Tobacco use as a predictor of illicit drug use and drug-related problems in Colombian youth

Smokeless Tobacco Use is Associated With Worse Medical and Surgical Outcomes Following Total Hip Arthroplasty

BACKGROUND

Studies have demonstrated increased complication risk after total hip arthroplasty (THA) in patients who smoke cigarettes. It is unclear if smokeless tobacco use confers a similar impact. The purpose of this study was to (1) evaluate rates of postoperative complications after THA in smokeless tobacco users and people who smoke compared to matched controls, and (2) compare rates of postoperative complications in smokeless tobacco users versus patients who smoke.

METHODS

A retrospective cohort study was conducted using a large national database. For patients who underwent primary THA, smokeless tobacco users (n = 950) and people who smoke (n = 21,585) were matched 1:4 with controls (n = 3,800 and 86,340, respectively), and smokeless tobacco users (n = 922) were matched 1:4 with people who smoke (n = 3,688). Joint complication rates within 2 years and medical complications within 90 days postoperatively were compared using multivariable logistic regressions.

RESULTS

Within 90 days of primary THA, smokeless tobacco users demonstrated significantly higher rates of wound disruption, pneumonia, deep vein thrombosis, acute kidney injury (AKI), cardiac arrest, transfusion, readmission and longer length of stay compared to tobacco naïve controls. Within 2 years, smokeless tobacco users demonstrated significantly higher rates of prosthetic joint dislocations and overall joint-related complications compared to tobacco naïve controls.

CONCLUSION

Smokeless tobacco use is associated with higher rates of medical- and joint-related complications following primary THA. Smokeless tobacco use may be under-diagnosed in patients undergoing elective THA. Surgeons may consider delineating between smoking and smokeless tobacco use during preoperative counseling.

How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia

BACKGROUND

Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings.

METHOD

A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11-15 years). The Theoretical Domains Framework guided a content analysis of the data.

RESULTS

We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape.

CONCLUSION

These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.

Put Down the Tin: Chewing Tobacco Use Is Associated With Worse Outcomes After Primary Lumbar Fusion

STUDY DESIGN

Retrospective study.

OBJECTIVE

This study evaluated the impact of chewing tobacco on both medical and spine-related complication rates after spinal lumbar fusions in comparison to both a control cohort and a smoking cohort.

SUMMARY OF BACKGROUND DATA

Smoking is a prevalent modifiable risk factor that has been demonstrated to be associated with increased complications after lumbar fusion. Although smoking rates have decreased in the United States, chewing tobacco use has not similarly reduced. Despite chewing tobacco delivering up to 4 times the dose of smoking, the impact of chewing tobacco is incompletely understood.

METHODS

A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent lumbar spine fusion and used chewing tobacco were matched with a control cohort and a smoking cohort. Medical complications within 90 days after primary lumbar fusion were evaluated, including deep venous thrombosis, acute kidney injury, pulmonary embolism, transfusion, acute myocardial infarction, and inpatient readmission. Spine-related complications were evaluated at 2 years postoperatively, including pseudoarthrosis, incision and drainage (I&D), instrument failure, revision, and infection.

RESULTS

After primary lumbar fusion, the chewing tobacco cohort demonstrated significantly higher rates of pseudoarthrosis [odds ratio (OR): 1.41], revision (OR: 1.57), and any spine-related complication (OR: 1.32) compared with controls. The smoking cohort demonstrated significantly higher rates of pseudoarthrosis (OR: 1.88), I&D (OR: 1.27), instrument failure (OR: 1.39), revision (OR: 1.54), infection (OR: 1.34), and any spine-related complication (OR: 1.77) compared with controls. The chewing tobacco cohort demonstrated significantly lower rates of pseudoarthrosis (OR: 0.84), I&D (OR: 0.49), infection (OR: 0.70), and any spine-related complication (OR: 0.81) compared with the smoking cohort.

CONCLUSIONS

This study demonstrated that chewing tobacco is associated with higher rates of both spine-related and medical complications after primary lumbar fusion. However, chewing tobacco use is associated with less risk of complications compared with smoking.

LEVEL OF EVIDENCE

Level III.

Smokeless Tobacco Use is Associated With Worse Outcomes Following Total Knee Arthroplasty

BACKGROUND

Studies have demonstrated increased complication risk after total knee arthroplasty (TKA) in patients who smoke cigarettes, but it is unclear if smokeless tobacco use confers a similar impact. The purpose of this study was to (1) evaluate rates of postoperative complications after TKA in smokeless tobacco users and smokers as compared to matched controls, and (2) compare rates of postoperative complications in smokeless tobacco users versus smokers to determine if one is associated with significantly higher rates of postoperative complications.

METHODS

A retrospective cohort study was conducted using a national database. For patients who underwent primary TKA, smokeless tobacco users (n = 1,535) and smokers (n = 28,953) were matched at a 1:4 with controls (n = 6,140 and 115,812, respectively), and smokeless tobacco users (n = 1,481) were matched at a 1:4 with smokers (n = 5,924). Rates of joint complications within 2 years and medical complications within 90 days postoperatively were compared using multivariable logistic regressions.

