Alcohol and drug use in UK university students

Cognitive processes in alcohol binges: a review and research agenda

Alcohol abuse is associated with a cluster of long-term changes in cognitive processes, as predicted by contemporary models of addiction. In this paper we review evidence which suggests that similar changes may occur during an alcohol binge, and as such they may play an important role in explaining the loss of control over alcohol consumption that occurs during alcohol binges. As a consequence of both acute alcohol intoxication (alcohol 'priming' effects) and exposure to environmental alcohol-related cues, we suggest that a number of changes in cognitive processes are likely. These include increased subjective craving for alcohol, increased positive and arousing outcome expectancies and implicit associations for alcohol use, increased attentional bias for alcohol-related cues, increased action tendencies to approach alcohol, increased impulsive decision-making, and impaired inhibitory control over drives and behaviour. Potential reciprocal relationships between these different aspects of cognition during an alcohol binge are discussed. Finally, we discuss the relationship between the current model and existing models of cognitive processes in substance abuse, and we speculate on the implications of the model for the reduction binge drinking and its consequences.

The use of psychoactive substances among medical students in southern Brazil

The objective of our study was to investigate the patterns of use of psychoactive substances among students of a medical school in Southern Brazil and to explore a putative role of discrete behavioral and social variables in their drug use. This is a descriptive and transversal cut study. All regularly enrolled medical students at the University of Caxias do Sul were invited to participate in the study. A self-administered questionnaire, which analyses lifetime drug use as well as drug use in the previous 30 days and 12 months was utilized to collect data. From a total of 318 regularly enrolled students, 183 (57.5%) completed and returned the questionnaires. The highest prevalence rates of lifetime drug use, drug use in the last 12 months and drug use in the last 30 days were observed, according to drug type, as follow in descending order: alcohol, tobacco, marijuana, inhalants, tranquilizers, amphetamine and cocaine. A multivariate analysis indicated that research respondents who live with their parents as well as those whose parents live together harmoniously, those who deny close ties to drug users, those who disapprove drug use, those who are not tobacco smokers and those who manifest religious beliefs and practice presented the most reduced levels of illicit drug use. The use of psychoactive substances among medical students in the University of Caxias do Sul is a significant problem. Appropriate and timely initiatives are needed to prevent and curb drug use among medical students.

Methodological considerations for the quantification of self-reported caffeine use

RATIONALE

The field of research regarding the effects of habitual caffeine use is immense and frequently utilizes self-report measures of caffeine use. However, various self-report measures have different methodologies, and the accuracy of these different methods has not been compared.

MATERIALS AND METHODS

Self-reported caffeine use was estimated from two methods (a retrospective interview of weekly caffeine use and a 7-day prospective diary; n = 79). These estimates were then tested against salivary caffeine concentrations in a subset of participants (n = 55).

RESULTS

The estimates of caffeine use (mg/day) from the interview- and diary-based methods correlated with one another (r = 0.77) and with salivary caffeine concentrations (r = 0.61 and 0.68, respectively). However, almost half of the subjects who reported more than 600 mg/day in the interview reported significantly less caffeine use in the diary.

CONCLUSIONS

Self-report measures of caffeine use are a valid method of predicting actual caffeine levels. Estimates of high caffeine use levels may need to be corroborated by more than one method.

Nya Grepp i Preventionsarbetet? – En Granskning av Alkoholkommitténs och Mobilisering mot Narkotikas Massmediekampanjer

Aims

To analyze how “pleasure” and similar recreational motives for drug use permeate and are handled in contemporary drug preventive massmedia campaigns in Sweden.

Design

Three campaigns were included in the analysis. Two campaigns were developed by the Alcohol Committee (entitled “Basic course for you who like to be drunk” and “The Party Method”) and one campaign by Mobilization against Narcotics (entitled “There are many reasons not to try narcotics”).

Results

Recreational motives for drug use are recognized in all three campaigns. The reason for this, it seems, is to facilitate the overall trustworthiness of the campaigns. No campaign attempts to counteract the validity of the positive sides of drug use. Instead, they try to make people aware that the negative sides of drug use far outweigh positive sides.

Conclusion

The campaigns partly employ a novel approach to dealing with drug problems but their “core” content resembles traditional elements in drug preventive interventions.

Measurement properties of the Arnetz and Hasson stress questionnaire in Swedish university freshmen

BACKGROUND

The aim of this study was to evaluate the measurement properties of the Arnetz and Hasson seven-item stress questionnaire in order to select high-risk freshmen for a stress and alcohol intervention research project.

METHODS

Two complete cohorts of university freshmen at two universities were asked to participate in an intervention study. All subjects responded to seven Visual Analogue Scales (VAS) measuring common areas associated with stress. Measurement properties were evaluated by analysing internal consistency and construct validity.

RESULTS

A total of 2,032 (72%) freshmen agreed to participate. In total 14,184 out of 14,224 (99.7%) of the Visual Analogue Scales were answered. The Chronbach's alpha coefficient for the complete scale was 0.787. The Varimax rotation factor analysis, using an eigen value of 1, resulted in one factor that covered all items with factor scores of 0.50 and over. This factor explained 46% of the variance. A logistic regression analysis established that mental symptoms, living outside a serious relationship, and female gender were associated with a high stress level.

