Steve Sussman

University of Southern California | USC · Institute for Health Promotion and Disease Prevention Research

Introduction E-cigarette retail/marketing surveillance is needed during regulatory changes, like the US increasing minimum legal sales age to 21 (T21) and flavor restrictions (2019 and 2020) and certain state/localities increasing related restrictions. Methods We examined regulatory compliance (e.g., minimum-age signage), promotional strategies (e...

Tobacco use among cancer patients is associated with an increased mortality and poorer outcomes, yet two-thirds of patients continue using following diagnosis, with disproportionately higher use among racial/ethnic minority and low socioeconomic status patients. Tobacco treatment services that are effectively tailored and adapted to population char...

The potential impact of the COVID-19 pandemic on young people’s mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schoo...

Globally little is known regarding substance use service providers' perceptions of substitute behaviours and this significant gap could hinder service provision and recovery outcomes. Semi-structured focus group discussions (including 22 service providers across five sites) were conducted in residential treatment facilities in the Western Cape, Sou...

Objective To estimate the extent to which drinking to cope with the COVID-19 pandemic and experiencing pandemic-related life stressors are associated with alcohol use escalation among young adults. Methods Respondents in Los Angeles, CA, USA (N = 2,130) completed prospective cohort study surveys before (baseline; October 2018–November 2019; mean a...

Adverse childhood experiences (ACE) have a strong association with alcohol and drug use; however, more research is needed to identify protective factors for this association. The present study assesses the longitudinal impact of ACE on problematic alcohol and drug use and the potential moderating effect of perceived social support. Data (n = 1404)...

Delta‐8 tetrahydrocannabinol (THC) is a psychoactive substance from the Cannabis plant that has been rising in popularity in the United States since the 2018 U.S. Farm Bill implicitly legalized it. This study reviewed research from peer‐reviewed and non‐peer‐reviewed (e.g., anecdotal and news) reports related to Delta‐8 THC to summarize current kno...

Background: Young adults often derive self-identity from affiliation with peer crowds, which may be defined as reputation-based peer groups centered around characterizable lifestyle norms. Little is known about peer crowds prevalent among Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) populations and the peer crowds' normativ...

Substitute addictions – addictions that replace terminated substance use disorders (SUDs) – involving addictive behaviours such as a new substance, food/eating, gambling, shopping, or sex, have implications for recovery but remain poorly understood. While extant studies suggest a multifaceted aetiology, research is needed to illuminate the nature,...

There is evidence that smoking prevalence rates are related to acculturation, education, and gender among Asian Americans. However, no studies have examined how smoking rates among Asian Americans vary based on acculturation, education, and gender together. This study used National Health Interview Survey (NHIS) data (2010–2018) to examine cigarett...

Vape shops specialize in sales of e-cigarettes and related products. This study examines whether vape shops adapted their products and services in response to changes in federal and state policies that affect the tobacco retail environment between 2014–2022. In this multicohort study, four waves of study data were used to examine the trends in prod...

Background Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD. Objectives This study explored resident physicians’ experiences with SUD education throughout medical school and residency and qualitat...

Behavioral addictions are highly comorbid with substance use disorders, presenting in as many as 54% of service users receiving substance use treatment. Few studies have examined whether treatment centers are attentive to such other addictions, which may undermine treatment. This study examined the mention and treatment of behavioral addictions on...

Background: Previous research in high-income countries (HICs) has shown that smokers reduce their cognitive dissonance through two types of justifications over time: risk minimizing and functional beliefs. To date, however, the relationship between these justifications and smoking behaviors over time has limited evidence from low- and middle-incom...

BACKGROUND AND OBJECTIVES Flavored non-tobacco oral nicotine products (eg, nicotine pouches and nontherapeutic nicotine gum, lozenges, tablets, gummies), are increasingly marketed in the United States. Prevalence of non-tobacco oral nicotine product use among adolescents is unknown. METHODS We calculated prevalence of ever and past 6-month use of...