RESULTS

After primary TKA, compared to controls, smokeless tobacco users demonstrated significantly higher rates of aseptic loosening/mechanical failure within 2 years, longer lengths of stay, and higher rates of urinary tract infection, pneumonia, deep vein thrombosis, and acute kidney injury within 90 days. Compared to smokers, smokeless tobacco users demonstrated significantly lower rates of aseptic revision and lower rates of wound disruption.

CONCLUSION

Smokeless tobacco use is associated with higher rates of both medical and joint complications following primary TKA. However, smoking is associated with higher risk for complications than smokeless tobacco use.

LEVEL OF EVIDENCE

Level III.

Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia

Background

In developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation.

Methods

Three cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms.

Results

Lifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]).

Conclusion

Lifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.

Socio-environmental and psychosocial predictors of smoking susceptibility among adolescents with contrasting socio-cultural characteristics: a comparative analysis

BACKGROUND

Despite a steady decline in adolescent smoking globally, it remains a prevalent risk factor for non-communicable disease. Previous research points to differences in socio-environmental and psychosocial risk factors for smoking and how they vary across different settings with disparate social and cultural characteristics. As a result, smoking rates have remained disproportionately higher in some settings while decreasing in others. This study explored the socio-environmental and psychosocial risk factors for smoking susceptibility in a high-income and upper-middle income setting.

METHODS

Cross-sectional data were obtained from 1,573 male and female adolescents aged 11-15 years who completed self-administered questionnaires in schools in Northern Ireland and Bogotá, Colombia. Using logistic regression analysis, we examined how socio-environmental and psychosocial predictors of smoking susceptibility compared across the two countries.

RESULTS

In Northern Ireland, reduced odds of smoking susceptibility were significantly associated with less family smoking (OR: 0.64, 95% CI: 0.41-1.00); having access to information about smoking in school (OR: 0.75, 95% CI: 0.59-0.96); negative attitudes towards smoking (OR: 0.35, 95% CI: 0.23-0.51); higher levels of openness (OR: 0.59, 95% CI: 0.50-0.69); and higher levels of self-reported wellbeing (OR: 0.57, 95% CI: 0.44-0.74). Increased odds of smoking susceptibility were associated with reporting less smoking of a mother (OR: 1.37, 95% CI: 1.06-1.76); higher levels of extraversion (OR: 1.40, 95% CI: 1.04-1.90); and receiving pocket money (OR: 1.20, 95% CI: 1.06-1.37). In Bogotá, reduced odds of smoking susceptibility were significantly associated with reporting less smoking among friends (OR: 0.86, 95% CI: 0.76-0.98); higher levels of self-efficacy (OR: 0.58, 95% CI: 0.40-0.83); greater perceived behavioural control to quit smoking (OR: 0.71, 95% CI: 0.56-0.90); and lower levels of truancy (OR: 0.69, 95% CI: 0.52-0.92). In Bogotá, no factors were associated with increased odds of smoking susceptibility in the final model.

CONCLUSIONS

The findings illustrate that there were differences in predictors of adolescent smoking susceptibility across the two settings. By using a comparative approach we demonstrate that smoking interventions and policies must be sensitive to the cultural and normative context within which they are implemented.

Association between contraband tobacco and illicit drug use among high school students in Canada

A particularly challenging issue to tobacco cessation efforts is the availability of contraband cigarettes. While studies have linked contraband tobacco to smoking initiation and poor cessation outcomes, little is known about its association with illicit drug use among adolescents. We examine the association between contraband tobacco and illicit drug use among adolescent students using a national representative sample of 2,136 current smoker students in grades 9-12 from the 2010-2011 Youth Smoking Survey. About 31 % of adolescent current smokers in grades 9-12 use contraband cigarettes. Prevalence in the use of illicit drugs ranged from 9 to 37 %, with MDMA being the most commonly used drug. Adjusted logistic regression revealed that smokers of contraband cigarettes, when compared with non-contraband cigarette smokers, were more likely to use cocaine (OR 2.14; CI 1.29-3.56), heroin (OR 7.92; CI 3.00-20.91), amphetamines (OR 4.25; CI 2.07-8.74), MDMA (OR 2.00; CI 1.25-3.19), hallucinogens (OR 2.18; CI 1.34-3.55), and ketamine (OR 3.48; CI 1.61-7.54). This paper adds to the existing evidence of the negative effects of contraband tobacco by showing that adolescent contraband smokers are more likely to use illicit drugs. Given the addictive nature of these drugs and the potential for such behavior to spill over into adulthood, more efforts should be invested in addressing this problem.

Prevalence and determinants of resistance to use drugs among adolescents who had an opportunity to use drugs

BACKGROUND

As drugs remain ubiquitous and their use increasingly viewed as socially normative, vulnerable population groups such as adolescents face continued and growing risk. A better understanding of the factors that discourage individuals from initiating drug use, particularly in enabling scenarios, is therefore needed. This study aims to identify individual, interpersonal and school-contextual factors associated with resistance to using drugs in the presence of a drug use opportunity among adolescents in Bogotá, Colombia.