CONCLUSIONS

The Arnetz and Hasson stress questionnaire is easy to use and offers sufficient internal consistency and construct validity.

Cues that signal the alcohol content of a beverage and their effectiveness at altering drinking rates in young social drinkers

AIMS

The aim of this study was to assess the impact of cues that signal the alcoholic strength of a beverage on drinking rate in young social drinkers.

METHODS

In Experiment 1, two groups of young social drinkers (n=20 per group) consumed a lager-based drink containing either 3% or 7% alcohol-by-volume. The pattern of drinking behaviour was observed, and drinking time was recorded. Self-reported mood was measured across the session, and participants also provided ratings of the drinks' sensory and hedonic properties. Experiment 2 replicated Experiment 1, but used a within-subjects design (n=12).

RESULTS

In both experiments, participants took significantly longer to consume the 7% drink compared with the 3% drink, and the total inter-sip interval was longer for the 7% drink. These effects were most closely related to the participants' changing estimates of alcohol strength across the test session, alongside concomitant changes in various aspects of self-reported mood. Sensory and hedonic evaluations of the drinks did not affect drinking behaviour in either experiment.

CONCLUSIONS

The findings suggest that the consumption rate of an alcoholic beverage can be modulated by its alcohol content, and that the perceived pharmacological effect of the alcohol serves as an effective signal to alter drinking behaviour.

Perceived Sleep Quality and Sleepiness in South African University Students

Little is known about the sleep habits of South African students. The objectives in this study were to evaluate sleep habits and daytime behaviours of South African university students and to examine possible factors associated with their sleep quality and daytime sleepiness. Nine hundred and eighty-six undergraduate students completed a questionnaire about their sleep and lifestyle habits over the previous month, and their fatigue-related driving history. Sleep habits were similar for male and female students, although male students went to bed later and had fewer night-time awakenings. Black students went to bed significantly later than white and Asian students and woke earlier than white students during the week; consequently they were more likely to have a shorter time in bed than white students. Black students were more likely to nap than white students, possibly to supplement their overall sleep amount. Sleep quality and daytime sleepiness were not influenced by gender or ethnicity. Twenty percent of the students reported having ever fallen asleep while driving and 2% reported having had a fatigue-related accident; these findings have implications for road safety. Eighteen percent of the students reported poor sleep quality, although few students (4%) had consulted a doctor about a sleeping problem. Logistic multiple regression modeling revealed that poor sleep quality was associated with the following factors: long sleep onset latency; night-time awakenings; late bed times; use of sleep medication; not getting enough sleep; and low energy. Based on the Epworth Sleepiness Scale, 44% of the students had a high propensity for daytime sleepiness, which was associated with not getting enough sleep, consuming more caffeinated beverages, daytime napping, and having no/little energy. Daytime sleepiness and associated factors in South African students need to be investigated further and it is recommended that students be better informed about sleep problems and their consequences. First-line help-professionals such as psychologists, doctors, and healthcare workers should be better trained to support students with sleep problems.

Sex, drugs and sexually transmitted infections in British university students

Summary:

Understanding predisposing factors for sexually transmitted infections (STIs) in young adults may identify targets for public health interventions. We conducted a cross-sectional web-based survey of university students’ sexual attitudes, behaviours and lifestyles and self-reported rates of STI. A total of 827 students responded, 22.4% had two or more sexual partners in the previous year with inconsistent condom use and the lifetime prevalence of STIs was 9.6%. Factors associated with a diagnosis of STI were increasing age and number of sexual partners ever, female gender (adjusted odds ratio [AOR] 2.70, 95% confidence interval [CI] 1.31, 5.56) and use of crack (AOR 10.45, 95% CI 1.46, 75.16). For female students, these were increasing age and number of partners ever, whereas for male students having sex with other men (bisexual AOR 4.8, 95% CI 1.02, 22.595, homosexual AOR 17.66, 95% CI 3.03, 103.04) and use of crack (AOR 32.24, 95% CI 3.33, 312.08). Multiple partners and recreational drug use may predict incidence of STI. Prevention strategies need to aim at reducing risk behaviour across various activities.

Changes in undergraduate student alcohol consumption as they progress through university

Background

Unhealthy alcohol use amongst university students is a major public health concern. Although previous studies suggest a raised level of consumption amongst the UK student population there is little consistent information available about the pattern of alcohol consumption as they progress through university. The aim of the current research was to describe drinking patterns of UK full-time undergraduate students as they progress through their degree course.

Method

Data were collected over three years from 5895 undergraduate students who began their studies in either 2000 or 2001. Longitudinal data (i.e. Years 1–3) were available from 225 students. The remaining 5670 students all responded to at least one of the three surveys (Year 1 n = 2843; Year 2 n = 2219; Year 3 n = 1805).

Results

Students reported consuming significantly more units of alcohol per week at Year 1 than at Years 2 or 3 of their degree. Male students reported a higher consumption of units of alcohol than their female peers. When alcohol intake was classified using the Royal College of Physicians guidelines [1] there was no difference between male and females students in terms of the percentage exceeding recommended limits. Compared to those who were low level consumers students who reported drinking above low levels at Year 1 had at least 10 times the odds of continuing to consume above low levels at year 3. Students who reported higher levels of drinking were more likely to report that alcohol had a negative impact on their studies, finances and physical health. Consistent with the reduction in units over time students reported lower levels of negative impact during Year 3 when compared to Year 1.