Introduction Exposure to E-cigarette marketing and media advertisements is prevalent among adolescents. A validated vaping media literacy scale is needed to inform effective vaping prevention programs. Methods A 6-item vaping media literacy scale was adapted from validated smoking and general media literacy scales with an emphasis on marketing inf...

Sometimes in health behavior research, purportedly novel theoretical models are offered that may help move thinking about behavior change forward, and may be well-received by clinicians, but over time end up being a subject of continual scientific disconfirmation. The transtheoretical model is one rather popular example. The five stages of change a...

American Indian Alaska Native (AIAN) youth have disproportionately higher rates of commercial tobacco product use compared to other racial and ethnic groups in the U.S. These rates underscore a need for commercial tobacco product cessation interventions that are culturally informed. This project studied the development, implementation, and some imp...

Vape shops specialize in the sales of e-cigarettes and other vaping products. In recent studies, young adults who use e-cigarettes have tended to identify with at-risk peer crowds. This is the first study to examine vape shop customers' clientele. Composed primarily of young adults and persons in early middle adulthood, we speculated that a relativ...

“Vulnerable populations” in health behavior research, practice and policy is generally used to refer to groups that, due to their life circumstances, may require extra consideration, reasonable accommodation, and legitimized protection [...]

This essay seeks to illuminate the shifting definitions of addiction over time by providing a brief, anecdotal history of addiction as well as a review of how it has been conceptualized by the American Psychiatric Association’s DSM classification system. While all addictions have in common the attempt to experience an appetitive effect (satiety), p...

Background: Tobacco regulations and COVID-19 state orders have substantially impacted vape retail. This study assessed vape retailers' perspectives regarding regulations and future retail activities. Methods: In March-June 2021, 60 owners or managers of vape or vape-and-smoke shops (n = 34 vs. n = 26) in six US metropolitan areas completed an on...

Background and objectives: While inadequate nutrition can weaken the immune system and lead to negative health sequelae for vulnerable populations, little is known about nutritional intake among people who inject drugs (PWID). We aimed to quantify nutritional intake among PWID and to explore associations between protein intake and drug use. Metho...

Background Adverse childhood experiences (ACE), including maltreatment and household dysfunction, are consistent predictors of health compromising behaviors in adulthood. While most ACE studies have focused on adults, there is an emerging body of research focusing on young adulthood. Methods This review describes research focused on the relationsh...

Oral nicotine pouches may appeal to young adult current nicotine/tobacco users interested in alternative forms of nicotine that lack pulmonary exposure, but may also appeal to young adult non-users of nicotine/tobacco products. We used data from a 2020 remote digital survey of an ongoing cohort study of young adults from Southern California (aged 1...

The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residen...

Objectives In February 2020, the US Food and Drug Administration issued a guidance restricting the sales and distribution of cartridge-based e-cigarettes with flavours other than tobacco and menthol. Disposable devices were exempt from this guidance. This study examined the prevalence of disposable pod use and flavour preference compared with refil...

Objective The 2016 FDA’s “Deeming Rule” prohibited free samples of vaping products. The purpose of this study was to investigate compliance with or adaptation to this newly established FDA policy. Methods Vape shops were recruited in Southern California between November 2017 and December 2018. Data collectors interviewed 121 vape shop employees, w...

Objectives. To evaluate disparities in youth e-cigarette use patterns and flavor use by race/ethnicity over time. Methods. We used data from the US 2014–2019 National Youth Tobacco Survey (NYTS) to examine trends in dual use (co-use of e-cigarettes and cigarettes or other tobacco products), occasional (≤ 5 days) versus frequent use (≥ 20 days) in t...

We conducted an analysis of the prevalence of substance and behavioral addictions across different transgender and gender diverse (TGD) subgroups. We performed a scoping review using MEDLINE and Google Scholar databases and examined 12 addictions, including alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, internet, sex, love, exer...

