Waterpipe tobacco use in college and non-college young adults in the US Running head: Non-college hookah smoking

Background. Waterpipe tobacco smoking (WTS or “hookah”) is common among adolescents and college students in the United States. However, there has not yet been a large-scale, nationally-representative study independently examining WTS among young adults who are not in college. Objective. This study sought to examine associations between attitudes, normative beliefs, certain socio-demographic factors and current WTS among young adults not in college and compare them to young adults in college. Methods. A total of 3131 US adults ages 18 to 30 completed an online survey about WTS behavior, attitudes, normative beliefs, and relevant socio-demographic factors. Multivariable logistic regression was used to examine independent associations between these variables and current WTS stratified by student status. Results. Ever WTS was reported by 29% of young adults not in college and by 35% of those in college, and current use rates were 3% and 7%, respectively. Multivariable models demonstrated that positive attitudes and perceived peer acceptability of WTS were significantly associated with increased current WTS for both young adults not in college (AOR=2.72; 95% CI, 2.00-3.71 and AOR=2.02; 95% CI, 1.50-2.71, respectively) and young adults in college (AOR=3.37; 95% CI, 2.48-4.58 and AOR=2.05; 95% CI, 1.49-2.83, respectively). The magnitude of these associations was not significantly different when comparing individuals in college and not in college. Conclusions. Among young adults, WTS is common in non-college-based populations as well as in college-based populations. Therefore, prevention programming should extend to all young adults, not only to those in college

Social media use, personality characteristics, and social isolation among young adults in the United States

Although increased social media use (SMU) has been linearly associated with increased real-life social isolation (SI), it is unknown whether these associations differ by personality characteristics. With a nationally-representative sample of 1,768 U.S. young adults aged 19–32, we assessed SI using a 4-item Patient-Reported Outcomes Measurement Information System scale, and personality using the 10-item Big Five Inventory. Using ordered logistic regression, we evaluated multivariable associations between SMU, personality characteristics, and SI. Extraversion and agreeableness were associated with lower odds of SI, while neuroticism was associated with higher odds. A significant interaction term demonstrated that the association between SMU and SI differed by conscientiousness. Among those with low conscientiousness, compared with the lowest quartile of SMU, those in the highest quartile had more than three times the odds (AOR=3.20, 95% CI=1.99, 5.15) for increased SI, but there was no significant association among the high conscientiousness group. Interaction terms between SMU and the other four personality characteristics were not significant. Conscientious individuals may approach social media in a way that helps maintain good face-to-face social interactions, reducing perceived SI

The Association between Social Media Use and Eating Concerns among US Young Adults

Background. Although the etiology of eating concerns is multi-factorial, exposure to media messages is considered to be a contributor. While traditional media, such as television and magazines, have been examined extensively in relation to risk for eating concerns, the influence of social media has received relatively less attention. Objective. To examine the association between social media use and eating concerns in a large, nationally representative sample of young adults. Design. Cross-sectional survey. Participants/setting. Participants were 1765 young adults ages 19-32, who were randomly selected from a national probability-based online non-volunteer panel. Outcome measures. An eating concerns scale was adapted from two validated measures: the SCOFF Questionnaire and the Eating Disorder Screen for Primary Care (ESP). Social media use was assessed using both volume (time per day) and frequency (visits per week). Statistical analyses. To examine associations between eating concerns and social media use, ordered logistic regression was used, controlling for all covariates. Results. Compared to those in the lowest quartile, participants in the highest quartiles of time per day and visits per week had significantly greater odds of having eating concerns (AOR = 2.18, 95% CI = 1.50 - 3.17 and AOR = 2.55, 95% CI = 1.72 - 3.78, respectively). There were significant overall linear associations between the social media use variables and eating concerns (P < 0.001). Conclusions. The results from this study indicate a strong and consistent association between social media use and eating concerns in a nationally-representative sample of young adults ages 19 to 32. This association was apparent whether social media use was measured using time per day or visits per week. Further research should assess the temporality of these associations. It would also be useful to examine more closely the influence of specific characteristics of social media use—including content-related and contextual features

The association between valence of social media experiences and depressive symptoms

Background: Social media (SM) may confer emotional benefits via connection with others. However, epidemiologic studies suggest that overall SM is paradoxically associated with increased depressive symptoms. To better understand these findings, we examined the association between positive and negative experiences on SM and depressive symptoms. Methods: We conducted a cross-sectional survey of 1,179 full-time students at the University of West Virginia ages 18–30 in August of 2016. Independent variables were self-reported positive and negative experiences on SM. The dependent variable was depressive symptoms as measured using the Patient-Reported Outcomes Measures Information System. We used multivariable logistic regression to assess associations between SM experiences and depressive symptoms controlling for socio-demographic factors including age, sex, race/ethnicity, education, relationship status, and living situation. Results: Of the 1,179 participants, 62% were female, 28% were non-White, and 51% were single. After controlling for covariates, each 10% increase in positive experiences on SM was associated with a 4% decrease in odds of depressive symptoms, but this was not statistically significant (AOR=0.96; 95% CI=0.91-1.002). However, each 10% increase in negative experiences was associated with a 20% increase in odds of depressive symptoms (AOR=1.20; 95% CI=1.11-1.31). When both independent variables were included in the same model, the association between negative experiences and depressive symptoms remained significant (AOR=1.19, 95% CI=1.10-1.30). Conclusion: Negative experiences online may have higher potency than positive ones because of negativity bias. Future research should examine temporality to determine if it is also possible that individuals with depressive symptomatology are inclined toward negative interactions