Conclusion

The current findings suggest that student alcohol consumption declines over their undergraduate studies; however weekly levels of consumption at Year 3 remain high for a substantial number of students. The persistence of high levels of consumption in a large population of students suggests the need for effective preventative and treatment interventions for all year groups.

Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review

BACKGROUND

Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.

METHODS

We searched Medline, Embase, CINAHL, PsycINFO, ISI Web of Knowledge, ISI Proceedings, ZETOC, BIOSIS, LILACS, and MEDCARIB from their inception to September, 2006, searched reference lists of studies selected for inclusion, and contacted experts. Studies were included if longitudinal and population based. 35 studies from 4804 references were included. Data extraction and quality assessment were done independently and in duplicate.

FINDINGS

There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1.41, 95% CI 1.20-1.65). Findings were consistent with a dose-response effect, with greater risk in people who used cannabis most frequently (2.09, 1.54-2.84). Results of analyses restricted to studies of more clinically relevant psychotic disorders were similar. Depression, suicidal thoughts, and anxiety outcomes were examined separately. Findings for these outcomes were less consistent, and fewer attempts were made to address non-causal explanations, than for psychosis. A substantial confounding effect was present for both psychotic and affective outcomes.

INTERPRETATION

The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

Who is becoming hallucinogen dependent soon after hallucinogen use starts?

This study, based upon epidemiological survey data from the United States (U.S.) National Household Surveys on Drug Abuse (NHSDA) from 2000 to 2001, presents new estimates for the risk of developing a hallucinogen dependence syndrome within 24 months after first use of any hallucinogen (median elapsed time approximately 12 months). Subgroup variations in risk of becoming hallucinogen dependent also are explored. Estimates are derived from the NHSDA representative samples of non-institutionalized U.S. residents ages 12 and older (n=114,241). A total of 2035 respondents had used hallucinogens for the first time within 24 months prior to assessment. An estimated 2-3% of these recent-onset hallucinogen users had become dependent on hallucinogens, according to the NHSDA DSM-IV computerized diagnostic algorithm. Controlling for sociodemographic and other drug use covariates, very early first use of hallucinogens (age 10-11 years) is associated with increased risk of hallucinogen dependence (p<0.01). Excess risk of developing hallucinogen dependence was found in association with recent-onset use of mescaline; excess risk also was found for recent-onset users of ecstasy and of PCP. This study's evidence is consistent with prior evidence on a tangible but quite infrequent dependence syndrome soon after the start of hallucinogen use; it offers leads that can be confirmed or disconfirmed in future investigations.

Lazer e uso de substâncias psicoativas na adolescência: possíveis relações

Este estudo objetivou: levantar as atividades de lazer praticadas por adolescentes usuários e não-usuários de drogas; verificar possíveis associações entre uso de drogas e lazer na adolescência. Participaram dele 568 adolescentes de ambos os sexos entre 14 e 20 anos que estavam cursando o ensino médio na cidade de São Carlos, SP. Estes responderam um questionário anônimo de auto-preenchimento. As análises envolveram: descrição da distribuição das variáveis na amostra; teste qui-quadrado; regressão logística múltipla. Segundo os resultados, as principais diferenças entre os grupos foram observadas nas atividades "freqüentar clubes/praias", "sair com amigos" e "freqüentar bares", mais freqüentes entre adolescentes usuários, enquanto "ir à Igreja/serviço religioso", "praticar esportes" e "sair com a família" foram mais freqüentes entre os não-usuários. Estes dados contribuem para a elaboração de ações preventivas ao uso de drogas, indicando a necessidade de estudos sobre opções de lazer para adolescentes na atualidade.

Socio-demographic Characteristics of Substance Abusers Admitted to a Private Specialist Clinic

SummarySubstance abuse is an increasing global socio-medical problem. The present study examines fifteen socio-demographic characteristics of abusers and compares some of the characteristics to randomly selected non-substance abusers. The results show that substance abuse is largely a problem of the young/adolescent males (p<0.05). There are significant differences between male and female substance abuses (p<0.05). Some of them seek treatment four to five years from their initial indulgence. About one third of abusers drop out of school at the secondary level of their education (p<0.05). More than half of the parents of abusers are either divorced, separated or never married (p<0.05). There were no significant differences between the abusers and non-abusers with regards to ethnicity or religious affiliation. Other factors, which are positively related to substance abuse, are large number of siblings in the family and crime. Surprisingly, most substance abusers perceive the attitudes of their parents towards them as warm and normal inspite of the emotional and financial stresses they cause to their parents.

Mental health in three generations of Iranian medical students and doctors. A cross-sectional study

OBJECTIVE

Despite research in Western countries finding high levels of psychological morbidity in medical students and doctors, little is known about difficulties faced by medical staff in the Middle East. The aim of the present study was to assess emotional disturbance and interpersonal attitudes in a representative sample of Iranian medical students and practitioners.

