Abstract Purpose College students are at high risk for mental health problems, yet many do not receive treatment even when services are available. Treatment needs may be even higher among sexual ...minority students, but little is known about how these students differ from heterosexual peers in terms of mental health needs and service utilization. Methods A total of 33,220 California college students completed an online survey on mental health needs (e.g., current serious psychological distress and mental health–related academic impairment) and service utilization. Using logistic regressions, we examined differences in student characteristics, mental health service use, and perceived barriers to using on-campus services by sexual minority status. Results Approximately 7% of students self-identified as sexual minorities. Compared with heterosexual students, sexual minority students endorsed higher rates of psychological distress (18% vs. 26%, p < .001) and mental health–related academic impairment (11% vs. 17%, p < .001) but were 1.87 (95% confidence interval: 1.50–2.34) times more likely to use any mental health services. Sexual minority students were also more likely to report using off-campus services and to endorse barriers to on-campus service use (e.g., embarrassed to use services and uncertainty over eligibility for services). Conclusions Sexual minority individuals represent a sizeable minority of college students; these students use mental health services at higher rates than heterosexual peers but have high rates of unmet treatment need. Efforts to address commonly reported barriers to on-campus service use, foster sexual minority-affirmative campus environments, and promote awareness of campus services may help reduce unmet treatment need in this population.
Despite overall declines in cigarette smoking prevalence in the United States (U.S.) in the past several decades, smoking rates remain highly variable across geographic areas. Past work suggests that ...smoking norms and exposure to other smokers in one's social environment may correlate with smoking risk and cessation, but little is known about how exposure to other smokers in one's community is causally linked to smoking behavior – in part due to endogeneity and inability to randomly assign individuals to different ‘smoking environments.’ The goal of this study was to evaluate how exposure to localities with high population-level smoking prevalence affects individual-level cigarette smoking behaviors, including quitting. The study addresses key limitations in the literature by leveraging a unique natural experiment: the plausibly exogenous compulsory assignment of military personnel to installations. Logistic and multivariate regressions estimated cross-sectional associations between smoking/quitting behaviors and our proxy for social environments for smoking, county-level smoking prevalence (CSP). Across 563 U.S. counties, CSP ranged from 3.8 to 37.9%. Among the full sample, a 10 percentage point increase in CSP was associated with an 11% greater likelihood of smoking. In subgroup analyses, young adults, women, those without children in the household, and risk/sensation-seekers were more likely to smoke and less likely to quit when exposed to counties with higher CSP. Relocation to areas with high population-level smoking prevalence may increase likelihood of smoking and impede quitting, and may disparately affect some population subgroups. Findings provide novel evidence that community smoking environments affect adult smoking risk and underscore a need for sustained, targeted efforts to reduce smoking in areas where prevalence remains high.
•Endogeneity hinders estimation of effects of social environment on tobacco use.•This study uses a natural experiment in military personnel to address endogeneity.•Assignment to counties with high smoking prevalence increases adult smoking risk.•Among smokers, exposure to high smoking prevalence counties impedes quitting.•Sustained efforts are needed to reduce smoking in areas where prevalence is high.
Major depressive disorder (MDD) is predicted to be the second leading cause of global disease burden by 2030. A large number of MDD patients do not respond to the currently available medication ...because of its poorly understood etiology. Recently, studies of microRNAs (miRNAs), which act as a molecular switch of gene expression, have shown promise in identifying a molecular network that could provide significant clues to various psychiatric illnesses. Using an in vitro system, a rodent depression model, and a human postmortem brain, we investigated the role of a brain-enriched, neuron-specific miRNA, miR-124-3p, whose expression is highly dysregulated in stressed rodents, and identified a set of target genes involved in stress response and neural plasticity. We also found that miR-124-3p is epigenetically regulated and its interaction with the RNA-induced silencing complex (RISC) is compromised in MDD. Using blood serum, we found similar dysregulation of miR-124-3p in antidepressant-free MDD subjects. Altogether, our study demonstrates potential contribution of miR-124-3p in the pathophysiology of MDD and suggests that this miRNA may serve as a novel target for drug development and a biomarker for MDD pathogenesis.
