therefore, the purpose of this pilot study is to assess how administration of an oral DHM formulation modulates alcohol consumption. Using a within-subjects study design and two-bottle choice drinking paradigm, we evaluated the effect of three concentrations of DHM (0.1 mg/mL, 3 mg/mL, and 6 mg/mL; p.o.) on EtOH consumption behaviors in female C57BL/6 mice (n=28). Results demonstrate that DHM significantly reduced ethanol intake and preference at the 3 mg/mL and 6 mg/mL dose. To further investigate DHM’s mechanism for altering alcohol preference, we collected serum, liver, and brain samples and analyzed the expression of fibroblast growth factor-21 (FGF-21), a peptide hormone implicated in ethanol consumption and alcohol preference. While the role of FGF-21 in AUD is not fully understood, evidence supports that the protein serves as a negative-feedback regulator for alcohol consumption. Preliminary results show notable increases in FGF-21 levels in serum and liver with DHM administration, with the most pronounced effects at the 0.1 mg/mL dose. Collectively, these findings support that oral administration of DHM reduces alcohol consumption and preference. Additional research is being conducted to further investigate the correlation between DHM and FGF-21, and DHM’s potential benefits for AUD.

Alcohol use disorder (AUD) is a chronic, relapsing disease state characterized by problematic patterns of alcohol use that affects approximately 29.5 million individuals in the US alone. Unfortunately, the advancement of effective treatments for this disorder is limited by an incomplete understanding of the various pathomechanisms implicated in AUD. While many neurobiological models of AUD focus on the fundamental mechanisms of addiction, they fail to acknowledge two critical disease contributors: metabolic impairments and neuroinflammation. Thus, the aim of this study is to review these mechanisms, particularly via assessing the role of thiamine and CNS response proteins in the progression of AUD. Thiamine was considered for its crucial role as a cofactor implicated in carbohydrate metabolism, cellular redox, and energetics, while three CNS response proteins were reviewed for their various roles in neuroinflammation: toll-like receptor 4 (TLR4) nod-like receptor protein 3 (NLRP3), and triggering receptor expressed on myeloid cells 2 (TREM2). A literature review was conducted using academic databases Google Scholar and PubMed, employing search terms which included “alcohol use disorder,” “thiamine deficiency,” “alcohol-induced neuroinflammation.” Both pre-clinical and clinical primary studies were considered. Overall, our research reveals connections between alcohol-induced thiamine deficiency and reduced activity of metabolic enzymes leading to energy deficits and oxidative stress. Additionally, alcohol activates TLR4, NLRP3, and TREM2 receptors, all of which play a role in immune regulation. While very few studies explore the relationship between thiamine metabolism and neuroimmune regulation, our research highlights connections between these two seemingly distinct pathomechanisms of AUD. Understanding the mechanisms that drive the pathology of AUD, and the connections between them, is important to informing effective treatment development. Overall, our critical review supports the need for more research in the field to further elucidate the direct connections between thiamine deficiency, neuroinflammation, and AUD.