METHOD

A total of 82 medical students, 92 interns and 89 general practitioners (GPs) participated in the study. Participants rated the 28-item version of the General Health Questionnaire (GHQ-28) and a measure of interpersonal attitudes.

RESULTS

A total of 44% of participants scored above the threshold of the GHQ-28, indicating probable psychiatric disorder. The GHQ-28 scores were higher in students than interns or GPs and in women compared with men. Medical students and doctors had high levels of indifference and cynicism.

CONCLUSIONS

This study suggests that psychological morbidity was common in Iranian medical students and practitioners, particularly women. Women were at particular risk. A high prevalence of emotional disturbance among health care practitioners is likely to compound existing problems of health care provision.

Alcohol use in Czech pharmacy students

In academic years 2002/3-2004/5, the use of alcohol was investigated by anonymous questionnaire in 1,032 first and third year pharmacy students in the Czech Republic. Frequencies of beer, wine and spirits use, the age of the first contact with alcoholic beverages, the age of the first drunkenness and the frequency of drunkenness in the last month were ascertained. Average age of the first contact with alcoholic beverages was 12.9 years. 40.5% and 10.9% of students reported regular and hazardous drinking, respectively, with significantly higher proportion of men than women. Hazardous alcohol drinking significantly increased between academic years 2002/3 and 2004/5, no significant differences were found in the proportion of non-drinkers and regular alcohol drinkers over the 3-year-period of the survey. Both regular and hazardous drinking patterns were significantly related to the financial situation of the students. Significant associations were also found between alcohol consumption and using of both licit and illicit drugs of abuse.

Motives for drinking, alcohol consumption, and alcohol-related problems among British secondary-school and university students

Relationships among reasons for drinking, alcohol consumption, and drinking-related problems were assessed among secondary-school students (N=328) and university students (N=74) in North Wales, United Kingdom, and results were compared with results from North America. The ability of drinking reasons to predict drinking problems was tested in both age groups. Khavari Alcohol Test, Quantity-Frequency-Variability Index, Reasons for Drinking Questionnaire, and Rutgers Alcohol Problems Index were used to measure the variables of interest. Regression and mediational analyses indicated that negative reasons were stronger predictors of drinking problems than were positive reasons among both secondary-school and university students. Results also showed that the effect of both positive and negative drinking reasons on alcohol-related problems was partially mediated by alcohol consumption among both secondary-school students and university students. There were different correlates of problematic drinking among younger and older students, which suggest that different types of intervention should be used with the two age groups.

A comparison of alcohol and drug use among dental undergraduates and a group of non-medical, professional undergraduates

OBJECTIVE

To compare the alcohol and drug use of dental and law undergraduates.

DESIGN

Anonymous self-report questionnaire.

SUBJECTS AND METHODS

All dental undergraduates (n = 263) and a randomly selected group of law undergraduates (n = 180) from the same university were questioned on their use of alcohol, tobacco and illicit drugs.

RESULTS

Current tobacco use was reported by 7% of dental students and 19% of law students. Alcohol use was reported by 86% of dental students and 88% of law students, with 44% of dental students and 52% of law students estimating they drank above recommended safe limits (14 units for females, 21 units for men). Binge drinking was reported by 71% of dental students and 75% of law students, with weekly binge drinking reported by 27% and 34% of dental and law students respectively. Cannabis experience was reported by 44% of dental students and 52% of law students, with current use reported by 12% and 25% of dental and law students respectively. A small proportion of dental and law students reported using other class A and B drugs including ecstasy, amphetamines and cocaine.

CONCLUSIONS

Dental students appear to be indulging in similar levels of alcohol and illicit drug use when compared to students of a different, non-medical faculty. Binge drinking may be more prevalent than previously thought, with potential risks to health, patient safety and professional status.

Student anxiety and depression: comparison of questionnaire and interview assessments

BACKGROUND

Recent reports note a reliance on self-report measures and a lack of information about diagnosable mental disorder in university students. Professional concern about perceived increases in student mental health problems raises questions about whether questionnaire assessments can provide valid approximations of such disorders in this group. The aim of this study was to validate the Hospital Anxiety and Depression Scale (HADS) against DSM-IV diagnoses in university students.

METHODS

Eighty-nine students were administered with the HADS followed by the Structured Interview for DSM-IV.

RESULTS

At recommended cut-offs HADS anxiety and depression scales both showed good sensitivity in detecting DSM-IV anxiety and depression disorders, and the depression scale showed good specificity and overall efficiency. The HADS anxiety scale showed poor specificity and moderate overall efficiency. In the absence of an anxiety diagnosis, high HADS anxiety scores were not significantly associated with other measured indicators of serious mental health problems.

LIMITATIONS

Further research is needed to investigate whether the current findings hold for student populations with higher social diversity.

CONCLUSIONS

The HADS depression scale is likely to be a reasonably accurate indicator of depressive conditions in university students at the recommended cut-off but the HADS anxiety scale overestimates the extent of clinical anxiety. Students' self-reported higher symptom levels in comparison to general population norms cannot be assumed to indicate higher levels of more serious mental health conditions. However this is not to deny the genuine distress and severe problems that some students experience.