Intermittent smokers (ITS) - who smoke less than daily - comprise an increasing proportion of adult smokers. Their smoking patterns challenge theoretical models of smoking motivation, which emphasize ...regular and frequent smoking to maintain nicotine levels and avoid withdrawal, but yet have gone largely unexamined. We characterized smoking patterns among 212 ITS (smoking 4-27 days per month) compared to 194 daily smokers (DS; smoking 5-30 cigarettes daily) who monitored situational antecedents of smoking using ecological momentary assessment. Subjects recorded each cigarette on an electronic diary, and situational variables were assessed in a random subset (n=21,539 smoking episodes); parallel assessments were obtained by beeping subjects at random when they were not smoking (n=26,930 non-smoking occasions). Compared to DS, ITS' smoking was more strongly associated with being away from home, being in a bar, drinking alcohol, socializing, being with friends and acquaintances, and when others were smoking. Mood had only modest effects in either group. DS' and ITS' smoking were substantially and equally suppressed by smoking restrictions, although ITS more often cited self-imposed restrictions. ITS' smoking was consistently more associated with environmental cues and contexts, especially those associated with positive or "indulgent" smoking situations. Stimulus control may be an important influence in maintaining smoking and making quitting difficult among ITS.
•Endogeneity can bias estimates of effects of cigarette excise taxes on tobacco use.•This study assessed tax effects using a natural experiment to overcome endogeneity.•Higher state taxes correlated ...with lower odds of smoking and higher odds of quitting.•Findings provide novel support for a role of state taxes in reducing adult smoking.
Cigarette excise taxes are a well-established policy lever for reducing tobacco use. However, estimating the effect of taxes on smoking behavior can be confounded by endogeneity concerns such as selection. This study leverages a unique natural experiment –compulsory relocation of U.S. military service members to installations – to estimate the relationship between state cigarette taxes and smoking behavior without concerns about selection into environments.
The current study uses data from the Department of Defense’s 2011 Health-Related Behaviors Survey and 2011 state cigarette excise taxes from the CDC STATE System. Logistic and Poisson regression analyses estimate the cross-sectional associations between state cigarette excise taxes and the following smoking behaviors: current cigarette smoking, frequency of smoking, heaviness of consumption, and cigarette cessation among individuals who smoked while at the current installation.
Higher taxes are associated with lower odds of current cigarette smoking (AOR = 0.94; 95 % CI: 0.89−0.98), fewer smoking days per month among current cigarette smokers (IRR = 0.98, 95 % CI 0.97−0.996), and higher likelihood of quitting smoking among individuals who had smoked at their current installation (AOR = 1.14, 95 % CI 1.05–1.25). Taxes are not associated with the number of cigarettes smoked per day among current smokers.
Exogenous assignment to installations in states with higher cigarette taxes is associated with lower likelihood of smoking and greater likelihood of quitting. Findings provide novel evidence in support of a causal impact of cigarette taxes on lower smoking levels among adults.
Individuals may compensate for workplace smoking bans by smoking more before or after work, or escaping bans to smoke, but no studies have conducted a detailed, quantitative analysis of such ...compensatory behaviors using real-time data.
124 daily smokers documented smoking occasions over 3weeks using ecological momentary assessment (EMA), and provided information on real-world exposure to smoking restrictions and type of workplace smoking policy (full, partial, or no bans). Mixed modeling and generalized estimating equations assessed effects of time of day, weekday (vs weekend), and workplace policy on mean cigarettes per hour (CPH) and reports of changing location to smoke.
Individuals were most likely to change locations to smoke during business hours, regardless of work policy, and frequency of EMA reports of restrictions at work was associated with increased likelihood of changing locations to smoke (OR=1.11, 95% CI 1.05–1.16; p<0.0001). Workplace smoking policy, time block, and weekday/weekend interacted to predict CPH (p<0.01), such that individuals with partial work bans –but not those with full bans - smoked more at night (9pm – bed) on weekdays compared to weekends.
There was little evidence that full bans interfered with subjects' smoking during business hours across weekdays and weekends. Smokers largely compensate for exposure to workplace smoking bans by escaping restrictions during business hours. Better understanding the effects of smoking bans on smoking behavior may help to improve their effectiveness and yield insights into determinants of smoking in more restrictive environments.
•Smoking bans may interfere with continuous ad libitum smoking on workdays.•A detailed analysis of temporal smoking patterns and workplace bans is presented.•Smokers escape bans to achieve consistent smoking patterns on workdays and weekends.•Additional policy measures may be needed to reduce smoking during business hours.
