Michael Dunbar

• RAND Corporation

Using data from the Behavioral Risk Factor Surveillance System (BRFSS) 2017–2022 we estimated adjusted and unadjusted differences in self-reported number of poor mental health days (past month) between gender minority (GM) and cisgender adults. We document that the disparity is largest among younger individuals. Among 18- to 23-year-olds, GM adults...

This study investigates the psychological mechanisms through which a removal of mentholated tobacco products from retail stores affects future smoking intentions among youth. Descriptive norms and injunctive norms were examined as candidate mediators. The study was conducted in the RAND StoreLab (RSL), a life-sized replica of a convenience store de...

Background and Objectives Limited research has examined how discrimination in young adulthood relates to substance use. We examined how multiple and specific types (e.g., race‐based) of experiences of unfair treatment are related to problematic alcohol and cannabis use. Methods We analyzed cross‐sectional data from a diverse cohort of young adults...

Objective: Predicting which young people are likely to use tobacco in the future is critical for prevention and intervention. Although measures for assessing susceptibility to using tobacco have fulfilled this goal for decades, there is almost no standard for the number of items that should be administered, or which items should be administered for...

Objective: A ban on the tobacco power wall is unlikely in the U.S. due to concerns that such bans violate commercial free speech rights. This experiment evaluated the effectiveness of a more measured strategy for mitigating the influence of the power wall on young people's susceptibility to tobacco use: limiting its size. Method: The experiment...

Prior research with young adults has demonstrated clear associations between experiences of sexual assault, symptoms of posttraumatic stress disorder (PTSD), and alcohol use, but most studies have been cross‐sectional or have not considered multiple theoretical pathways to understand these associations. Using six waves of data from a longitudinal c...

Objective: Prevalence rates of cannabis use and PTSD vary, with men reporting greater cannabis use than females, females reporting higher rates of PTSD than males, and race and ethnic minority persons reporting higher rates of both cannabis and PTSD compared to non-Hispanic White individuals. This study extends our understanding of directional asso...

Objective: Thus far, behavioral health research in the United States has not explored the prevalence or correlates of sober curiosity (SC; exploratory or experimental abstinence or moderation) or temporary alcohol abstinence challenges (TAACs; e.g., "Dry January"), despite significant attention in media and popular discourse. We explored these act...

The goal of the current study is to examine heterogeneity in mental health treatment utilization, perceived unmet treatment need, and barriers to accessing care among U.S. military members with probable need for treatment. Using data from the 2018 Department of Defense Health Related Behavior Survey, we examined a subsample of 2,336 respondents wit...

Background: Assessments of patients have sought to increase the patient voice through direct patient interviews and performance-based testing. However, some patients in post-acute care (PAC) are unable to communicate and cannot participate in interviews or structured cognitive tests. Therefore, we tested the feasibility and reliability of observati...

Objective: Alcohol and other drug (AOD) use increases substantially from adolescence to emerging adulthood, and recent longitudinal studies show disparities in AOD-related outcomes by racial and ethnic, as well as sexual and gender minority (SGM), identities. Greater insight is needed into how individual, social, and environmental contexts interact...

Background: Vaping and smoking are common modes of using cannabis (THC) among young adults, but little is known about how patterns of cannabis vaping and smoking unfold over time or how using one or both types of products may differently affect mental and physical well-being. This study examines parallel processes of cannabis vaping and smoking ov...

Background: Evidence for the effectiveness of menthol cigarette bans comes mostly from studies of adults that smoke. This experiment evaluated whether the absence of menthol products from a convenience store influenced young people's susceptibility to cigarette smoking after they shopped in the store. Methods: This experiment took place in the R...

Background: Some U.S. states and municipalities have banned the sale of flavored tobacco products to help curb youth vaping. However, evidence supporting such bans is limited. This experiment tested whether removing flavored tobacco products from a retail setting diminished adolescents' (ages 11-20) future intentions to use vaping products. Metho...

Objective: A large body of literature has noted detrimental effects of childhood adversity on young adult behavioral health, yet few studies have assessed how early childhood adversity influences the development of alcohol and cannabis co-use. Method: In the present study we use data from an ongoing longitudinal cohort (N = 2507) to understand h...

Objective: To examine longitudinal associations between exposure to two types of advertisements (medical/recreational cannabis and e-cigarette retailers [vape shops]) and young adults’ cannabis and nicotine vaping behavior. Positive and negative expectancies for cannabis and vaping nicotine were examined as mediators of these associations. Method:...