Dancing hot on Ecstasy: physical activity and thermal comfort ratings are associated with the memory and other psychobiological problems reported by recreational MDMA users

BACKGROUND

Non-drug factors such as ambient temperature can heighten the adverse effects of MDMA (3,4-methylendioxymethamphetamine) in animals. We assessed whether dancing and feeling hot on Ecstasy would be associated with more psychobiological problems in recreational users.

METHODS

In an internet study, 206 unpaid participants (modal age 16-24) reported that they had used recreational Ecstasy/MDMA. They completed a drug use questionnaire, the Prospective Memory Questionnaire (PMQ), questions about dancing and feeling hot when on Ecstasy, and psychobiological problems afterwards.

RESULTS

Those who danced 'all the time' when on Ecstasy, reported significantly more PMQ memory problems than the less intensive dancers. Prolonged dancing was also associated with more complaints of depression, memory problems, concentration and organizational difficulties afterwards. Feeling hot when on Ecstasy was associated with poor concentration in the comedown period, and with mood fluctuation and impulsivity off-drug. PMQ long-term problems demonstrated a significant curvilinear relationship with thermal self-ratings; more memory problems were noted by those who felt very hot, and by those who did not feel hot when on Ecstasy.

CONCLUSIONS

Non-drug factors such as dancing and feeling hot are associated with the incidence of psychobiological problems reported by recreational Ecstasy/MDMA users.

Anxiety sensitivity interacts with marijuana use in the prediction of anxiety symptoms and panic-related catastrophic thinking among daily tobacco users

The present investigation evaluated whether anxiety sensitivity interacted with marijuana use in relation to the prediction of panic-relevant variables among young adult tobacco smokers (n=265). Approximately 73% of the sample was composed of current marijuana smokers, with 78.5% of this sub-sample using marijuana more than once per week. As expected, after covarying cigarettes per day, alcohol use, and negative affectivity, the interaction between marijuana use and anxiety sensitivity predicted anxiety symptoms and agoraphobic cognitions. Partially consistent with prediction, the interaction between frequency of marijuana use and anxiety sensitivity predicted only anxiety symptoms. These results are discussed in relation to better understanding the potential role of regular marijuana use and anxiety sensitivity for panic-relevant emotional vulnerability among regular tobacco smokers.

How the quality of peer relationships influences college alcohol use

Peer relationships are consistently linked to alcohol use in college students. However, this disparate literature often reveals contradictory findings regarding the precise mechanisms of peer influence. In this review, we use an organisational framework based on social learning theory (SLT) to demonstrate how the quality of peer relationships may influence personal alcohol use. We propose that the quality of peer relationships enhance the influence of social reinforcement, modelling and cognitive processes on personal alcohol use. Research indicates that the quality of peer relationships influences drinking via three pathways: the lack or breakdown of quality peer relationships, alcohol use being an integral part of peer interactions, and if peers disapprove of alcohol use or do not drink. This conceptualisation of peer influence informs the consistent finding of gender differences in college student drinking. Limitations of the reviewed research include reliance on cross-sectional surveys, self-report and homogeneous populations. Future directions for research on quality peer relationships involve detailed longitudinal assessment and the application of advanced statistical methods.

Personality traits as risk factors of depression and anxiety among Japanese students

The aim of this study is to examine the effects of personality (temperament and character) on specific depression and specific anxiety. A total of 541 Japanese undergraduates were investigated by using the Temperament and Character Inventory (TCI) and the Hospital Anxiety and Depression (HAD) scale. Hierarchical multiple regression analyses demonstrated that specific depression was predicted by lower Reward-Dependence, Persistence, Self-Directedness, Cooperativeness, and Self-Transcendence; specific anxiety was predicted by higher Novelty-Seeking, Harm-Avoidance, Persistence, and Self-Transcendence, and lower Self-Directedness. Immaturity of Self-Directedness is a risk factor for negative affectivity. Immaturity of all character dimensions is a risk factor for specific depression. The relationship between Harm-Avoidance and depression in previous studies may be linked partly to somatic symptoms that were deliberately eliminated in the HAD scale.

The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study

BACKGROUND

Medical education requires detailed investigation because it is a period during which the attitudes and behaviors of physicians develop. The purpose of this study was to calculate the yearly smoking prevalence and incidence rates of medical faculty students and to identify the risk factors for adopting smoking behaviour.

METHODS

This is a cohort study in which every student was asked about their smoking habits at the time of first registration to the medical faculty, and was monitored every year. Smoking prevalence, yearly incidence of initiation of smoking and average years of smoking were calculated in analysis.

RESULTS

At the time of registration, 21.8% of the students smoked. At the end of six years, males had smoked for an average of 2.6 +/- 3.0 years and females for 1.0 +/- 1.8 years (p < 0.05). Of the 93 medical students who were not smokers at the time of registration, 30 (32.3%) were smokers at the end of the 6 years of the course.

CONCLUSION

The first 3 years of medical education are the most risky period for initiation of smoking. We found that factors such as being male, having a smoking friend in the same environment and having a high trait anxiety score were related to the initiation of smoking. Targeted smoking training should be mandatory for students in the Medical Faculty.