Background: Nicotine is commonly co-used with other psychostimulants. While prior research has demonstrated significant correlations between the utilization of illicit stimulants like cocaine and methamphetamine and nicotine products, scant attention has been directed towards their link with the nonmedical usage of prescription stimulants (NMPS). The prevalence of young adults misusing these medications, such as Adderall or Ritalin, has steadily risen, particularly notable on college campuses where there exists a pervasive belief in their enhancement of academic performance. While high co-use patterns of NMPS and nicotine products have been indicated in the literature, the prospective association of NMPS with subsequent nicotine product use (e.g., combustible tobacco, e-cigarettes) throughout young adulthood is not well-established. This study investigates the longitudinal prospective association of NMPS with subsequent nicotine product use, such as combustible tobacco and e-cigarettes. Methods: The data were derived from a prospective cohort study of health behavior among young adults in Los Angeles including six survey waves spanning 2018 to 2024. The analytic sample consists of individuals who had never used combustible tobacco (n=1,350) and e-cigarette (n=1,236) at baseline. The exposure variable included past 6-month NMPS use (yes/no). Outcomes included any combustible tobacco use (including cigarettes, cigars, cigarillos, hookah, and pipe) and e-cigarette use in the past six months. Time-varying and time-lagged associations between NMPS and nicotine product use were modeled using multilevel logistic random-effect repeated-measures regression models. Results: NMPS during the past 6 months was significantly and positively associated with subsequent combustible tobacco use among individuals who had never used combustible tobacco at baseline (AOR=2.70, p<.01, 95%CI=1.39, 5.28), after adjusting for individuals’ sociodemographic characteristics and other substance use (e.g., alcohol, marijuana, and other drugs). The association between NMPS and subsequent e-cigarette use was not significant for the past 6-month e-cigarette use outcome. Conclusion: This study provides evidence of the prospective association between NMPS and combustible tobacco, suggesting that NMPS may serve as an indicator of future combustible tobacco use in young adulthood. The implications for prevention and intervention efforts aimed at curbing NMPD will be discussed.

Background: Alexithymia is a set of symptoms including a lack of imagination, difficulty verbally expressing emotion, and use of action to avoid conflict. While alexithymia is relatively common among adolescents, its relationship with substance use is poorly understood. Methods: Data are from 10th and 11th graders from the Southern California ADVANCE cohort study collected in Spring 2023 (N=2,914). Alexithymia was measured using the 20-item Toronto Alexithymia Scale. We assessed recency of alcohol and cannabis use (past 30-day vs. ever use vs. never use). Alcohol dependence was measured with the Rutgers Alcohol Problems Index (RAPI); cannabis dependence was measured with the Cannabis Abuse Screening Test (CAST). We evaluated the association of alexithymia (none vs. possible vs. probable alexithymia) with alcohol and cannabis recency and dependence (in separate models). Models were adjusted for demographic variables, depression, and anxiety. Results: Overall, 30.9% reported possible alexithymia and 36.9% reported probable alexithymia symptoms. Alexithymia was more prevalent in participants who self-identified as female or gender minorities (vs. male), sexual minorities (vs. heterosexual), or financially struggling or inconsistent (vs. financially well off) (ps<0.05). Alexithymia was also highly correlated with generalized anxiety disorder and major depressive disorder. Individuals with possible (OR=1.51; 95% CI=1.06, 2.14) or probable alexithymia (OR=1.88; 95% CI=1.32, 2.69) had higher odds of reporting past 30-day alcohol use, but not alcohol dependence. Individuals with probable alexithymia had higher odds of past-30 day cannabis use (OR=1.54; 95% CI=1.02, 2.35) and high-risk cannabis dependence (OR=4.04; 95% CI=1.41, 11.58). Conclusions: Alexithymia was disproportionately prevalent among adolescents belonging to disadvantaged groups, perhaps due to an increase in negative valence that engenders emotional repression and substance use as coping mechanisms. Alexithymia was associated with recent alcohol use, recent cannabis use, and cannabis dependence, but not alcohol dependence. This may be because alcohol access is typically more limited to social gatherings. Because alexithymia limits the ability to identify and express emotions, these associations may suggest deficits in healthy emotional coping. Implementing psychoeducation and healthy emotional processing skills into school curricula may be effective methods of reducing premature substance use.