Background ‘Ice’ e-cigarette flavours—marketed as a combination of fruity/sweet and cooling flavours (eg, ‘blueberry ice’ or ‘melon ice’)—recently entered the US market. The prevalence and correlates of ice flavoured e-cigarette use in young adults are unknown. Methods This cross-sectional study of a Los Angeles, California, USA, cohort analysed d...

Introduction E-cigarette users typically initiate vaping with flavoured e-liquids. People who vape flavours tend to underestimate the harm of vaping. We examined the inter-relationship between flavour preference, vaping for cessation purposes, e-cigarette dependence, e-cigarette harm perception and purchase/use intention, given a hypothetical flavo...

Background: College students are among the heaviest users of smartphones and the Internet, and there is growing concern regarding problematic Internet (PIU) and smartphone use (PSU). A subset of adverse childhood experiences, household dysfunction [(HHD) e.g.; parental substance use, mental illness, incarceration, suicide, intimate partner violenc...

The addictions are subject to a great deal of stigma, the constituents of which include negative attributions such as being immoral, weak-willed, or sick. Negative outcomes include exclusion from positive life opportunities. In this commentary, I briefly discuss the definition of stigma, descriptors of addiction-related stigma, and negative consequ...

We provide a conceptual framework for considering how an individual’s identity is influenced by social groups and an empirical exploration of how identity is related to cigarette smoking and e-cigarette use. We report findings on e-cigarette use and cigarette smoking from studies of adolescents and young adults. Mediation analyses focused on (a) pa...

The present study investigated the prevalence and co-occurrence of addictions to tobacco, alcohol, other drugs, food/eating, the internet, texting, video games, shopping, love, sex, exercise, work, and gambling among American Indian (AI) youth in California. As with previous work in other cultural groups, the most prevalent addictions were love, in...

Background Addictions share common etiological factors associated with personality vulnerabilities such as narcissism or emotional instability. Also, there are gender differences in the type of and risk for addiction (e.g., men may be more prone to addictions, overall). These are considerably less understood in relation to behavioral addictions (BA...

Background: Substitute addictions, addictive behaviors that sequentially replace each other’s functions, have implications for recovery trajectories but remain poorly understood. We sought to scope the extent, range, and characteristics of research on substitute addictions in persons with substance use disorders. Method: Using Arksey and O’Malley’s...

Background There has been a tremendous increase in the use of smartphones among college students and alongside the benefits there is growing concern over problematic/addictive smartphone use (PSU). Among the most robust predictors of behavioral and substance use disorders are a subset of adverse childhood experiences conceptualized as household dys...

The overall aim of this study is to examine vape shop business operations during COVID-19 among a cohort of 88 vape shops in the Greater Los Angeles area in Southern California, located in ethnically diverse communities. A total of six web- and/or phone-based assessments were conducted over a 12-week period (April 1, 2020–June 10, 2020), extending...

Objectives: Given the need to understand e-cigarette retail and its impact, we examined sociodemographic, tobacco and marijuana use, and e-cigarette retail experiences as correlates of (1) past 30-day e-cigarette use, (2) past 30-day advertising/media exposure, and (3) point-of-sale age verification among young adults. Methods: We analyzed basel...

This cross-sectional study estimates the association of political party affiliation with physical distancing behaviors among young adults during the coronavirus disease 2019 pandemic.

Introduction This study examined vape shop customers’ behaviors in relation to shop display practices. We hypothesized that display of signs conveying supportive attitude toward vaping at vape shops would be positively associated with customer purchasing and in-shop vaping behaviors. Methods We recruited vape shops throughout Southern California (...

Introduction: Adverse childhood experiences (ACE) predict health-compromising behaviors such as substance use. However, few studies have examined the association between ACE and prescription drug misuse among young adults—a growing public health concern. College students are especially vulnerable to prescription drug misuse due to social and academ...

Background Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective This study assesses the effectiv...

BACKGROUND Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. OBJECTIVE This study assesses the effectiv...