MDMA in humans: factors which affect the neuropsychobiological profiles of recreational ecstasy users, the integrative role of bioenergetic stress

Many recreational ecstasy/MDMA users display neuropsychobiological deficits, whereas others remain problem free. This review will investigate some of the drug and non-drug factors which influence the occurrence of these deficits. Acute and chronic MDMA usage are both important. Intensive use within a session is often associated with more problems. In term of lifetime usage, novice users generally remain unimpaired, whereas most heavy users report memory or other psychobiological problems which they attribute to ecstasy. These complaints are confirmed by objective deficits in working memory, attention, frontal-executive, and episodic memory tasks. Psychobiological deficits include disturbed sleep, sexual dysfunction, reduced immuno-competence, and increased oxidative stress. Further MDMA-related factors which may contribute to these changes, include acute and chronic tolerance, and drug dependence. Around 90ñ95% of ecstasy/MDMA users also take cannabis, and this can independently contribute to the adverse neuropsychobiological pro.les; although in some situations the acute co-use of these two drugs may be interactive rather than additive, since cannabis has relaxant and hypothermic properties. Alcohol, nicotine, amphetamine, and other drugs, can also affect the psychobiological pro.les of ecstasy polydrug users in complex ways. Pure MDMA users are rare but they have been shown to display significant neurocognitive deficits. Psychiatric aspects are debated in the context of the diathesis-stress model. Here the stressor of ecstasy polydrug drug use, interacts with various predisposition factors (genetic, neurochemical, personality), to determine the psychiatric outcome. Recreational MDMA is typically taken in hot and crowded dances/raves. Prolonged dancing, feeling hot, and raised body temperature, can also be associated with more psychobiological problems. This is consistent with the animal literature, where high ambient temperature and other metabolic stimulants boost the acute effects of MDMA, and cause greater serotonergic neurotoxicity. In conclusion, the neuropsychobiological effects of MDMA are modulated by a wide range of drug and non-drug factors. These multiple influences are integrated within a bioenergetic stress model, where factors which heighten acute metabolic distress lead to more neuropsychobiological problems.

Gender differences in health habits and in motivation for a healthy lifestyle among Swedish university students

The aim of the present study was to investigate gender differences in students' health habits and motivation for a healthy lifestyle. The sample of students comprised a probability systematic stratified sample from each department at a small university in the south-west of Sweden (n = 479). A questionnaire created for this study was used for data collection. Self-rated health was measured by number of health complaints, where good health was defined as having less than three health complaints during the last month. A healthy lifestyle index was computed on habits related to smoking, alcohol consumption, food habits, physical activity and stress. Female students had healthier habits related to alcohol consumption and nutrition but were more stressed. Male students showed a high level of overweight and obesity and were less interested in nutrition advice and health enhancing activities. The gender differences are discussed in relation to the impact of stress on female students' health, and the risk for male students in having unhealthy nutritional habits in combination with being physically inactive and drinking too much alcohol.

Where students go when they are ill: how medical students access health care

BACKGROUND

Doctors have high levels of self-treatment, investigation and referral, but little is known about how medical students seek health care. Methods We carried out a questionnaire survey of Year 2 and 4 students, exploring their health-seeking behaviour and attitudes to self-care.

SETTING

A London medical school.

RESULTS

The response rate was 80%. Nearly all students (99%) were registered with a general practitioner (GP). A total of 43% had informally consulted doctors who were friends or relatives in the previous 12 months (61% of those with a doctor as a family member had informally consulted, and 33% of those without a doctor as a family member had informally consulted; P = 0.001). In all, 13% of Year 4 students and 2.2% of Year 2 students had received a prescription from a friend (P = 0.007). Almost a quarter (22%) of Year 4 and 1.3% of Year 2 students reported having directly contacted a specialist (P = 0.01). A third (32%) (43% Year 4, 1.3% Year 2; P = 0.006) of those referred in the previous 12 months had contacted the consultant directly. In all, 9.2% (0% Year 2, 20% Year 4; P = 0.001) had initiated their own investigations, and 25% (47% Year 4, 7% Year 2; P = 0.001) had been examined by a colleague. Students agreed that it was appropriate for doctors to self-investigate (52%), self-refer (59.1%) and self-prescribe (39.2%).

CONCLUSION

Medical students appear to bypass their GPs and initiate investigations, referrals or treatment. This is associated with increased clinical access or access through family members. Self-management of illness is learnt early on in students' careers and is increased with availability and increasing clinical access.

Alcohol-related problems experienced by university students in New Zealand

OBJECTIVE

To examine reported problems associated with alcohol use in a large sample of New Zealand university students.

METHOD

A random sample (n=1910) of students at the University of Otago Dunedin was invited to complete an Internet-based survey of their patterns of alcohol use and associated behaviours.

RESULTS

The survey achieved a response rate of 82% (n=1564). Reports of alcohol-related problems were relatively common and included the physical consequences of bingeing as well as interpersonal, anti-social and academic problems.

CONCLUSIONS

Problems associated with alcohol consumption are relatively common and represent potential harm to the students' immediate health and academic performance. A study of the effects of alcohol on actual academic performance of students is warranted.