Background and aims: Although the co-occurrence of cannabis and depression is well-established, less is known about the temporal sequence of cannabis use and depression. The present study had three main aims: to test a symptom-driven pathway in which depression may drive increases in cannabis use, to test a substance-induced pathway in which canna...

Background Two major theories aid in explaining the association between anxiety and cannabis use: a symptom-driven pathway (heightened anxiety precedes greater cannabis use) and a substance-induced pathway (greater use precedes heightened anxiety). Although the co-occurrence of cannabis use and anxiety symptomology is well-established, less is know...

We examined longitudinal associations between binge drinking (BD), depressive symptoms, and sexual violence (sexual harassment and sexual assault) among sexual and gender minority (SGM) and non-SGM emerging adults. Data were drawn from four annual web-based surveys of a diverse cohort of 2,553 emerging adults, spanning from approximately age 19 (20...

Objective: Cannabis and tobacco retailers are believed to cluster in areas with more racial/ethnic minorities, which could account for the disproportionate use of blunts in Black and Hispanic communities. The current study examined the spatial relationship between cannabis and licensed tobacco retailers in Los Angeles County, California, and asses...

Objectives: Since the beginning of the COVID-19 pandemic, there has been concern that the pandemic and associated mitigation efforts would have a particularly adverse effect on communities that are marginalized. This study examined disparities in the perceived impacts of the pandemic on sleep, mental and physical health, social functioning, and su...

Tobacco use remains a leading cause of preventable death and disease worldwide [...]

Purpose: Transgender (TG) individuals are a historically understudied and underserved patient population. Although clinical guidelines for the care of TG patients exist, quality measures (QMs) specific to this population are lacking. The goal of this study was to obtain expert input on aspects of care for which quality measurement may be appropriat...

Objectives: Pain is highly prevalent among patients in post-acute care (PAC) settings and can affect quality of life, treatment outcomes, and transitions in care. Routine, accurate assessment of pain across settings is important for pain management and care planning; however, existing PAC assessment instruments do not assess patient pain in a stan...

Background: Assessments of patients have sought to increase the patient voice through direct patient interviews and performance-based testing. However, some patients in post-acute care (PAC) are unable to communicate and cannot participate in interviews or structured cognitive tests. Therefore, we tested the feasibility and reliability of observat...

Background Trajectory studies have consistently shown that alcohol and cannabis (AC) use during emerging adulthood (EA) affect functioning; however, few studies examine whether racial/ethnic disparities may occur at similar levels of use. Methods We conducted web-based surveys across five waves from mean age 18.3 through 22.6. The sample (N=2,945)...

Substance use disproportionately affects health and psychosocial outcomes for some racial/ethnic groups, but few longitudinal studies examine the extent to which sexual and gender minority (SGM) emerging adults of different racial/ethnic groups may experience disparities in outcomes at similar levels of alcohol or cannabis use. This study used five...

Objective: Sexual and gender minority (SGM) young people may use alcohol or cannabis (A/C) at higher rates that non-SGM peers, but little is known about whether SGM young adults experience poorer health, psychosocial, and other outcomes at similar levels of A/C use. Method: We used longitudinal survey data from a community cohort recruited from...

Combination therapy with estrogen and spironolactone may help some transgender women achieve desired results. We used two databases, OptumLabs® Data Warehouse (OLDW) and Veterans Health Administration (VHA), to examine trends in feminizing therapy. We included 3368 transgender patients from OLDW and 3527 from VHA, all of whom received estrogen, spi...

Objective Cannabis-derived products containing cannabidiol with no or minimal levels of delta 9-tetrahydrocannabinol (CBD products) are widely available in the United States and use of these products is common among young adults and those who use marijuana. The purpose of this study was to examine patterns and correlates of CBD product use and co-u...

Introduction The Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associat...

Objective: Recent work has attempted to uncover heterogeneity in experiences of victimization. However, few studies have included important trauma-related characteristics such as known perpetrator, fear of life or injury, and negative reactions to disclosure. Little focus on potentially important subgroup differences including sexual/gender identit...

Background Differences in access to medical versus recreational cannabis outlets and their associations with intentions to use cannabis have not yet been examined among young adults. This study compares the associations between densities of medical versus recreational cannabis outlets and young adults’ intentions to use cannabis, electronic cigaret...

Introduction . 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 es...

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 e...

Background Valid and reliable quality measures can help catalyze improvements in health care. The care of transgender patients is ripe for quality measurement, as there is increasing awareness of the increasing prevalence of this population and the urgency of improving the health care they receive. While best practices may not exist for some aspect...

