Psychosocial and pharmacologic explanations of nicotine's "gateway drug" function

Effects of the Universal Prevention Curriculum for Schools on Substance Use Among Peruvian Adolescents: A Randomized Trial

This group-randomized trial assessed the effects of a universal prevention training curriculum for school administrators and teachers that focused on effective strategies to prevent adolescent substance use and related problems. Twenty-eight schools in three regions of Peru were randomly assigned to either an intervention or control condition (14 schools per condition). Repeated cross-sectional samples of 11 to 19-year-old students participated in four surveys from May 2018 to November 2019 (N = 24,529). School administrators and teachers at intervention schools participated in a universal prevention training curriculum focusing on the development of a positive school climate as well as effective policies related to school substance use. All intervention and control schools were offered Unplugged, a classroom-based substance use prevention curriculum. Outcome measures included: lifetime drug use; past-year and past-month tobacco, alcohol, marijuana, and other drug use; awareness of school tobacco and alcohol use policies; perceived enforcement of school policies; school bonding; perceived friends' use of tobacco, alcohol, marijuana and other drugs; and personal problems in general and problems related to substance use. Multi-level analyses indicated significant reductions in past-year and past-month smoking, friends' substance use, and problems related to substance use and in general at intervention relative to control schools. Significant increases were found in intervention vs. control schools related to students' awareness of school substance use policies, perceived likelihood of getting caught for smoking, and school bonding. These findings suggest that the universal prevention training curriculum and the school policy and climate changes it promoted reduced substance use and related problems in the study population of Peruvian adolescents.

Assessment of characteristics and exposure to vulnerable factors for drug use among male illicit drug users in Sri Lanka: A multicenter cross-sectional study

Background:

Methodology:

Results:

Conclusion:

Exploring substance use disorders and relapse in Mauritian male addicts

Background

Substance Use Disorder (SUD) places a heavy burden on societal and health systems given its association with high mortality and morbidity rates worldwide, including Mauritius. Illicit substances act as a positive reinforcement and stimulate addiction through its pleasure-seeking attributes.

Aim

This study focused on identifying the risk factors leading to SUD among Mauritian male addicts as well as examining the potency of those factors in SUD development. The study also aimed at determining the prevalence of relapse and its causation.

Research setting

A cross-sectional study was conducted over a period of six months using a sample of 180 male addicts registered in a public hospital. A questionnaire investigating dimensions such as risk factors, self-esteem and peer pressure was administered.

Findings

A high percentage of relapse was noted amongst users within the first year of abstinence. Majority of respondents originated from nuclear or single parents’ family and were deprived of adequate social supports given their marital status. 57.5% of participants had a positive family history of SUD. Cannabis was the most commonly abused substance and 76.2% of the addicts were introduced to drugs through curiosity. Transposing the results against the Gateway Drug Theory showed a constant progression from soft to hard drugs for male addicts, a trend which was consistent with literature. Lastly, a theoretical model was developed based on the strong statistical association found between impulsivity and reduced thought processes prior to relapse; data revealing increased impulsivity which is a common trait in antisocial personality disorder and borderline personality disorder as being largely responsible for relapse.

Conclusion

The study was successful in bringing out the most common risk factors of SUDs which are linked to low socioeconomic status. The inability of addicts to progress with their rehabilitation given the alarming 92% of relapse was related to social pressure as prime deterrent to successful remission. Programmes involving relapse prevention must implemented in the first year of abstinence to facilitate rehabilitation.

Exploring the Progressive Use of Performance Enhancing Substances by High-Performance Athletes