Significance: Adolescent polyuse of nicotine and cannabis is a rising public health concern. Youth who use both (vs. just one substance) are more likely to report substance dependence. Most studies define polyuse of nicotine and cannabis as having used both substances in the past month; however, this definition may not adequately capture more problematic forms of polyuse, such as using nicotine and cannabis on the same day. Methods: This study examined patterns of nicotine and cannabis polyuse among a cohort of Southern California high school students (N=3,823; mean age[SD]=16.2[0.59] years). Participants were classified into five mutually exclusive exposure groups based on past 30-day use of nicotine and/or cannabis: 1) use of both substances on the same day at least once in the past 30 days; 2) use of both substances in the past 30 days without same-day use; 3) exclusive nicotine use; 4) exclusive cannabis use; 5) no use of either product. Nicotine dependence was assessed using the Hooked on Nicotine Checklist and a modified vaping dependence measure; cannabis dependence was assessed using the Cannabis Abuse Screening Test. Logistic regression models were run to assess odds of nicotine and/or cannabis dependence for each group and adjusted odds ratios (aORs) were reported. Results: Among those who reported past 30-day nicotine and/or cannabis use (9.5% of full sample), 35.1% used both substances on the same day, 15.5% used both substances in the past 30-days but not on the same day, 16.9% reported exclusive nicotine use and 32.6% reported exclusive cannabis use. Poly same day users had higher odds of nicotine and cannabis dependence compared to poly no same day users (aORs=1.83, 95% CI [0.83-4.01]; 4.44, 95% CI [1.99-9.88], respectively), and the no past-30 day use group (aORs=5.46, 95% CI [2.33-12.8]; 9.49, 95% CI [4.75-18.9], respectively). Exclusive cannabis users exhibited similar odds of dependence as poly no same day users (aOR=1.06, 95% CI [0.49-2.32]). Conversely, participants who reported only using nicotine had reduced odds of dependence compared to poly no same day users (aOR=0.38, 95% CI [0.14-1.02]). Conclusion: Adolescents reporting same-day polyuse had higher levels of nicotine and cannabis dependence than those who used both substances in the past month but not on the same day. A same-day definition of polyuse might capture more problematic use than a past-month definition alone and warrants further research.

Background Energy drinks contain large amounts of caffeine, added sugars, and other legal stimulants. They are promoted to enhance mental/physical performance yet can have dangerous ramifications. Despite the American Academy of Pediatrics (AAP)’s recommendations to limit consumption among adolescents, most of the consumption occurs within this population. Objective To understand how energy drinks are marketed/regulated to adolescents and the effect of these policies on consumption/perception of the product. Methods A review of research studies using the PubMed database (PubMed.gov); clinical trials (clinicaltrials.gov); FDA Recall, Market Withdrawals, and Safety Alerts (FDA.gov); and emergency department visits from reports from the Drug Abuse Warning Network (DAWN) was conducted. An IRB-approved survey was designed to determine the percentage of respondents who consume caffeine, the frequency at which individuals consume caffeine, and the reasons for consuming caffeine. It also sought to understand perceptions and thoughts on energy drinks and caffeine regulation and consumption. The survey was sent to university students through advertised QR codes and university email distribution lists. Results Data from 112 research studies and 13 clinical trials conducted among ages 0-17 were reviewed. Within the US, no FDA recalls have been observed for “energy drinks” or the top 4 selling brands (Red Bull, Monster, Bang Energy, Rockstar). While some recalls regarding container manufacturing were made outside the US. ED visits from energy drinks doubled from 2007 to 2011, 1/10 of them resulting in hospitalization. Survey data from 58 respondents at USC found that most students consumed caffeine (n=49) the majority consuming caffeine 4 or more days out of a week (n=41). Of the students who consume caffeine, about half of them consume energy drinks (n=29). Red Bull (n=15), Celsius (n=13), and Monster (n=12) are the most popular energy drink brands consumed. Furthermore, most students believe consuming 2 cups of coffee (~200mg) is a safe amount in a day (n=22). Discussion Due to the limited understanding of energy drinks, the commercialization of this product to adolescents remains loosely regulated. The lack of regulations and studies surrounding energy drinks is a public health concern. Regulatory agencies should invest in developing new protocols or regulations regarding the content of energy drinks as well as find ways to monitor the marketing strategies.