Self-reported driving behaviour and attitudes towards driving under the influence of cannabis among three different user groups in England

The study characterized self-reported driving behaviour, attitudes towards driving and assumptions about the effects of cannabis on driving, among two different volunteer groups: 63 regular cannabis users (RCUs; cannabis use>monthly) and 46 undergraduate student users, all from the West Midlands. More detailed information was provided by structured interviews with an additional sample of 23 regular users from southern England. Within each group, many respondents had driven whilst under the influence of cannabis (regular users, 82%; students, 40%; interviewees, 100%). Majorities among the regular users and interviewees continued to do so at least monthly. Most users believed that cannabis impaired driving only slightly. More stops by the police for drug-driving than for drink-driving were reported, but these rarely resulted in conviction and were not deterrent. Hence, cannabis users are very willing to drive after using the drug (often combined with alcohol), and even while intoxicated. They consider its effects on driving to be minimal; indeed, many consider it to promote better driving. Attitudes towards drink-driving were much more negative. Finally, most interviewees said that roadside drug testing would be the only efficacious deterrent to drug-driving.

Psychosocial correlates of substance use among adolescents in Mersin, Turkey

The objective of this study was to determine the effects of psychosocial factors such as peer group, family and academic self-perception on smoking, alcohol and substance use by adolescents living in Mersin, Turkey. The study included a total of 3282 students from the sixth and tenth grades and college. The number of participating students required from each school was obtained through stratification, and by weighing the enrolled student population in each subgroup. The final sample was derived using a simple random sampling technique. A 45-item self-administered questionnaire was used. The questionnaire included questions about socio-demographic characteristics and lifetime and current (i.e. within the past month) use of cigarettes, alcohol, cannabis, inhalants and other illicit drugs (heroin, cocaine, sedative-hypnotic drugs, etc.). This study found that: (1) higher socio-economic status of the family increased the likelihood of smoking and alcohol use in adolescents; (2) the prevalence of alcohol use was higher in adolescents whose mothers had a higher educational level and whose mothers and fathers drank alcohol; (3) there was a significant association between substance use and having a peer who used a substance; and (4) the prevalence of smoking was significantly higher in students who perceived their academic performance to be poor. Understanding the role and importance of psychosocial factors associated with smoking, alcohol and substance use will be crucial to develop preventive measures for adolescents.

Abnormal brain activity in prefrontal brain regions in abstinent marijuana users

We used PET (15)O and a modified version of the Stroop task to determine if 25-day abstinent heavy marijuana (MJ) users have persistent deficits in executive cognitive functioning (ECF) and brain activity. Performance on a modified version of the Stroop task and brain activity was compared between 25-day abstinent, heavy marijuana users (n = 11), and a matched comparison group (n = 11). The 25-day abstinent marijuana users showed no deficits in performance on the modified version of the Stroop task when compared to the comparison group. Despite the lack of performance differences, the marijuana users showed hypoactivity in the left perigenual anterior cingulate cortex (ACC) and the left lateral prefrontal cortex (LPFC) and hyperactivity in the hippocampus bilaterally, when compared to the comparison group. These results suggest that marijuana users display persistent metabolic alterations in brain regions responsible for ECF. It may be that marijuana users recruit an alternative neural network as a compensatory mechanism during performance on a modified version of the Stroop task. These differences in brain activity may be a common denominator in the evolution of maladaptive behaviors such as substance abuse and other neuropsychiatric disorders.

Club drug use in Germany

In this paper the epidemiology of club drug use in Germany, including the use of 3,4-methylendioxy-N-methamphetamine (MDMA) known as 'ecstasy' and related substances such as speed, amphetamines, hallucinogens, and cannabis is described on the basis of five different surveys. Two of them are representative household surveys to monitor the licit and illicit drug use behavior of the German population. The third one is a longitudinal study aimed at exploring comorbidity and posited risk and protective factors in adolescents and young adults with specific emphasis on substance use-related disorders. Since ecstasy seemed to be associated with a new music culture of the '90s called "techno," two studies investigating the relationship of using ecstasy and related substances in the techno party scene are additionally presented. The question of the clinical impact of using ecstasy and related substances is raised in terms of substance use-related and mental disorders associated with the use of ecstasy. Finally, the motivation for using and stopping the use of ecstasy is addressed. It is shown that ecstasy has reached the second place (after cannabis) in illegal drug preferences of adolescents and young adults in Germany. Evidence is found that ecstasy use as well as ecstasy use-related disorders such as "abuse" and "dependence" are of a transient, "youth-limited" nature.