Background: Given implications associated with the use of performance-enhancing substances (PESs), stakeholders must remain informed about usage precipitants and anticipate conditions signaling athlete vulnerability to hazardous exposures. Objectives: To gain deeper qualitative insight into high-level athlete PES usage; explore the variables leading them to escalate their PES use regimens; reveal PES experiences during their careers and, unlike other studies, not to focus exclusively on "doping" as measured by the use of WADA-banned substances. Methods: A macro life course-based framework from which the data could emerge through a thematic coding analysis was utilized. Sixteen narrative life course histories of recently retired high-performance athletes report on the factors impelling their escalation in PES use, including for some, the first use of banned PES. Results: Informant reports, thematically coded, reveal performance maximization urgency to be a central factor in escalating PES use, driven by four variables: Requirements, Opportunities, Influencers and Outcomes. These variables each comprise two key components that stimulate an urgency ecosystem affecting an athlete's proximity to an escalation threshold. Conclusions/Importance: Such a comprehensive investigation of PES use precipitants has not previously been undertaken. Advances in PES use were instantiated by a substantive, sometimes radical and often sudden increase in urgency to improve performance related to output requirements, specific demands, knowledge and access, timing windows, the competitive landscape, loyalty to coaches, efficiency expectations and likelihood of detection. This study informs incremental models of doping, the use of which is encouraged in order to analyze life course narratives to better understand athlete behaviors.

“I Wanna Be Sedated”: A Closer Examination of Psychosocial Factors Associated With Past-Year Tranquilizer Use Among National Sample of Sexual Minority Adults

Sexual minorities are at increased risk of substance use disorders. Gaps in the research exist regarding tranquilizer use among sexual minorities. Identifying risk factors associated with tranquilizer use may assist public health professionals in developing specific interventions for this vulnerable population. The present study examined potential factors associated with past-year tranquilizer use among a national sample of sexual minorities. A secondary data analysis of the 2017 National Survey on Drug Use and Health was conducted. Results revealed that one in five (21.9%) sexual minorities used a tranquilizer within the past year. Associated risk factors included being female, 18 years of age or older, past-year use of illicit drugs, and having lost interest or pleasure in once pleasurable activities. Findings from the present study can assist prevention professionals in further developing and implementing initiatives to mitigate tranquilizer use among sexual minorities.

A critique of the US Surgeon General's conclusions regarding e-cigarette use among youth and young adults in the United States of America

BACKGROUND

In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America.

METHODS

Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions.

RESULTS

Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is either infrequent or experimental, and negligible among never-smoking youth. The majority of the very small proportion of US youth who use e-cigarettes on a regular basis, consume nicotine-free products. The sharpest declines in US youth smoking rates have occurred as e-cigarettes have become increasingly available. Most of the evidence presented in the Surgeon General's discussion of nicotine harm is not applicable to e-cigarette use, because it relies almost exclusively on exposure to nicotine in the cigarette smoke and not to nicotine present in e-cigarette aerosol emissions. Moreover, the referenced literature describes effects in adults, not youth, and in animal models that have little relevance to real-world e-cigarette use by youth. The Surgeon General's report is an excellent reference document for the adverse outcomes due to nicotine in combination with several other toxicants present in tobacco smoke, but fails to address the risks of nicotine decoupled from tobacco smoke constituents. The report exaggerates the toxicity of propylene glycol (PG) and vegetable glycerin (VG) by focusing on experimental conditions that do not reflect use in the real-world and provides little discussion of emerging evidence that e-cigarettes may significantly reduce harm to smokers who have completely switched.

CONCLUSIONS

The U.S. Surgeon General's claim that e-cigarette use among U.S. youth and young adults is an emerging public health concern does not appear to be supported by the best available evidence on the health risks of nicotine use and population survey data on prevalence of frequent e-cigarette use. Nonetheless, patterns of e-cigarettes use in youth must be constantly monitored for early detection of significant changes. The next US Surgeon General should consider the possibility that future generations of young Americans will be less likely to start smoking tobacco because of, not in spite of, the availability of e-cigarettes.

Demographic and social correlates of tobacco, alcohol and cannabis use among 15-16-year-old students in Albania: Results of the ESPAD survey

Aims

Our aim was to assess the demographic and social factors associated with lifetime use of tobacco, alcohol and cannabis among school students aged 15-16 in Albania in order to make information and knowledge available for health promotion specialists working on substance use prevention.

Design

This cross-sectional study was conducted in March-May 2011 in the framework of the European School Survey Project on Alcohol and Other Drugs (ESPAD). In total, 3189 students born in 1995 participated in the survey. The standardised ESPAD questionnaire was used to collect data about substance use.

Results

Our multivariable adjustment analysis showed that being a male and having easy access to cigarettes were the only universal factors significantly increasing the likelihood of ever using tobacco, alcohol or cannabis. Own smoking was strongly and significantly associated with alcohol and cannabis use. The associations of own substance use with peer substance consumption were weak to moderate.