Importance Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. Objectives To investigate the prevalence of SUDDs among transgender and cisgender adu...

Introduction: Prior studies have identified associations between specific health conditions and occupational impairments in the U.S. military, but little is known about the relative magnitude of impairments associated with different mental and physical health conditions among military service members. The goal of this study is to comparatively ass...

Background and Objectives To expand on epidemiologic studies examining associations between the legalization of recreational cannabis and use among young adults, we examined the associations between licensed and unlicensed cannabis outlet density and cannabis outcomes. Methods A total of 1097 young adults aged 21 and older living in Los Angeles Co...

Background The ways in which young people learn about cannabis product availability and where they obtain cannabis products are important to understand for prevention and intervention efforts. Methods Young adults who reported past month cannabis use (N = 758) completed an online survey in 2018–2019 on how they obtained cannabis and the products t...

Background: Large administrative databases often do not capture gender identity data, limiting researchers' ability to identify transgender people and complicating the study of this population. Objective: The objective of this study was to develop methods for identifying transgender people in a large, national dataset for insured adults. Resear...

Introduction Concurrent co-use of tobacco/nicotine and cannabis (T/C) products is common among young people and may increase risks for negative health and psychosocial outcomes, but little is known about developmental patterns of T/C co-use. This study aimed to identify distinct trajectory classes of concurrent T/C co-use from ages 16 to 21 and com...

Verbal aggression victimization, such as homophobic name‐calling, has been linked to heavier substance use among young people, but little longitudinal research has examined how different types of victimization may affect substance use or whether certain psychosocial factors moderate these risks. In a diverse cohort (N = 2,663), latent transition an...

Research Objective Medicaid has historically reimbursed community mental health centers using fee‐for‐service or negotiated managed care rates that did not always cover the full costs of the services provided by these clinics. To address this problem and improve quality of care, eight states implemented the Certified Community Behavioral Health Cli...

Co-administration of tobacco/nicotine and marijuana (e.g., using both products on the same occasion by mixing them in the same delivery device) is a risky, yet common, form of co-use among young adults. Understanding motivations for co-administration co-use, and how these are associated with subsequent use and related problems, is needed to inform...

At least one in five adult New Yorkers is likely to meet the criteria for a mental health diagnosis, yet most do not receive mental health services to treat these problems. Mental health problems, such as depression and anxiety, disproportionately affect historically underserved segments of the population, such as racial/ethnic minority and low-inc...

Introduction Tobacco companies have devoted increased resources in recent years to developing and marketing heated tobacco products (HTPs) as alternatives to combustible products like cigarettes. However, little is known about correlates of awareness and use of these products in American young adults. Methods Two thousand four hundred ninety-seven...

The changing legal landscape of cannabis in the USA has coincided with changes in how cannabis is used, including its co-use with other substances. This study analyzed 10 years of data from a diverse cohort of youth (N = 2429; 54% Hispanic, 16% Asian, 16% white, 3% black, 10% multiracial) to examine predictors in early and late adolescence of co-us...

UNSTRUCTURED An increasing number of states have laws for the legal sale of recreational and/or medical cannabis out of brick-and-mortar retailers. Given the proliferation of cannabis outlets and the potential for their impact on local economies, neighborhood structures, and individual patterns of cannabis use, it is essential to create practical a...

Background: An increasing number of states have laws for the legal sale of recreational and medical cannabis out of brick-and-mortar storefront locations. Given the proliferation of cannabis outlets and their potential for impact on local economies, neighborhood structures, and individual patterns of cannabis use, it is essential to create practic...

Prior work suggests that exposure to graphic health warning posters (GWPs) at retail point-of-sale may increase future cigarette smoking susceptibility in adolescents who are already at risk for future smoking, but not among committed never-smokers. However, little is known about what psychological mechanisms may account for this effect of GWPs on...

Background: Cannabis and tobacco co-use is a growing concern, yet little is known about its developmental course or associated outcomes during emerging adulthood. This study examines developmental trajectories of cannabis and tobacco co-use from adolescence to emerging adulthood, associations of co-use trajectories with four domains of functioning...

Adolescents and young adults in the United States are constantly exposed to substance-related media and advertising content. The current study seeks to explore, developmentally, how exposure to substance-related media content influences both normative beliefs about peer alcohol use and individual alcohol use. Youth (N = 4‚840; 50.6% female) were fo...

This experiment tested whether the presence of graphic health warning labels on cigarette packages deterred adult smokers from purchasing cigarettes at retail point-of-sale (POS), and whether individual difference variables moderated this relationship. The study was conducted in the RAND StoreLab (RSL), a life-sized replica of a convenience store t...