METHODS

Data are analyzed from 724 school-attending adolescents (15.1 years, SD=1.3) who have had an opportunity to use drugs. Schools were selected in a multistage probability cluster sample. Random intercept multilevel logistic regression models were implemented to estimate the effect of individual, interpersonal and school-contextual level variables on the likelihood of resisting using drugs.

RESULTS

Drug use resistance was observed in less than half (41.4%) of those students who experienced an opportunity to use drugs. Drug use resistance was strongly associated with having experienced a passive drug use opportunity (AOR = 3.1, 95% CI = 2.0, 4.9), the number of drugs offered (AOR = 0.7, 95% CI = 0.6, 0.8) and family factors such as not having a drug-using first-degree relative (AOR = 2.3, 95% CI=1.2, 4.3) and a high degree of parental supervision (AOR = 1.9, 95% CI = 1.0, 3.2).

CONCLUSIONS

A large proportion of students who experienced a drug-use opportunity did not initiate drug use despite living in a context of high drug availability and social disorganization. The findings highlight the need for effective family-based drug use prevention interventions within the Colombian context.

Substance use and sexual behaviour among female students in Nigerian universities

Substance use continues to constitute social and health problems, more so among adolescents and young adults. One consequence is risky sexual behavior, a major problem in sub-Saharan Africa already facing the synergistic problems of poverty and HIV/AIDS. This study of female students aged ≥ 18 years in two universities in Nigeria uses a multi-stage stratified random sampling method, and each subject that gave consent to the study was administered with a structured questionnaire by trained interviewers; 2,408 female students were studied (1,854 from the University of Ibadan and 554 from the Bayero University, Kano). The mean age of the respondents was 21.6 (SD = 2.9), and about two-thirds (65.7%) were aged between 20-24, with 2,204 (91.5%) being single and 4.3% married. In all, 23.4% of the subjects used one form of substance. Alcoholic drinks of palm wine, alcoholic wine, and beer were the most common of substances used (22.7%), followed by tobacco (2%) and cannabis (1%). Substance use was significantly associated with religious affiliation of the students (p < 0.001), as the prevalence of substance use was least among Muslim students (11.7%) and highest among those who professed traditional religion (39.4%). Alcohol use was also positively associated with sexual activity (p < 0.001). Among the 547 students who used alcohol, 147 (26.9%) had sex in the 4 weeks prior to the survey, while among the 1,861 non-users, only 8.9% did so. The practice of unprotected sex was found not to be associated with substance use: a slightly lower proportion (29.5% vs. 36.6%) of substance users engaged in unprotected sex in their last encounter compared to non-users. There is need to scale up public health education on the dangers of substance use and its associated sexual risk behavior.

Tobacco use among 10th grade students in Istanbul and related variables

Aim of this study was to determine prevalence of cigarette smoking and hookah use among 10th grade students in Istanbul, Turkey, and to compare sociodemographic, psychological and behavioral variables according to frequency of tobacco use. Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul/Turkey. The questionnaire included sections about demographic data, family characteristics, school life, psychological symptoms and use of substances including tobacco, hookah, alcohol, marijuana, volatiles, heroin, cocaine, non-prescribed legal tranquillizers (benzodiazepines, alprazolam etc.) and illegal tranquillizers (flunitrazepam). The analyses were conducted based on the 4957 subjects. Trial at least once in life is observed as 45.4% for hookah use and as 24.4% for cigarette use. Risk of hookah and cigarette use was significantly higher in male students than in female students. Frequency of tobacco use is related with various sociodemographic, psychological and behavioral variables. Our data also shows that using tobacco and alcohol increases the risk of all the other substances use and these effects are interrelated. The data suggest that there is a link between tobacco use and substance use, psychological, behavioral and social factors. There is also a strong association between tobacco use and suicidal behavior as well as self-mutilative, impulsive, hyperactive, delinquent, aggressive and behavioral problems. The illumination of these relationships may be relevant in prevention and management of tobacco use as well as important problems, such as substance use, impulsivity, hyperactivity, delinquent, aggressive self-mutilative and suicidal behavior among 10th grade students in Istanbul.

Young adults who smoke cigarettes and marijuana: analysis of thoughts and behaviors

INTRODUCTION

Smoking both cigarettes and marijuana is increasingly common among young adults, yet little is known about use patterns, motivations, or thoughts about abstinence. In a U.S. sample, this study explored young adults' severity of cigarette and marijuana co-use, quit attempts, and thoughts about use.

METHODS

Young adults age 18-to-25 who had smoked at least one cigarette in the past 30 days completed an anonymous online survey.

RESULTS

Of 1987 completed surveys, 972 participants reported both past-month cigarette and marijuana use (68% male, 71% Caucasian, mean age 20.4 years [SD=2.0]). Frequency of use, temptations to use, measures of dependence, decisional balance, and past-year quit attempts were associated across the two substances (all p<.05), but not motivation to quit. Relative to marijuana, participants reported greater desire and a later stage of change for quitting cigarettes and were more likely to endorse a cigarette abstinence goal, yet they had lower expectancy of success with quitting cigarettes and with staying quit (all p<.001).