Background: While early (i.e. without mandated period of abstinence) liver transplant (LT) for alcohol-associated hepatitis (AH) is the fastest growing indication for LT in the US and Europe, return to drinking occurs in up to 40% of LT recipients. Harmful alcohol use post-LT is associated with poor outcomes, but the effect of establishing sustained abstinence after relapse (i.e. re-abstinence) is understudied. Methods: In this cohort from 12 US LT centers, we included consecutive LT recipients for clinically-diagnosed severe AH between 2006-2021. Harmful alcohol use was defined by NIAAA criteria of “binge” (>5 [men] or >4 [women] drinks in < 24 hours) or “frequent” (>4 days in one week) by clinical interview or phosphatidylethanol (Peth) >20ng/mL. Re-abstinence was >12 consecutive months without harmful alcohol use following any post-LT harmful alcohol use. Multivariable Cox regression was used to estimate survival, adjusted for age, sex, and MELD-Na at LT with post-LT all-cause mortality as the outcome. Logistic regression was used in an exploratory multivariable analysis to identify factors associated with ever achieving re-abstinence after post-LT harmful alcohol use. Results: Among 347 LT recipients (64% male, median age 43, median MELD-Na at LT 38) with median post-LT follow-up of 2.2 years (IQR 1.2 – 3.7), 71 (20%) had any post-LT harmful alcohol use, of which 35 (45%) had a period of re-abstinence. Utilizing dynamic, time-varying classification of alcohol use demonstrated that re-abstinence after post-LT harmful alcohol use had similar survival to never having post-LT harmful alcohol use (aHR 0.90, 95% CI 0.07 – 11.5) while continued harmful alcohol use was associated with lower survival (aHR 3.59, 95% CI 2.17-5.95). Adjusted 3- and 5-year post-LT survival was similar among LT recipients without harmful alcohol use vs. those with re-abstinence (95% and 93% vs. 95% and 94%, p = 0.89), while survival rates were significantly lower in the continued harmful use group (84% and 77%, p < 0.001 compared to never harmful use group). Conclusions: In a cohort of LT for AH recipients, re-abstinence (vs. continued harmful alcohol use) restored 3- and 5-year survival to rates similar to LT recipients without any episode of post-LT harmful alcohol use. These findings should inform strategies that provide early recognition of return to harmful use and enable treatments to restore abstinence that ultimately improve survival among LT recipients for AH.

Introduction: Cannabis products containing delta-8-THC, a psychoactive cannabinoid derived from hemp, have gained popularity in the United States (US) but remain federally unregulated. In lieu of federal regulations, states have implemented delta-8-THC regulations, with variation in the types and restrictiveness of policies. We characterized the state-level policy landscape of delta-8-THC, including types of regulations implemented across states and associations with marijuana legalization. Methods: We conducted an online search of delta-8-THC policies from June-August 2023 using official government memorandums/websites and grey literature sources (e.g., CBD and Delta-8 websites). States were categorized into the following regulatory categories: banned (i.e., delta-8-THC is prohibited), regulated (i.e., delta-8-THC is restricted), or not regulated (i.e., no delta-8-THC legislation). Among states with bans and regulations, we identified the specific types of policies implemented. States were also classified by adult-use (i.e., recreational) marijuana legalization status (legal vs. illegal). We used descriptive statistics to show the distribution of delta-8-THC policies, and calculated risk ratios (RR) and 95% confidence intervals (CI) to determine whether marijuana legalization was associated with any delta-8-THC regulation (regulated or banned). Results: As of August 2023, n=24 (47%) states including Washington DC had no regulations of delta-8-THC, n=9 (17.6%%) had regulated delta-8-THC, and n=18 (35.3%) had banned delta-8-THC. In states with delta-8-THC regulations, examples of policies included potency caps (n=7 states), minimum-age laws (n=8 states), and restrictions on packaging/labeling (n=5 states), marketing (n=2 states), testing/production (n=5 states), product placement (n=2 states), product types (n=3 states), and retail licensing and/or registration (n=4 states¬). States that banned delta-8-THC did so by either including delta-8-THC in their controlled substances list (n=14 states) or banning the chemical isomerization of delta-8-THC (n=5 states). States with (vs. without) adult-use marijuana legalization were 1.9 times more likely to have any delta-8-THC regulation (71% vs. 37%; RR=1.91, 95%CI: 1.10-3.33). Conclusion: Findings show a diverse landscape of delta-8 THC regulations across the United States and a meaningful relationship between a state’s marijuana legal status and its approach to regulating delta-8-THC.