We develop an effect persistence model for intensive longitudinal data under a general assumption of an exponential loss of association between exposure and outcome over time. The working model proposed may be useful for understanding the complexity of phenomena for which subjects can be repeatedly exposed to an intervention or a naturally occurrin...

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 a...

We appreciate the comments made by Kalan in response to our article¹ and agree with the sentiments expressed with respect to the importance of examining differences across distinct classes or types of product use. However, this was not the purpose of our study. The purpose of our study was to examine reciprocal longitudinal associations between the...

Accurate assessment of pain in post-acute care (PAC) settings is critical to ensuring appropriate pain management and patient-centered care. However, current PAC instruments vary considerably in pain assessment content, particularly for assessments of non-communicative individuals, which may reduce reliability, utility, and interoperability of asse...

This study determines the preliminary impact of CalMHSA's prevention and early intervention activities on the knowledge, attitudes, and behaviors of California community college faculty and staff regarding supporting students' mental health needs.

In the National Defense Authorization Act for Fiscal Year 2016, Congress included a requirement to improve prevention of and response to sexual assaults in which the victim is a male member of the U.S. armed forces. To support this effort, RAND researchers reviewed previous research on male sexual assault and specifically considered research on mal...

Background: Longitudinal studies report associations between use of electronic cigarettes (ECs) and cigarettes over time among young people, but do not distinguish within- from between-person effects, which complicates interpretation of findings. Further, the role of shared risk factors, such as substance use and mental health, in explaining longi...

Knowing the names, locations, and signage of medical marijuana dispensaries is critical for assessing how marijuana availability affects neighborhood quality and marijuana use, yet no detailed methods for locating and coding dispensaries are published. Limitations regarding accuracy of official records, unregulated businesses, and the size of areas...

The purpose of this correlational study was to evaluate the association between attention paid by adolescents to the tobacco power wall and their susceptibility to future smoking. The study was conducted in the RAND Store Lab (RSL), a life-sized replica of a convenience store designed to investigate how tobacco advertising displays in retail point-...

Introduction Adolescents’ e-cigarette use is now more prevalent than their combustible cigarette use. Youth are exposed to e-cigarette advertising at retail point-of-sale (POS) locations via the tobacco power wall (TPW), but no studies have assessed whether exposure to the TPW influences susceptibility to future e-cigarette use. Methods The study...

Objective: To examine the relationship between college students' familiarity with and involvement in Active Minds, a student peer organization focused on increasing mental health awareness, decreasing stigma, and affecting mental health knowledge, attitudes, and behaviors. Method: Students (N = 1,129) across 12 California colleges completed thre...

The mental health system often does not reach all individuals who need mental health services. The Connections to Care (C2C) program, a $30 million public-private partnership under the federal Social Innovation Fund, with oversight from the C2C Collaborative, aims to address this problem by reaching up to 40,000 New Yorkers over five years by encou...

Objective: A survey assessed use of and attitudes toward online mental health services among community college students to inform how such services may contribute to reducing unmet treatment need. Methods: A total of 6,034 students completed a Web-based survey on mental health and use of and attitudes toward mental health services. Logistic regr...

Introduction: 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. Methods: 124 daily smokers documented smoking occasions over 3weeks using ecological momentary as...

Objectives This experiment tested whether introducing graphic antitobacco posters at point-of-sale (POS) had any effect on adolescents’ susceptibility to future cigarette smoking and whether these effects were moderated by adolescents’ baseline risk of cigarette smoking. Methods The study was conducted in the RAND StoreLab, a life-sized replica of...

Purpose: Cigarette smoking among youth is associated with poorer health and psychosocial outcomes. However, few studies address how smoking may differentially relate to the emergence of disparities in functioning across races/ethnicities over adolescence. Methods: Youth (n = 2,509) were surveyed eight times from ages 11 to 18. We measured cigare...

Ecological momentary assessment was used to examine immediate changes in 87 college students’ smoking-related attitudes, beliefs, and intentions as a joint function of their exposure to antismoking media and smoking status. Students (37 never smokers, 41 experimental smokers, and 9 current intermittent smokers) carried handheld data-collection devi...

Objectives: Tobacco power walls display hundreds of tobacco products and are known to be a key part of the impact of point-of-sale tobacco advertising on risk for smoking in adolescents. The current study examined factors that are hypothesized to mediate the effect of tobacco power wall exposure on adolescents' susceptibility for smoking in the fu...