CONCLUSIONS

Cigarette and marijuana use, temptations to use, and pros/cons of using were related in this young adult sample. Differences in motivation and thoughts about abstinence, however, suggest that young adults may be more receptive to interventions for tobacco than marijuana use. Use patterns and cognitions for both substances should be considered in prevention and intervention efforts.

Prior exposure to THC increases the addictive effects of nicotine in rats

Although it is more common for drug abuse to progress from tobacco to cannabis, in many cases cannabis use develops before tobacco use. Epidemiological evidence indicates that prior cannabis use increases the likelihood of becoming dependent on tobacco. To determine whether this effect might be due to cannabis exposure per se, in addition to any genetic, social, or environmental factors that might contribute, we extended our series of studies on 'gateway drug' effects in animal models of drug abuse. Rats were exposed to THC, the main psychoactive constituent of cannabis, for 3 days (two intraperitoneal injections/day). Then, starting 1 week later, they were allowed to self-administer nicotine intravenously. THC exposure increased the likelihood of acquiring the nicotine self-administration response from 65% in vehicle-exposed rats to 94% in THC-exposed rats. When the price of nicotine was manipulated by increasing the response requirement, THC-exposed rats maintained higher levels of intake than vehicle-exposed rats, indicating that THC exposure increased the value of nicotine reward. These results contrast sharply with our earlier findings that prior THC exposure did not increase the likelihood of rats acquiring either heroin or cocaine self-administration, nor did it increase the reward value of these drugs. The findings obtained here suggest that a history of cannabis exposure might have lasting effects that increase the risk of becoming addicted to nicotine.

The Association of Externalizing Behavior and Parent-Child Relationships: An Intergenerational Study

We investigated the influence of the child's behavior on the quality of the mutual parent-child attachment relationships across three generations. We did so using a prospective longitudinal study which spanned 20 years from adolescence through adulthood. Study participants completed in-class questionnaires as students in the East Harlem area of New York City at the first wave and provided follow-up data at 4 additional points in time. 390 participants were included in these analyses; 59% female, 45% African American, and 55% Puerto Rican. Using structural equation modeling, we determined that externalizing behavior in the child was negatively related to the mutual parent-child attachment relationship for two generations of children. We also found continuity in externalizing behavior for the participant over time and from the participant to his/her child. Additionally, we found continuity in the quality of the mutual attachment relationship from the participant's relationship with his/her parents to the participant's relationship with his/her child. Finally, the mutual attachment relationship of the participant with his/her parents had a negative association with the participant's externalizing behavior in adulthood. Based on these results, we propose that family interventions should focus on the role of the child's externalizing behavior in the context of the parent-child attachment relationship. Furthermore, we suggest that prevention programs should address externalizing behavior as early as possible, as the effects of externalizing behavior in adolescence can persist into adulthood and extend to the next generation.

Association of cigarette smoking with drug use and risk taking behaviour in Irish teenagers

BACKGROUND

Cigarette smoking has been shown to act as a 'gateway' to cannabis use and further risk taking behaviours. This study aims to (1) establish the prevalence of cigarette smoking and cannabis use in Irish teenagers, (2) to quantify the strength and significance of the association of cigarette smoking and cannabis use and other high risk behaviours and (3) examine whether the above associations are independent of the extent of social networking.

METHODS

Adolescent students across five urban, non-fee paying schools completed an abridged European schools survey project on alcohol and other drugs (ESPAD) questionnaire.

RESULTS

370/417 (88.7%) students completed the questionnaire. 228 (61.6%) were female, 349 (94.3%) were aged 15-16 years. 48.4% of those surveyed had smoked tobacco at some stage in their lifetime, 18.1% in the last 30 days. 15.1% have used cannabis with 5.7% using it in the last 30 days. 29.6% of cigarette smokers have used cannabis in comparison to 1.6% of non-smokers. On multivariate analysis lifetime cigarette smoking status was independently associated with hard drug use, adjusted OR=6.0, p<0.01; soft drug use, adjusted OR=4.6, p<0.01 and high risk sex practises, adjusted OR=10.6, p<0.05.

CONCLUSIONS

Cigarette smoking prevalence remains high in Irish teenagers and is significantly associated with drug use and other risk taking behaviours. Specific teenage smoking cessation strategies need to be developed targeting these combined high risk health behaviours.

Effects of risk perception of marijuana use on marijuana use and intentions to use among adolescents in Bogotá, Colombia

BACKGROUND

Perceived risk is a key concept of behavioral theories used to predict substance use among youth and a core component of drug use prevention interventions. The present study aimed to (1) assess degrees of risk perception of regular marijuana use, (2) identify factors associated with risk perception, and (3) explore the associations between perceived risk and marijuana use and intentions to use marijuana among school-attending adolescents in Bogotá, Colombia.