Impulsivity, risk taking and recreational 'ecstasy' (MDMA) use

The present study investigated characteristics of recreational drug users, especially 'ecstasy' (MDMA) users, in 254 undergraduates. All participants completed a drug history questionnaire (DHQ), the impulsiveness venturesomeness and empathy questionnaire, a novel risk-taking task (Bets16), and 59 also completed the tri-dimensional personality questionnaire (TPQ). DHQ responses allocated participants to five groups: non-drug controls, cannabis users, polydrug (no ecstasy) users, low (<20 occasions) ecstasy users and high (>20 occasions) ecstasy users. Eighteen percent of the sample had used ecstasy and of the ecstasy users, only one had not used other substances. A larger proportion of high ecstasy users had also used amphetamines, cocaine and LSD in comparison to the low ecstasy and non-ecstasy polydrug users. High ecstasy users typically took significantly more ecstasy tablets compared with low ecstasy users. Impulsiveness, venturesomeness and novelty seeking behaviour increased from the non-drug users to high ecstasy users. Ecstasy users (low and high) and polydrug (non-ecstasy) users had higher levels of impulsivity, venturesomeness and novelty seeking behaviour compared with non-drug users. Furthermore, high ecstasy users scored higher on the Bets16 risk-taking measure than non-drug users, cannabis users and low ecstasy users. The findings are discussed in relation to: (i) the possibility that increased impulsivity pre-dated drug use; and (ii) the possible link between impulsivity and the putative serotonergic neurotoxicity of ecstasy.

A case control study to examine the pharmacological factors underlying ventricular septal defects in the North of England

BACKGROUND

Amphetamine exposure is associated with congenital cardiac abnormalities in animals. We previously reported an association between recreational use of 2,4-methylenedioxymethamphetamine (ecstasy, MDMA) and ventricular septal defect in babies born to users. We have carried out a case control study to investigate risks in the occurrence of ventricular septal defect in a cohort of babies born in the North East of England.

METHODS

Cases were identified from paediatric cardiology units in Newcastle upon Tyne and Leeds, and controls were recruited from the mothers of babies born in the same hospital as the index case. Research nurses carried out interviews using a structured questionnaire.

RESULTS

A total of 296 case control pairs were studied. There was insufficient exposure to ecstasy to test the primary hypothesis. Increased risk of ventricular septal defect was found to be associated with consumption of cough and cold remedies [pre-conception OR 2.2, 95% CI 1.41, 3.51; pregnancy OR 5.1, 95% CI 2.56, 11.27; exposure in either OR 2.83, 95% CI 1.85, 4.45; P<0.005] and in the case of non-steroidals for exposures in pregnancy (OR 4.2, 95% CI 1.54, 14.26; P<0.005).

CONCLUSIONS

These findings suggest that ventricular septal defect is associated with consuming the medications identified. They are also compatible with the hypothesis that sympathomimetics (pseudoephedrine, phenylephrine and phenylpropanolamine) present in cough mixtures cause the increased risk, and with our original hypothesis that sympathomimetics and amphetamines are potentially cardiotoxic in utero.

Différences entre les hommes et les femmes face au risque routier

BACKGROUND

In France 7,720 people were killed in traffic accidents in 2001, 75% of which were men; the number of injured people is estimated at 153,945, of which 65% were men. The objective of the study is to describe differences between males and females regarding accidents, and to explain the main reasons for these differences.

METHODS

Analysis is conducted from both national police data (2001) and data from the Rhone medical road accident trauma Register (1996-2001).

RESULTS

The male/female incidence rate is 3.1 for mortality (95% CI: 3.0-3.3) and 1.7 for morbidity (95% CI: 1.7-1.8). Two-wheel motorised vehicle accidents are very specific to males, which explains part of this overrepresentation. The fatality rate and the severe injuries rate among survivors are higher for males. This is true for every main user group (car users, motorised two-wheelers, cyclists, pedestrians) after adjusting for accident circumstances and age of casualties. Males are more severely injured for all body regions and have more often severe after-effects.

CONCLUSIONS

This paper shows the mechanisms leading to this unfavourable outcome for men. They correspond to differences in the number of trips, in the choice of road transport types, and moreover to differences in risk-taking behaviours. Underlying these behaviours, deep-rooted, strong and rather invariant differences between genders are to be found in the values associated with risk-taking on the road.

Increased intensity of Ecstasy and polydrug usage in the more experienced recreational Ecstasy/MDMA users: a WWW study

Recreational Ecstasy/MDMA (3,4-methylenedioxymethamphetamine) users often take a variety of psychoactive drugs, but there is little empirical data on how these drug consumption patterns change with greater experience of Ecstasy. The aim of this study was to compare the polydrug usage patterns reported by non-Ecstasy users, novice Ecstasy users, moderate Ecstasy users, and heavy Ecstasy users. In a WWW study of 763 unpaid volunteers, 481 had never taken Ecstasy, whereas 282 reported they had taken it. The Ecstasy users comprised 109 novice users (1-9 occasions), 136 moderate Ecstasy users (10-99 occasions), and 36 heavy Ecstasy users (+100 occasions). Each participant also reported their experience with a range of other psychoactive drugs. The Ecstasy users reported significantly greater psychoactive drug usage than the non-Ecstasy users. The novice, moderate, and heavy Ecstasy users also differed significantly from each other in the use of cocaine, amphetamine, LSD, and psilocybin mushrooms, but not of alcohol, cannabis, or cigarettes/nicotine. Experienced Ecstasy users also took significantly more MDMA tablets on each occasion, and reported a higher maximum weekly intake. The increased use of Ecstasy is associated with more intensive patterns of Ecstasy/MDMA intake, and the greater use of illicit CNS stimulants and hallucinogens, but not of alcohol, nicotine, or cannabis. These results are discussed in the context of cross-tolerance and drug predisposition/preference.