Conclusions

Own smoking seems to be the most important single independent risk factor which strongly and significantly predicted alcohol and cannabis use among Albanian school students. Policy makers need to strengthen the rule of law whereas health promotion professionals should firmly address smoking in adolescence through target interventions.

Nicotine and the adolescent brain

Adolescence encompasses a sensitive developmental period of enhanced clinical vulnerability to nicotine, tobacco, and e-cigarettes. While there are sociocultural influences, data at preclinical and clinical levels indicate that this adolescent sensitivity has strong neurobiological underpinnings. Although definitions of adolescence vary, the hallmark of this period is a profound reorganization of brain regions necessary for mature cognitive and executive function, working memory, reward processing, emotional regulation, and motivated behavior. Regulating critical facets of brain maturation are nicotinic acetylcholine receptors (nAChRs). However, perturbations of cholinergic systems during this time with nicotine, via tobacco or e-cigarettes, have unique consequences on adolescent development. In this review, we highlight recent clinical and preclinical data examining the adolescent brain's distinct neurobiology and unique sensitivity to nicotine. First, we discuss what defines adolescence before reviewing normative structural and neurochemical alterations that persist until early adulthood, with an emphasis on dopaminergic systems. We review how acute exposure to nicotine impacts brain development and how drug responses differ from those seen in adults. Finally, we discuss the persistent alterations in neuronal signaling and cognitive function that result from chronic nicotine exposure, while highlighting a low dose, semi-chronic exposure paradigm that may better model adolescent tobacco use. We argue that nicotine exposure, increasingly occurring as a result of e-cigarette use, may induce epigenetic changes that sensitize the brain to other drugs and prime it for future substance abuse.

High affinity α3β4 nicotinic acetylcholine receptor ligands AT-1001 and AT-1012 attenuate cocaine-induced conditioned place preference and behavioral sensitization in mice

Cholinergic signaling via the nicotinic acetylcholine receptors (nAChRs) in the mesolimbic circuitry is involved in the rewarding effects of abused drugs such as cocaine and opioids. In mouse studies, nonselective nAChR antagonist mecamylamine blocks cocaine-induced conditioned place preference (CPP) and behavioral sensitization. Among subtype-selective nAChR antagonists, the β2-selective antagonist dihydrobetaerythroidine and α7 antagonist methyllycaconitine (MLA), but not MLA alone prevent behavioral sensitization to cocaine. Since the role of the α3β4 nAChR subtype in the rewarding and behavioral effects of cocaine is unknown, the present study investigated the effect of two potent and selective α3β4 nAChR ligands, AT-1001 and AT-1012, on the acquisition of cocaine-induced CPP and behavioral sensitization in mice. At 5-30mg/kg, cocaine produced robust CPP, whereas behavioral sensitization of locomotor activity was only observed at the higher doses (20-30mg/kg). Pretreatment with AT-1001 (1-10mg/kg) or AT-1012 (3-10mg/kg) blocked CPP induced by 5mg/kg cocaine, but not by 30mg/kg cocaine. Lower doses of AT-1001 (0.3-1mg/kg) and AT-1012 (1-3mg/kg) did not affect the increase in locomotor activity induced by 5 or 30mg/kg cocaine. But AT-1001, at these doses, blocked locomotor sensitization induced by 30mg/kg cocaine. These results indicate that the α3β4 nAChR play a role in the rewarding and behavioral effects of cocaine, and that selective α3β4 nAChR ligands can attenuate cocaine-induced behavioral phenomena. Since the selective α3β4 nAChR functional antagonist AT-1001 has also been shown to block nicotine self-administration in rats, the present results suggest that α3β4 nAChRs may be a target for the treatment of cocaine addiction as well as for cocaine-nicotine comorbid addiction.