Associations between Internet-Based Professional Social Networking and Emotional Distress

Professional social networking websites are commonly used among young professionals. In light of emerging concerns regarding social networking use and emotional distress, the purpose of this study was to investigate the association between frequency of use of LinkedIn, the most commonly used professional social networking website, and depression and anxiety among young adults. In October 2014, we assessed a nationally-representative sample of 1,780 U.S. young adults between the ages of 19 to 32 regarding frequency of LinkedIn use, depression and anxiety, and socio-demographic covariates. We measured depression and anxiety using validated Patient-Reported Outcomes Measurement Information System measures. We used bivariable and multivariable logistic regression to assess the association between LinkedIn use and depression and anxiety while controlling for age, sex, race, relationship status, living situation, household income, education level, and overall social media use. In weighted analyses, 72% of participants did not report use of LinkedIn, 16% reported at least some use but less than once each week, and 12% reported use at least once per week. In multivariable analyses controlling for all covariates, compared with those who did not use LinkedIn, participants using LinkedIn at least once per week had significantly greater odds of increased depression (adjusted odds ratio [AOR] = 2.10, 95% confidence interval [CI] = 1.31 - 3.38) and increased anxiety (AOR = 2.79, 95% CI = 1.72 - 4.53). LinkedIn use was significantly related to both outcomes in a dose-response fashion. Future research should investigate directionality of this association and possible reasons for it

Association between Social Media Use and Depression among U.S. Young Adults

Importance: Social media use is rapidly increasing among U.S. young adults. While some research suggests that social media exposure may help depressed individuals cope with their condition, other studies indicate that social media use may actually be associated with increased depression. Objective: To assess the association between social media use and depression in a nationally-representative sample of young adults. Design: Cross-sectional study. Setting: General community. Participants: We surveyed 1,787 U.S. young adults between the ages of 19 to 32 regarding social media use and depression. Participants were recruited via random digit dialing and address-based sampling. Data were collected from October to November 2014. Exposure: Social media use was assessed by self-reported total time per day on social media, average number of social media site visits per week, and the score on a global frequency scale adapted from the Pew Internet Research Questionnaire. Main Outcome Measures: Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale Short Form. Results: In the weighted sample, 50.3% were female and 57.5% were White. Compared to those in the lowest quartile of total time per day spent on social media, participants in the highest quartile had significantly increased odds of depression (Adjusted Odds Ratio [AOR] = 1.66, 95% Confidence Interval [CI] = 1.14-2.42), even after controlling for all covariates. Similarly, in multivariable models, compared with those in the lowest quartile, depression was more common among those in the highest quartiles of social media site visits per week (AOR = 2.74, 95% CI = 1.86-4.04) and the global frequency score (AOR = 3.05, 95% CI = 2.03-4.59). All associations between independent variables and depression demonstrated strong dose-response relationships (P < .001), and results were robust to all sensitivity analyses. Conclusion and Relevance: In this cross-sectional study, multiple measures of social media use were significantly associated with increased depression. Given the proliferation of social media and the morbidity and mortality associated with depression worldwide, identifying the mechanisms and direction of this association is critical for informing interventions that address social media use and depression

Emotional Support from Social Media and Face-to-Face Relationships: Associations with Depression Risk Among Young Adults

Background. Emotional support is highly protective against poor mental health. Though several measures of emotional support exist, none specifically addresses social media (SM) as a source of emotional support. Therefore, the objectives of this study were to determine if SM-based emotional support is an extension of or distinct construct from face-to-face (FTF) emotional support and to assess the independent associations between each domain of emotional support and depression risk among U.S. young adults. Methods. In March 2018, we surveyed 2,408 18–30 year olds. We assessed perceived FTF emotional support with the brief PROMIS emotional support scale and perceived SM-based emotional support using a new four-item measure. Depression risk was assessed using the PHQ-9. We performed factor analysis (FA) to determine the underlying factor structure of all items and to develop composite scales. Multivariable logistic regression was used to examine the independent association between each resulting emotional support scale and depression risk. Results. FA revealed two distinct constructs. FTF emotional support was associated with 43% lower odds of depression per 1-unit increase on the 5-point scale (AOR=0.57, 95% CI=0.52-0.63). However, SM-based emotional support was significantly associated with 20% greater odds of depression per 1-unit increase on the 5-point scale (AOR=1.20, 95% CI=1.09-1.32). Limitations. This study utilized a cross-sectional design and self-report data. Conclusions. While FTF emotional support was associated with slightly lower odds of depression, SM-based emotional support was associated with slightly greater odds of depression. It may be valuable for clinicians treating individuals with depression to ask about sources of emotional support