The global spread of COVID-19, subsequent stay-at-home requirements, spatial distancing measures, and long-term isolation present additional challenges for persons in recovery. Using an illustrative case from South Africa, we discuss COVID-19 related pornography use through the lens of relapse and substitute addiction. South Africa is the epicenter...

Many policies are enacted by the different levels of government in the United States in order to ensure a healthy population. The creators of these policies hope that they will help to also decrease the burden of disease. A successful example of this is tobacco‐related policies, which have significantly decreased tobacco use behaviors. There were s...

Introduction Adverse childhood experiences (ACE) predict health-compromising behaviors such as substance use. However, few studies have examined the association between ACE and prescription drug misuse among young adults—a growing public health concern. College students are especially vulnerable to prescription drug misuse due to social and academi...

Background This study examined smoking cessation advice offered by vape shop employees, as well as their perceived awareness of vaping research. Methods This cross-sectional study was conducted in 121 vape shops in the Greater Los Angeles area of Southern California in four multiethnic communities (Hispanic/Latino, African American, Korean/Asian,...

Introduction Vaping and vape shops pose risk for COVID-19 and its transmission. Objectives We examined vape shop non-compliance with state-ordered business closures during COVID-19, changes in their marketing and experiences among consumers. Methods As part of a longitudinal study of vape retail in six metropolitan statistical areas (MSAs; Atlant...

Over the past decade in the US there have been marked pivotal changes in the policy and retail environment regarding cannabinoids, particularly cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). Many vape shops may carry products relevant to these two markets. This study interviewed vape shop owners/managers to assess their perceptions of co...

The purpose of this study is to present current data on the prevalence and co-occurrence of 12 substance and behavioral addictions among adult cisgender sexual minorities (SM). We utilized MEDLINE, PsycINFO, and Google Scholar databases to systematically review the literature on alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, Int...

Introduction: In the US, prominent sources of vaping products are specialty vape shops, which are subject to Food and Drug Administration (FDA) regulation. This study interviewed vape shop owners/managers to assess: 1) reasons for entering into or engaging in vape shop retail; 2) personnel training, particularly with regard to FDA and state regula...

Prospective longitudinal data collection is an important way for researchers and evaluators to assess change. In school-based settings, for low-risk and/or likely-beneficial interventions or surveys, data quality and ethical standards are both arguably stronger when using a waiver of parental consent—but doing so often requires the use of anonymous...

Introduction Past studies have documented disparities in regulation compliance among tobacco retailers with respect to ethnic diversity in neighbourhoods. This study investigated the association between compliance with the Food and Drug Administration (FDA) and California state rules and neighbourhood ethnic composition of a vape shop location. Me...

The novel 2019 Coronavirus Disease (COVID-19) pandemic has led to the closing of all but essential businesses in California. However, several nonessential businesses have remained open in Southern California despite the mandated “stay at home” order issued by the governor. As part of an ongoing vape shop project involving 88 participating shops, th...

Objectives: Vape shops have proliferated in the United States (US) in recent years. As of May 2016, the US Food and Drug Administration (FDA) asserted its authority to regulate electronic nicotine delivery systems. It is critical to understand how these polices have affected the vape shop industry, as the rise and fall of vape shop proliferation h...

Introduction JUUL, a small pod-based vaping device that aerosolizes nicotine salts, is popular among adolescents and young adults. Because of JUUL’s high nicotine content, JUUL users can become nicotine dependent very quickly and have difficulty quitting. Nicotine-dependent JUUL users might turn to Twitter to seek advice, share their cessation stru...

Background Students in the United States spend a meaningful portion of their developmental lives in school. In recent years, researchers and educators have begun to focus explicitly on social and emotional learning (SEL) in the school setting. Initial evidence from meta-analyses suggests that curricula designed to promote SEL likely produce benefit...

Introduction Vape shops represent prominent, unique retailers, subject to Food and Drug Administration (FDA) regulation in the United States. Aims and Methods This study assessed compliance of US vape shop retail marketing strategies with new regulations (eg, required age verification, prohibited free samples) and pre-implementation conditions for...