METHODS

Data from 2079 standardized questionnaires administered in 23 schools were analyzed in this study. Schools were selected in a multi-stage probability cluster sample to reflect the socio-economic characteristics of Bogotá's student population.

RESULTS

Just over 11% of participants perceived regular marijuana use to be a low risk behavior. Older age (>16 years) (adjusted odds ratio=2.9; 95% confidence interval=1.4-6.0) and low level of knowledge regarding the physical and psychological harms of illegal drugs (AOR=2.9; 95%CI=2.0-4.3) were the strongest predictors of low risk perception, Low perceived risk was also significantly associated with ever having used marijuana (AOR=2.5; 95%CI=1.7-3.7), monthly marijuana use among ever marijuana users (AOR=2.7; 95%CI=1.4-5.0), and a positive intention to use marijuana within the next 12 months among non-users (AOR=2.1; 95%CI=1.4-3.5).

CONCLUSIONS

Consistent with previous findings, perceiving regular marijuana use as a risky behavior functions as a protective factor against the intention to use, use and occasional use of marijuana. Incorporation of this message into drug use prevention activities for non-users and early-stage users may enhance their effectiveness.

Course of comorbidity of tobacco and marijuana use: psychosocial risk factors

INTRODUCTION

This longitudinal study examined the psychosocial factors associated with the comorbidity of pairs of tobacco and marijuana use trajectories from adolescence extending into adulthood in two ethnic groups, Blacks and Puerto Ricans.

METHODS

Data on psychosocial functioning and tobacco and marijuana use at four points in time were obtained.

RESULTS

The association between the trajectories of tobacco and marijuana use was quite high. Pairs of comorbid trajectories of tobacco and marijuana use may share at least three kinds of influence: (a) a constellation of externalizing personality risk factors, (b) Depressive Mood and low Ego Integration, and (c) identification with certain group values.

DISCUSSION

Knowledge of the risk and protective factors for pairs of comorbid trajectories of use may strengthen the foundation for individual and group targets for prevention and treatment programs.

The role of temperament in the relationship between early onset of tobacco and cannabis use: the TRAILS study

BACKGROUND

While temperamental characteristics have been related to the onset of cannabis use, it is not clear at what point(s) along the trajectory from early onset of tobacco use (EOT) to early onset of cannabis use (EOC) these characteristics exert their impact. This study examined if (1) temperamental characteristics predispose to EOT that on its turn predisposes to EOC, and (2) temperament moderates the importance of EOT on the progression to EOC.

METHODS

Data from 1848 (83%) participants in the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective population study of Dutch adolescents, were analyzed. We used parent-reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high-intensity pleasure, frustration, effortful control, shyness and fearfulness at age 10-12. EOT and EOC were defined as use at least once before the ages of 12 and 13 years, respectively, assessed by means of self-reports. We performed mediation and moderation analyses in Mplus.

RESULTS

High levels of high-intensity pleasure predisposed to entrance in the trajectory from EOT to EOC. Once tobacco use had been initiated at early age, low levels of shyness and high levels of high-intensity pleasure increased the risk of progression to EOC.

CONCLUSIONS

Besides a common liability for EOT and EOC based on temperament, the risk of transition from tobacco to cannabis use is modified by temperamental characteristics. Differences in interplay with other risk factors may explain the impact of temperament on distinct points along the substance use trajectory.

The at-risk adolescent marijuana nonuser: expanding the standard distinction

This research expands the user/nonuser dichotomy commonly used in research on marijuana. By conceptualizing nonusers as homogeneous, vital nuances in susceptibility to risk and protective factors may be overlooked. Research operations tested the predictive validity of a brief measure that divided nonusers into resolute and vulnerable subcategories; determined whether variables that distinguished nonusers and users were more informative when a tripartite classification was used; and with an eye on future prevention, examined variables on which resolute nonusers were similar to vulnerable nonusers or users, and on which they differed from both. A nationally representative sample of respondents (N = 2,111; ages 12-16 years) from the National Survey of Parents and Youth was used in this secondary analysis. Panel data gathered yearly over four rounds included information on intentions and use of marijuana and other illicit substances, along with social, demographic, intrapersonal, and parental variables. The three groups differed significantly on associates' marijuana use, participants' approval of others' use, and cigarette and alcohol use. Resolute nonusers differed from vulnerable nonusers and users alike on religiosity, delinquency (self and friends'), refusal strength, sensation seeking, parental monitoring and warmth, and adult supervision. Results support the utility of distinguishing vulnerable from resolute nonusers, counsel against considering nonusers as a homogeneous group, and provide insight into variables that might prove useful in future prevention efforts.