Pennsylvania policymakers’ knowledge, attitudes and likelihood for action regarding waterpipe tobacco smoking and electronic nicotine delivery systems

INTRODUCTION Use of waterpipe tobacco smoking (WTS, or hookah smoking) and electronic nicotine delivery systems (ENDS, such as e-cigarettes) is rapidly increasing. However, legislatures have been slow to update policy measures related to them. Therefore, we aimed to assess knowledge, attitudes and likelihood to take future action regarding WTS and ENDS among Pennsylvania legislators. METHODS We approached all Standing Members of key Pennsylvania House and Senate health and welfare committees to complete a survey about substances of abuse, including WTS and ENDS. Closed-ended knowledge, attitude and action items used a 100-point scale. Responses to open-ended items were assessed using thematic analysis by three independently working researchers. RESULTS We received responses from 13 of 27 eligible policymakers (48%). Participants answered a mean of only 27% (SD=20%) of knowledge items correctly. When asked to rank by priority eight issues in substance abuse, WTS ranked eighth (least urgent) and ENDS ranked fifth. Participants reported low likelihood to introduce legislation on WTS (mean=29, median=25) and/or ENDS (mean=28, median=10). Thematic analysis revealed that participants readily acknowledged lack of understanding of WTS and ENDS, and were eager for additional information. CONCLUSIONS Policymakers exhibit a lack of knowledge concerning newer forms of tobacco and nicotine delivery systems and consider them to be relatively low legislative priorities. However, respondents expressed a desire for more information, suggesting the potential for public health entities to promote effective policy development via improved dissemination of information

Social Media Use and Perceived Social Isolation Among Young Adults in the U.S.

Introduction: Perceived social isolation (PSI) is associated with substantial morbidity and mortality. Social media platforms, commonly used by young adults, may offer an opportunity to ameliorate social isolation. This study assessed associations between social media use (SMU) and PSI among U.S. young adults. Methods: Participants were a nationally representative sample of 1787 U.S. adults aged 19–32 years. They were recruited in October–November 2014 for a cross-sectional survey using a sampling frame that represented 97% of the U.S. population. SMU was assessed using both time and frequency of using 11 social media platforms, including Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit. PSI was measured using the Patient-Reported Outcomes Measurement Information System scale. In 2015, ordered logistic regression was used to assess associations between SMU and SI while controlling for eight covariates. Results: In fully adjusted multivariable models that included survey weights, compared with those in the lowest quartile for SMU time, participants in the highest quartile had twice the odds of having greater PSI (AOR=2.0, 95% CI=1.4, 2.8). Similarly, compared with those in the lowest quartile, those in the highest quartile of SMU frequency had more than three times the odds of having greater PSI (AOR=3.4, 95% CI=2.3, 5.1). Associations were linear (p<0.001 for all), and results were robust to all sensitivity analyses. Conclusions: Young adults with high SMU seem to feel more socially isolated than their counterparts with lower SMU. Future research should focus on determining directionality and elucidating reasons for these associations

For Better or for Worse? A Systematic Review of the Evidence on Social Media Use and Depression Among Lesbian, Gay, and Bisexual Minorities

Background: Over 90% of adults in the United States have at least one social media account, and lesbian, gay, and bisexual (LGB) persons are more socially active on social media than heterosexuals. Rates of depression among LGB persons are between 1.5- and 2-fold higher than those among their heterosexual counterparts. Social media allows users to connect, interact, and express ideas, emotions, feelings, and thoughts. Thus, social media use might represent both a protective and a risk factor for depression among LGB persons. Studying the nature of the relationship between social media use and depression among LGB individuals is a necessary step to inform public health interventions for this population. Objective: The objective of this systematic review was to synthesize and critique the evidence on social media use and depression among LGB populations. Methods: We conducted a literature search for quantitative and qualitative studies published between January 2003 and June 2017 using 3 electronic databases. Articles were included if they were peer-reviewed, were in English, assessed social media use either quantitatively or qualitatively, measured depression, and focused on LGB populations. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed appropriate reporting of studies using the Strengthening the Reporting of Observational Studies in Epidemiology and the Consolidated Criteria for Reporting Qualitative Research for quantitative and qualitative studies, respectively. Results: We included 11 articles in the review; 9 studies were quantitative and cross-sectional and 2 were qualitative. Appropriate reporting of results varied greatly. Across quantitative studies, we found heterogeneity in how social media use was defined and measured. Cyberbullying was the most studied social media experience and was associated with depression and suicidality. Qualitative studies found that while social media provides a space to disclose minority experiences and share ways to cope and get support, constant surveillance of one’s social media profile can become a stressor, potentially leading to depression. In most studies, sexual minority participants were identified inconsistently. Conclusions: This review supports the need for research on the role of social media use on depression outcomes among LBG persons. Using social media may be both a protective and a risk factor for depression among LGB individuals. Support gained via social media may buffer the impact of geographic isolation and loneliness. Negative experiences such as cyberbullying and other patterns of use may be associated with depression. Future research would benefit from more consistent definitions of both social media use and study populations. Moreover, use of larger samples and accounting for patterns of use and individuals’ experiences on social media may help better understand the factors that impact LGB mental health disparities