Smoking's effects on respiratory sinus arrhythmia in adolescent smokers

Respiratory sinus arrhythmia (RSA) has emerged as an indicator of how well the body maintains homeostasis and flexibly responds to environmental demands. Previous research has shown that smoking has both acute and chronic effects on RSA in adults. More recent work has focused on adolescent smokers because the natural decrease in RSA over the lifespan might be hastened by smoking at an early age. The goal of the current study, then, was to examine the acute effects of smoking on RSA and mean heart rate (HR) in a group of adolescent smokers. Participants completed two experimental sessions separated by 6-10 weeks, during which resting electrocardiogram (EKG) data were collected before and after smoking or not smoking a single cigarette ad libitum. Results indicate that smoking significantly decreased resting RSA and increased mean HR. In addition, those who smoked their first cigarette earlier in life (i.e., before age 8 or 10) evidenced a greater decrease in RSA during their smoking session relative to those who tried smoking after age 10. Importantly, these findings are largely consistent with the adult literature and suggest that smoking has acute effects on both RSA and HR in adolescence.

Nutritional supplement and doping use in sport: Possible underlying social cognitive processes

There is growing evidence suggesting that nutritional supplement (NS) use is strongly associated to doping use in elite and amateur sports. However, there is a paucity of research on the psychological processes that underlie this association. The present study investigated the cognitive and behavioral components of the association between NS use and doping among adolescent sub-elite athletes. Six hundred and fifty adolescent athletes completed a questionnaire including measures of doping intentions, attitudes, norms, and beliefs about NS use. The results showed that NS users who did not report doping use had significantly stronger doping intentions and more positive attitudes and favorable beliefs toward doping use, as compared with athletes who did not use NS. In support of the "shared mental representations" hypothesis, the present findings show that NS use is associated with biased reasoning patterns in favor of doping use. This mechanism may explain why some NS users decide to engage in doping.

Age-dependent alterations in reward-seeking behavior after brief nicotine exposure

RATIONALE

Adolescence is a developmental period that coincides with the onset of tobacco use. Teen smokers are also more likely to abuse other drugs compared to nonsmokers. Previous studies with rats have shown that low-dose nicotine pretreatment enhances initial acquisition of cocaine self-administration when given during early adolescence, but not at later ages. The aim of the present study was to determine whether these nicotine pretreatment effects extend to extinction and reinstatement of reward-seeking behavior.

METHODS

Adolescent [postnatal day (P)28] and adult rats (P86) were pretreated for 4 days with nicotine (60 μg/kg, i.v.) or saline. Following pretreatment, rats were allowed to nose poke for cocaine (500 μg/kg/infusion) or sucrose pellets for at least 12 days or until meeting acquisition criterion. Responding was then extinguished for at least 7 days or until extinction criterion was met. The following day, the rats were reinstated with either a priming injection of cocaine (10 mg/kg, i.p.) or sucrose pellets.

RESULTS

Nicotine markedly enhanced extinction of cocaine self-administration in adolescent rats, but not adults. Pretreatment also enhanced the acquisition of cocaine self-administration in adolescents, while reducing discrimination for the reinforced hole in adults. There were no pretreatment or age effects on cocaine-induced reinstatement. In contrast, nicotine induced only minor enhancement of sucrose-taking behavior in adolescents, with no significant impact on extinction or reinstatement at either age.

CONCLUSIONS

Nicotine pretreatment affects reward-related behavior in both an age- and reward-dependent manner. These findings show that brief nicotine exposure during early adolescence enhances drug-related learning.

Smoking and suicidality in subjects with bipolar disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

Smoking in patients with bipolar disorder is known to be related to suicidality. This link has not been investigated, however, in community-based samples. The aim of this study is to delineate the sociodemographic and clinical characteristics of bipolar smokers and examine the relationship between these characteristics and suicidal ideation or attempts in an epidemiologic database, the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).

METHODS

Subjects (n = 1,643) with bipolar disorder I and II, defined by the DSM-IV criteria, who had a history of low moods lasting more than 2 weeks were included in our analysis. Current smokers, former smokers, and lifetime nonsmokers were compared in terms of demographic, clinical characteristics, and functional level. Suicidality, evaluated by a history of suicide ideation and attempts while in low mood were compared.

RESULTS

Current smokers with bipolar disorder showed a greater number of DSM-IV symptoms while in acute episodes, higher rate of alcohol, and drug use disorders, as well as poorer functional levels than nonsmokers. Previous smokers displayed intermediate characteristics between current smokers and nonsmokers. The logistic regression analysis revealed that current smoking status predicted the risk of having a history of attempted suicide (Odds ratio 1.35, 95% CI: 1.05-1.76) after adjusting for age, sex, race, bipolar subtype, lifetime axis II/anxiety/alcohol use/substance use disorder; however, lifetime smoking status did not.