Objective: Underage alcohol use, and associated deleterious consequences, persists as a serious public health issue. In particular, early initiation of alcohol use increases risk for the development of alcohol use disorders later on in life. Religiosity - a multidimensional construct, encompassing personal beliefs, commitments, practices, and publ...

Background. American Indian/Alaska Native (AIAN) adolescents have a higher prevalence of commercial tobacco, alcohol, and marijuana use than other racial/ethnic groups in the United States. It is unclear whether cultural factors such as ethnic identity, spirituality, and ceremonial use of traditional tobacco are associated with substance use, espec...

Background Aggressive marketing has resulted in exponential growth of energy drink sales in recent years. Despite growing concerns about the negative health effects of energy drinks, they are increasingly popular among young people. Little is known about temporal associations between energy drink consumption and other drug use, though some research...

Due to the high accessibility and mobility of smartphones, widespread and pervasive smartphone use has become the social norm, exposing users to various health and other risk factors. There is, however, a debate on whether addiction to smartphone use is a valid behavioral addiction that is distinct from similar conditions, such as Internet and gami...

The role of appetitive needs in the etiology of addiction is described in this chapter, including consideration of typologies of needs, how appetitive need-satiation cycles may cross over into addiction, and factors that may facilitate dysregulation of appetitive effects. An overview of an Associational Memory-Appetitive System Relations Model (AMA...

Lack of sex education in schools has been an ongoing issue in Russia, mainly due to conservative opposition to providing accurate sexual health information openly. Many adolescents may be misinformed about contraceptive methods and may not have reliable access to effective contraception. This study assessed sexual behaviour and knowledge of contrac...

Behavioral addictions consist of a series of actions that expose one to “mood-altering events” on which one achieves pleasure and becomes dependent, which may alter neurotransmitter function, particularly mesolimbic dopaminergic turnover. Compulsive sexual behavior is a behavioral addiction. Sexual addiction is a pattern of sexual behavior that is...

Teens tend to identify with social groups that characterize their lifestyles, interest in different musical styles and preference in specific activities. Previous studies conclude that group identification is a significant prospective predictor of drug use and other problematic behaviors but may not operate the same way in all cultures. There are...

“Special populations” refer to groups of people whose needs are not fully addressed by traditional health services delivery. Greater access to these services, or tailored services, must be provided to reduce inequities in physical and mental health-care systems. Many different groups have been identified as special populations. We comment on contro...

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Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countrie...

Use of Internet websites and mobile applications to meet potential romantic and sexual partners is becoming increasingly popular. While the Internet might foster better communication and sexual negotiation between partners, it can also be a deceptive environment that instigates and accelerates sexual risk-taking. Given the complexities of the Inter...

Background: Stigma and discrimination are often experienced by individuals going through substance use treatment, and can influence treatment seeking, retention, and outcomes including long-term recovery. Aims: The aim of the current study was to evaluate the psychometric properties of the Micro-Condescension Scale (MCS), a newly developed tool to...

Tobacco regulatory science seeks in part to reduce harm of new tobacco products. Part of this interest is to help chronic adult smokers switch to potentially less harmful products, while not facilitating use of these modified risk tobacco products by nonusers (particularly teens). Studies to discern a lack of interest in reduced harm products are c...

This commentary intends to provide constructive input into the "Ten myths about work addiction" by Griiffiths et al. (2018). I place the information into an appetitive motivation theoretical lens of addiction as well as outline the kernels of truth associated with each myth. Advancement of an understanding of the underlying mechanisms of addiction...

Introduction: Evidence of a concentration of cigarette advertising in predominantly low-income, non-White neighborhoods underscores the need to examine retail marketing and promotions for novel tobacco products like little cigars and cigarillos (LCCs). We sought to investigate neighborhood racial/ethnic disparities in LCC marketing at retail, incl...