PERSONALITY, DEPRESSIVE SYMPTOMS AND SMOKING STATUS AMONG TURKISH UNIVERSITY STUDENTS

The association between the sociotropic/autonomic personality characteristics, depressive symptoms and cigarette-smoking status of 385 male and 241 female university students was examined. Depressive symptoms and sociotropic/autonomic personality were measured using the Beck Depression Inventory (adapted for use in Turkey by Hisli [1998]) and the Sociotropy-Autonomy Scale (adapted for use in Turkey by Şahin, Ulusoy, & Şahin [1993]); smoking behaviors were also assessed. Logistic regression analysis was used to assess the association between sociotropic/autonomic personality characteristics, depressive symptoms and cigarette-smoking status. Current smokers showed a trend, scoring higher than nonsmokers on depressive symptoms, and they also scored significantly higher than nonsmokers on autonomy. Results also show that depressive symptoms (OR = 1.07, 95% CI = 1.05–1.10), and autonomy (OR = 1.02, 95% CI = 1.01–1.03) were predictive variables of current smoking status.

Chronologically overlapping occurrences of nicotine-induced anxiety- and depression-related behavioral symptoms: effects of anxiolytic and cannabinoid drugs

BACKGROUND

Anxiety and depression are among the most frequently-observed psychiatric symptoms associated with nicotine (NC). In addition to the similarity to other addictive drugs, these NC-induced symptoms are characteristic in that the opposite behavioral effects, i.e. anxiolytic and antidepressant effects, which may reinforce the habitual use of NC, have also been reported. In the present study, the time course of anxiety- and depression-related behavioral alterations was examined in mice. Furthermore, based on the reported similarity in the mechanisms responsible for NC-induced anxiety- and depression-related symptoms, as well as the contribution of brain cannabinoid (CB) receptors to these behavioral symptoms, the effects of anxiolytics and CB receptor ligands (CBs) against these behavioral symptoms were investigated.

RESULTS

Repeated subcutaneous NC treatments (0.3 mg/kg, 4 days), compared with a single treatment (0.5 mg/kg), caused both prolonged anxiogenic effects in the elevated plus-maze test, and prolonged depressive effects in the forced swimming test, even at 120 min time point after the last NC treatment. A transient anxiolytic preference for open arms was also observed in the elevated plus-maze test. Among the anxiolytics and CBs, the serotonin 1A (5-HT1A) antagonist WAY 100135 and the endogenous mixed CB agonist/antagonist virodhamine (VD), when administered intraperitoneally before each NC treatment, provided the strongest antagonistic effects against the anxiety-related symptoms. However, against the depression-related symptoms, only VD provided significant antagonistic effects in both single and repeated treatment groups.

CONCLUSION

The present results support the presence of a chronological overlap of NC-induced anxiety- and depression-related behavioral symptoms, and the contribution of brain CB receptors to these behavioral symptoms. The repeated NC-induced prolongation of these behavioral symptoms and the early transient anxiolytic behavioral alterations support an increased possibility of the habitual use of NC. Furthermore, based on the antagonistic effects of VD, one can predict that the characteristic effects on brain CB receptors as a mixed CB agonist/antagonist contributed to its therapeutic effects as both an anxiolytic and an antidepressant.

Factors associated with the onset of cannabis use: a systematic review of cohort studies

OBJECTIVE

To determine the factors associated with the onset of cannabis use through a systematic review of cohort studies.

METHODS

An internet-based search was performed using several keywords and their combinations. Original studies with longitudinal design and the onset of cannabis use as dependent variable, as well as review studies were included, published between January 1980 and May 2004. Methodology quality of the studies was assessed independently by two reviewers, according to pre-established criteria, in order to classify studies in high, mid or low quality. Agreement between reviewers was assessed through kappa coefficient.

RESULTS

A total of 32 relevant studies were identified, of which 13 were of higher quality. Selection bias for the inclusion of consumers at the baseline measurement and lack or insufficient adjustment for confounders were the causes of exclusion. The factors of great evidence related to the onset of cannabis use were masculine sex, consumption of tobacco or alcohol, having a problematic relationship with parents, and cannabis consumption by friends.

CONCLUSION

Results highlight the importance of different individual, family and environmental factors on the onset of cannabis use. These must be considered to properly arrange intervention programs focusing on primary prevention among teenagers.

Comparison of tobacco, alcohol and illegal drug usage among school students in three Pacific Island societies

BACKGROUND

Many Pacific Island countries are in social and epidemiological transition, but there are little population data about drug and alcohol usage among adolescents in this region.

METHODS

Random samples of school students aged 11-17 years completed surveys in three populations: Pohnpei State in the Federated States of Micronesia (n=1495), Tonga (n=2808) and Vanuatu (n=4474).

RESULTS

Among 15-year-olds, boys in Tonga reported the highest prevalence of weekly smoking (29%), followed by boys in Pohnpei (17%). Kava use at a potentially harmful level (i.e. daily) was low in all countries. Drunkenness on two or more occasions was much more common among 15-year-old boys in Pohnpei (51%) than same-age youth in the other countries. Marijuana use was most often reported by boys (20%) and girls (20%) in Pohnpei, while solvents had been used most often by boys in Pohnpei (15%), and methylated spirits by boys in Tonga (20%). In all countries bullying of other students was independently related to regular smoking, while bullying behaviour and strong relationships with peers and others outside of the family were related to past drunkenness and use of illegal drugs in Tonga and Vanuatu.