The tobacco industry is continually evolving to adapt to increasing tobacco control pressure and regulation, and to cater to consumer preferences. Recently, RJ Reynolds rolled-out a nicotine-containing gum, Zonnic®, which is marketed as a smoking cessation and reduction product and is sold at convenience stores at a lower price and in a smaller qua...

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:...

Many veterans and their families struggle with behavioral health problems, family reintegration difficulties, and relationship problems. Although many veterans are eligible to receive care at Department of Veterans Affairs health facilities, family members are generally not eligible and therefore must seek care elsewhere. This situation can pose a...

Objectives: E-cigarettes (ECs) are increasingly popular among adolescents, who perceive them as "safer" than cigarettes. Although research has examined risk factors for adolescent EC use, little is known about how EC use correlates with health status and protective health behaviors. Methods: In all, 2488 adolescents (mean age = 17.31 years, SD =...

Background: Use of other tobacco products (OTPs) among smokers is increasing. Little is known about types of OTP used and the reasons for use, and how OTP use and reasons for use correlate with smoking patterns and nicotine dependence in daily and nondaily smokers. This paper addresses these gaps in the literature. Methods: 656 daily smokers and...

It is well established that environmental stimuli influence smoking in light, and to a lesser degree, heavy smokers. A 2-factor model of dependence suggests that the influence of stimulus control is masked among heavier smokers who primarily smoke for nicotine maintenance. The current study aimed to assess the influence of stimulus control across a...

Laboratory cue reactivity (CR) assessments are used to assess smokers' responses to cues. Likewise, EMA recording is used to characterize real-world response to cues. Understanding the relationship between CR and EMA responses addresses the ecological validity of CR. In 190 daily smokers not currently quitting, craving and smoking responses to cues...

"Social smoking" - smoking mostly or even only with others - may be an important pattern that implies smoking motivated extrinsically by social influences. Non-daily smokers (intermittent smokers; ITS) are often assumed to be social smokers, with some authors even assuming that all ITS are social smokers (SS+). We sought to identify and characteriz...

Nondaily, or intermittent smokers (ITS), represent a growing pattern in adult smoking that needs to be explained by models of drug dependence. ITS regularly and voluntarily abstain from smoking, yet have difficulty quitting. We examine potential accounts of ITS' smoking by exploring their experience of craving and withdrawal on the days they abstai...

Gender differences in smoking behavior have been proposed to account for poorer outcomes among women attempting to quit. Specifically, it has been suggested that women's smoking behavior is less motivated by nicotine-seeking and more driven by environmental cues. To date, however, few real-world studies have examined the hypothesis that women's smo...

Many adult smokers are intermittent smokers (ITS) who do not smoke daily. Prior analyses have suggested that, compared with daily smokers (DS), ITS smoking was, on average, more linked to particular situations, such as alcohol consumption. However, such particular associations assessed in common across subjects may underestimate stimulus control ov...

Introduction: Nondaily, or intermittent smokers (ITS), who constitute a substantial fraction of U.S. smokers, are thought to smoke in response to cues. Previous cue reactivity research showed no difference between ITS and daily smokers in response to cues. This report examines whether "converted" ITS (CITS) with a history of past daily smoking dif...

Background: Nicotine dependence has been associated with higher "background" craving and smoking, independent of situational cues. Due in part to conceptual and methodological differences across past studies, the relationship between dependence and cue-reactivity (CR; e.g., cue-induced craving and smoking) remains unclear. Methods: 207 daily smo...

Background: Nondaily or intermittent smokers (ITS) are increasingly common, but how much nicotine, if any, ITS take in and how quickly they metabolize it has not yet been studied. Methods: We compared carbon monoxide (CO), urinary cotinine, and nicotine metabolism [nicotine metabolite ratio (NMR): 3-hydroxycotinine:cotinine] in 224 ITS and 222 d...

This study aimed to assess average and peak craving intensity among nondaily intermittent smokers (ITS), in smoking episodes and when not smoking, compared to that of daily smokers (DS). Two hundred and twelve ITS and 194 DS monitored their smoking and craving for 3 weeks using Ecological Momentary Assessment methods. Craving was assessed (0-100 sc...

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...

Rationale Non-daily, or intermittent smokers (ITS), are increasingly prevalent. Their smoking may be more situational than that of daily smokers (DS), and thus is hypothesized to be more influenced by cues. Objectives To assess ITS’ response to cues, and compare it to that of DS. Methods Samples of 239 ITS and 207 DS (previously reported in Shiffma...