Alcohol and cannabis are the most commonly used substances among college students, a population at risk for experiencing negative consequences from use of both substances. Food restriction (i.e., intentional fasting, dieting) is also common among college students, with common co-occurrence (e.g., food restriction and heavy alcohol or cannabis use). Though it is known that those who restrict food on alcohol use days are at greater risk for alcohol-related consequences (e.g., physical fights, being taken advantage of sexually) than those who do not restrict food on alcohol use days, there is limited research on consequences related to food restriction on cannabis use days. Thus, further research is needed to assess food restriction in cannabis use contexts. The current cross-sectional study investigated college student alcohol and cannabis use consequences and food restriction on alcohol and cannabis use days in the past year and month. The sample contained 729 college students who used alcohol in the past year (78.2%; n = 660 past month use) and 614 students who used cannabis in the past year (58.9%; n = 496 past month use). Independent samples t-tests revealed that those who restricted food on alcohol use days in the past year (n = 231; 31.6% of past year drinkers) exhibited significantly higher scores on the AUDIT than those who did not. However, those who restricted food on alcohol use days in the past month (n = 187; 25.6% of drinkers) did not report significantly more alcohol-related consequences (via the BYAACQ) than those who did not restrict. Those who restricted food on cannabis use days in the past year (n = 128; 20.8% of past year cannabis users) exhibited significantly higher CUDIT scores than those who did not restrict. Those who restricted food on a cannabis use day in the past month (n = 96; 15.6% of past year cannabis users) reported significantly more cannabis consequences on the BMACQ than those who did not restrict. Chi-square tests revealed that, when compared to those who did not restrict food on a cannabis use day in the past month, those who did restrict were significantly more likely to endorse all (e.g., high driving and physical dependence symptoms) but three of the 21 consequences on the BMACQ. These results establish the presence of the risk associated with food restriction on cannabis use days, meriting additional research on the contexts of and motivations for this restriction, as well as targeted interventions to reduce harm.

Sexual and gender minority (SGM) individuals have elevated smoking rates and distinct barriers in quitting smoking. While smoking cessation interventions have traditionally centered on individual behavior change, recent research highlights the significance of exploring the social context surrounding smoking behavior, especially within SGM populations. The current secondary analysis from a longitudinal study examining smoking cessation in dual-smoking couples focuses on N=78 SGM adults who reported information about their smoking behavior and social networks at baseline (i.e., before a cigarette quit attempt) and three months after a quit attempt. Social network surveys measured each participant’s ten closest relationships (i.e., ego-centric network) to assess the level of interconnected (i.e., density) and shared smoking status (i.e., homophily). Past-month smoking behavior at follow-up was assessed with the Timeline Followback (TLFB) method. Findings revealed a main effect of Time, where at baseline the average proportion of those who smoked in one’s network (homophily) stood at 0.39 (SD = 2.6), and at 3-month follow-up, this proportion significantly decreased to 0.31 (SD = .026; t = -2.9 [78]; p = .005). Furthermore, there was a significant Time x Smoking Status interaction (F = 9.2 [1,76]; p = 0.003), wherein the proportion of smoking individuals in one’s social network decreased only among those abstaining at follow-up. Among these individuals who abstained at follow-up, they experienced no significant decrease in network density despite the decrease in smoking individuals (p = .795). These findings highlight the relationship between social networks and smoking cessation in SGM individuals. Successful quitting is associated with a reduced presence of smoking individuals in the network, highlighting the potential importance of social support of non-smokers and/or avoidance of social contact with other smokers during a quit attempt. Additionally, similar network densities despite changes in the proportion of smokers in the network suggests participants may have altered their networks without a decrease in the interconnectedness of their social support system. Thus, interventions should address individual behavior and social dynamics for tailored cessation strategies. Further research is warranted to explore additional factors influencing smoking abstinence and relapse prevention in SGM individuals and couples over prolonged follow-up periods.