CONCLUSIONS

Overall, levels of adolescent substance use were consistently higher in Tonga and Pohnpei than in Vanuatu. These unique data provide a basis for setting priorities and evaluating action to address the health risks posed by substance use in these Pacific Island societies.

Drug use among juveniles in conflict with the law

OBJECTIVE

To study the pattern of drug use, reasons for initiation and the perception about the effects of using drugs, among juveniles in conflict with law.

METHODS

A qualitative study was conducted at Prayas Observation Home for boys, New Delhi. Eight key informant interviews were conducted to find the prevalence of prior drug use among boys. Five focus group discussions were conducted with 34 children using a topic outline guide.

RESULTS

The study showed that drug use was related to other criminal activities. Peer group and media were the most important influences for initiation of drug use. All kinds of drugs could easily be procured by children and there was a gradual progression from non-use to tobacco and alcohol use, to marijuana and ultimately to other drugs. Knowledge about medical and social mal-effects of consuming drugs did not seem to effect either the consumption of drugs or the desire to leave this habit.

CONCLUSION

Results of the study demonstrate an urgent need for taking stringent measures in order to curb drug use among adolescents.

Nicotine dependence and withdrawal symptoms among occasional smokers

PURPOSE

This study describes the levels of nicotine dependence, withdrawal symptoms, depressive mood, and risk behavior reported by male and female weekly and monthly adolescent smokers in South Africa.

METHODS

A cross-sectional survey was conducted among 554 grade 9-11 weekly and monthly smokers in the Southern Cape-Karoo Region. Differences between the gender groups and smoking status were analyzed while controlling for demographic characteristics.

RESULTS

Weekly and monthly smokers were classified as light smokers having smoked 6-10 cigarettes and 0-1 cigarettes a week, respectively. However, they displayed substantial levels of dependence, with 11.6% of weekly smokers classified as highly dependent. Furthermore, 55.9% of weekly smokers and 47.1% of the overall sample experienced more than two withdrawal symptoms. Although dependency levels and withdrawal symptoms were higher among weekly smokers, the levels were not negligible among monthly smokers. Weekly smokers reported higher levels of depressive mood and risk behavior than monthly smokers. Females reported higher levels of dependence, withdrawal symptoms, depressive mood, and lower levels of risk behavior than males. Gender differences were not found on the number of cigarettes smoked in a week.

CONCLUSIONS

This study demonstrates multiple symptoms of dependence among a large sample of adolescent occasional smokers in a multi-ethnic cultural setting. Smoking cessation programs may, therefore, be required to help adolescents quit smoking and possibly consider pharmacotherapy for highly dependent smokers. Prevention programs should also consider providing occasional smokers skills to identify and cope with withdrawal symptoms.

Subchronic nicotine exposure in adolescence induces long-term effects on hippocampal and striatal cannabinoid-CB1 and mu-opioid receptors in rats

There is evidence for the existence of functional interactions between nicotine and cannabinoids and opioid compounds in adult experimental animals. However, there is scarce information about these relationships in young animals. In the present study we evaluated short and long-term effects of a subchronic nicotine treatment [0.4 mg/kg daily i.p. injections from postnatal day (PND) 34 to PND 43], upon hippocampal and striatal cannabinoid-CB(1) and mu-opioid receptors in Wistar rats of both genders. Rats were sacrificed 2 h after the last nicotine injection (short-term effects, PND 43) or one month later (long-term effects, PND 75). Hippocampal and striatal cannabinoid CB(1) and mu-opioid receptors were quantified by Western blotting. The subchronic nicotine treatment induced a region-dependent long-lasting effect in cannabinoid CB(1) receptor: a significant increase in hippocampal cannabinoid CB(1) receptors and a significant decrease in striatal cannabinoid CB(1) receptors, with these effects being similar in males and females. With respect to mu-opioid receptors, subchronic nicotine induced a significant down-regulation in hippocampal and striatal mu-opioid receptors in the long-term, and within the striatum the effects were more marked in adult males than in females. The present results indicate that juvenile nicotine taking may have implications for the endocannabinoid and endogenous opioid function and for the behaviors served by those systems, this includes possible modification of the response of adults to different psychotropic drugs, i.e. cannabis and morphine/heroin when taken later in life.

Cigarette smoking and the risk for alcohol use disorders among adolescent drinkers

BACKGROUND

Cigarette smoking and alcohol use disorders (AUDs) are closely linked, but it is not clear whether higher rates of AUD among smokers are solely attributable to heavier drinking or, alternatively, whether smokers are more vulnerable to alcohol abuse and dependence than nonsmokers who drink comparable quantities. We sought to address this issue using data from a nationally representative U.S. sample of adolescents and young adults. Specifically, we analyzed the relationship between cigarette smoking, drinking, and AUDs.

METHODS

Data were from the aggregated 2002 through 2004 U.S. National Survey on Drug Use and Health. Participants were randomly selected, household-dwelling adolescents and young adults (ages 12-20) from the noninstitutionalized, civilian population of the United States (N=74,836). Measurements included current DSM-IV alcohol abuse or dependence, number of drinks in the past 30 days, and past-year cigarette smoking, defined as having smoked more than 100 cigarettes across the lifetime and having smoked during the past year.