Cannabis and tobacco/nicotine use are highly comorbid. Given expanding access to cannabis through legalization for recreational use, it is important to understand how patterns of cannabis and ...tobacco/nicotine co-use are associated with young adult outcomes. A predominantly California-based sample of 2,429 young adults (mean age = 20.7) completed an online survey. Based on past-year reports of cannabis and tobacco/nicotine use, we defined 5 mutually exclusive groups: (a) single-product use; (b) concurrent use only (using both products, but only on separate occasions); (c) sequential use only (using both products on the same occasion, one right after the other, but not mixing them together); (d) coadministration only (using both products on the same occasion by mixing them in the same delivery device); and (e) both sequential use and coadministration. We examined group differences in use patterns, dependence, consequences of use, and psychosocial functioning. Fifty percent of respondents reported cannabis use, 43% tobacco/nicotine use, and 37% co-use of both substances. The most prevalent method of co-use involved smoking combustible products. Overall, individuals who co-used both substances on the same occasion in some way reported heavier use and greater problematic behaviors than those who did not. Sequential use (especially among those that also engaged in coadministration) was typically associated with worse physical and mental functioning overall compared to using each substance separately. Findings illuminate both prevalence and risks associated with co-use of cannabis and tobacco/nicotine products and can inform policies for states considering regulation of cannabis and tobacco/nicotine products.
The influence of tibial slope on tibial component migration following total knee arthroplasty has not been widely studied, although excessive posterior slope has been implicated in some failures. As ...implant micromotion measured with radiostereometric analysis can indicate successful fixation, the purpose of this study was to determine the associations between tibial slope, tibial component migration, and inducible displacement.
Radiostereometric analyses at 6 visits over 2 years quantified implant migration for 200 cemented total knee arthroplasties. Longitudinal data analysis examined the influence of postoperative tibial slope on implant migration (overall maximum total point motion (MTPM) migration and anterior–posterior tilt migration), accounting for age, sex, and body mass index. The correlations of tibial slope with 1-year migration, continuous migration, and inducible displacements were also examined. Additionally, the amount of change in slope was compared to migration.
The mean posterior tibial slope was 8.0° (standard deviation SD 3.8°) preoperatively and 3.8° (SD 3.1°) postoperatively, with a mean reduction in slope of 4.2° (SD 4.7°). Postoperative tibial slope (range 14.0° posterior slope to 3.4° anterior slope) was not associated with longitudinal overall migration (P = .671) or anterior–posterior tilt migration (P = .704). There was no association between postoperative tibial slope and migration at 1 year postoperatively (P = .441 for MTPM migration, P = .570 for tilt migration), change in migration from 1 to 2 years (P = .951), or inducible displacement (P = .970 MTPM, P = .730 tilt). The amount of change in tibial slope was also not associated with migration or inducible displacement.
Residual and change in postoperative tibial slope were not associated with implant migration into tilt or overall migration, or inducible displacement for a single implant design. These findings support positioning tibial implants in a range of slopes, which may support patient-specific approaches to implant alignment.
The present study examined the prospective value of response expectancies (ie, pain, sleep) and behavioral outcome expectancies (ie, return to function) in the prediction of pain severity and ...functional limitations 12 months after total knee arthroplasty (TKA). The study sample consisted of 120 individuals (73 women, 47 men) with osteoarthritis of the knee who were scheduled for TKA. Measures of expectancies, pain severity, pain catastrophizing, pain-related fears of movement, and depression were completed prior to surgery. Participants also completed measures of pain severity and functional limitations 12 months following surgery. Analyses revealed that behavioral outcome expectancies were stronger predictors of follow-up pain and functional limitations than response expectancies. Consistent with previous research, analyses also revealed that pain catastrophizing, pain-related fear of movement, and depression predicted follow-up pain and function. In a multivariate analysis, only pain catastrophizing contributed significant unique variance to the prediction of follow-up pain and function. Behavioral outcome expectancies partially mediated the relation between catastrophizing and follow-up pain and function. The relation between catastrophizing and follow-up pain severity and functional limitations remained significant even when controlling for behavioral outcome expectancies. The results suggest that interventions designed to specifically target behavioral outcome expectancies and catastrophizing might improve post-surgical outcomes.
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