RESULTS

Past-year smokers (prevalence=16.0%) drank in higher quantities than never-smokers, but were also at elevated risk for AUD when compared with never-smokers who drank equivalent quantities. The effect was observed across age groups, but was more prominent among younger adolescents. After adjusting for drinking quantity and sociodemographic variables, smokers had 4.5-fold higher odds of AUD than never-smokers [95% confidence interval (95% CI), 3.1-6.6]. Youths who reported smoking but did not cross the 100-cigarette threshold were at intermediate risk [odds ratio (OR), 2.3; 95% CI, 1.7-3.3]. Differences in AUD between smokers and never-smokers were most pronounced at lower levels of drinking.

CONCLUSIONS

The results are consistent with a higher vulnerability to AUDs among smokers, compared with nonsmokers who drink equivalent quantities.

Clustering of smoking, alcohol drinking and cannabis use in adolescents in a rapidly developing country

BACKGROUND

Smoking, alcohol drinking and cannabis use ("risk behaviors") are often initiated at a young age but few epidemiological studies have assessed their joined prevalence in children in developing countries. This study aims at examining the joint prevalence of these behaviors in adolescents in the Seychelles, a rapidly developing country in the Indian Ocean.

METHODS

Cross-sectional survey in a representative sample of secondary school students using an anonymous self-administered questionnaire (Global Youth Tobacco Survey). The questionnaire was completed by 1,321 (92%) of 1,442 eligible students aged 11 to 17 years. Main variables of interest included smoking cigarettes on > or =1 day in the past 30 days; drinking any alcohol beverage on > or =1 day in the past 30 days and using cannabis at least once in the past 12 months.

RESULTS

In boys and girls, respectively, prevalence (95% CI) was 30% (26-34)/21% (18-25) for smoking, 49% (45-54)/48% (43-52) for drinking, and 17% (15-20)/8% (6-10) for cannabis use. The prevalence of all these behaviors increased with age. Smokers were two times more likely than non-smokers to drink and nine times more likely to use cannabis. Drinkers were three times more likely than non-drinkers to smoke or to use cannabis. Comparison of observed versus expected frequencies of combination categories demonstrated clustering of these risk behaviors in students (P < 0.001).

CONCLUSION

Smoking, drinking and cannabis use were common and clustered among adolescents of a rapidly developing country. These findings stress the need for early and integrated prevention programs.

Adolescent tobacco smoking and associated psychosocial health risk factors

OBJECTIVE

To determine the relationship between tobacco smoking and psychosocial health risk factors in adolescents.

DESIGN

An in-class survey of schoolchildren in the final grade of basic school and in all three grades of secondary school.

SETTING

Four of the 11 secondary schools in Tartu, Estonia.

SUBJECTS

977 schoolchildren, ages ranging from 14 to 18.

MAIN OUTCOME MEASURES

A questionnaire was developed to explore various psychosocial aspects of tobacco smoking behaviour. The 21-item Beck Depression Inventory was used to measure depression.

RESULTS

In the total sample, smokers accounted for 24.5% of the girls and 26.5% of the boys, of which 13% of the girls and 19% of the boys were daily smokers. Not enjoying time spent with parents (OR = 0.6), skipping breakfast (OR = 1.3), frequent headache (OR = 1.3) and stomach-ache (OR = 1.4), dislike of school (OR = 0.7), using illicit drugs (OR = 5.0) and having multiple sexual partners (OR = 2.4) were all associated with daily smoking. Higher BDI scores were seen among adolescent smokers, particularly in girls and among pupils whose parents were non-smokers. The girls who smoked daily showed a higher risk of having suicidal thoughts (OR = 2.4) compared with non-smokers.

CONCLUSION

Smoking by adolescents is an indicator of risk for depression, distress and risk-taking health-damaging behaviours.

Substance abuse in adolescents: a complex conundrum for the clinician

Substance abuse remains a complex and pervasive conundrum for society and for clinicians seeking to improve the lives of their pediatric patients. Substance abuse is linked to the human instinct for pleasure at any cost and is fueled by enticing encouragement of the media teaching society to seek drug-induced pleasure without fear of negative consequences. Other complications are the limited education about psychoactive substances provided to youth and the health care profession pledged to serve them. Primary care clinicians must provide their adolescent patients with adequate screening and counseling about substance abuse. Treatment of the substance-abusing patient is often a combination of behavioral interventions (including family therapy), and, in limited situations, addiction-specific medications. Research suggests that female drug addicts have a better outcome in female-only drug treatment programs. In addition, new drugs are being developed that target specific brain mechanisms involved in drug addiction; these drugs will have less toxicity and less abuse potential than illicit drugs such as cocaine. Vaccines are being developed that will block the effects of such drugs as cocaine and PCP. Medications developed for the treatment of depression and epilepsy will be a source of medications for the treatment of drug addiction. The study of endorphins and the neurobiology of stress and substance abuse promise to develop potent anti-addiction chemicals, greatly aiding in the war on drug abuse.