CONCLUSIONS

The present study confirms that current cigarette smoking can predict attempted suicide in a community representative sample of people with bipolar disorder.

Cigarette smoking as a risk factor for other substance misuse: 10-year study of individuals with and without attention-deficit hyperactivity disorder

BACKGROUND

We previously documented that cigarette smoking is a risk factor for subsequent alcohol and drug misuse and dependence in adolescent girls with attention-deficit hyperactivity disorder (ADHD).

AIMS

To revisit this hypothesis with a large longitudinal sample of both genders followed up for 10 years into young adulthood.

METHOD

We used data from two identically designed, longitudinal, case-control family studies of boys and girls with and without ADHD ascertained from psychiatric and paediatric sources. We studied 165 individuals with ADHD and 374 controls followed up longitudinally and masked for 10 years. We assessed ADHD, smoking and substance use status using structured diagnostic interviews. We tested the association between cigarette smoking and subsequent substance use outcomes using Cox proportional hazard regression models.

RESULTS

Youth with ADHD who smoked cigarettes (n = 27) were significantly more likely to subsequently develop drug misuse and dependence compared with youth with ADHD who did not smoke (n = 138, P<0.05).

CONCLUSIONS

These results confirm that cigarette smoking increases the risk for subsequent drug and alcohol use disorders among individuals with ADHD. These findings have important public health implications, and underscore the already pressing need to prevent smoking in children with ADHD.

Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders

BACKGROUND

Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n=303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD.

METHODS

Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo).

RESULTS

Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8±1.1 to 6.2±1.1 cigarettes per day).

CONCLUSIONS

Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel.

Cigarette smoking and short-term addiction treatment outcome

Cigarette smoking is common among patients in cocaine and opioid dependence treatment, and may influence treatment outcome. We addressed this issue in a secondary analysis of data from an outpatient clinical trial of buprenorphine treatment for concurrent cocaine and opioid dependence (13 weeks, N=200). The association between cigarette smoking (lifetime cigarette smoking status, number of cigarettes smoked per day prior to study entry) and short-term treatment outcome (% of urine samples positive for cocaine or opioids, treatment retention) was evaluated with analysis of covariance, bivariate correlations, and multivariate linear regression. Nicotine-dependent smokers (66% of participants) had a significantly higher percentage of cocaine-positive urine samples than non-smokers (12% of participants) (76% vs. 62%), but did not differ in percentage of opioid-positive urine samples or treatment retention. Number of cigarettes smoked per day at baseline was positively associated with percentage of cocaine-positive urine samples, even after controlling for baseline sociodemographic and drug use characteristics, but was not significantly associated with percentage of opioid-positive urine samples or treatment retention. These results suggest that cigarette smoking is associated with poorer short-term outcome of outpatient treatment for cocaine dependence, but perhaps not of concurrent opioid dependence, and support the importance of offering smoking cessation treatment to cocaine-dependent patients.

Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings

This article reviews the research on the treatment of cigarette smoking in individuals who have comorbid mental illnesses or non-nicotinic addictions. The prevalence of smoking in mentally ill and substance-abusing populations is presented, as well as reasons for this high prevalence. The historical role of cigarettes and tobacco in mental illness and addiction is reviewed to help the reader better understand the pervasiveness of smoking in these disorders and the relative absence of intervention efforts in mental heath and addiction treatment settings. The article then discusses the several reasons for integrating smoking treatment into mental health and addiction settings. The outcome research for adult and adolescent comorbid smokers is reviewed, and barriers to treatment are discussed. The review closes with a brief discussion of models of integration and thoughts about prevention.

The impact of cigarette smoking on stimulant addiction

OBJECTIVES

Stimulant users smoke cigarettes at high rates; however, little is known about the relationship between tobacco and stimulants.

METHODS

Our goal in this article is to synthesize a growing literature on the role of cigarette smoking in stimulant addiction.

RESULTS

Early nicotine exposure may influence the development of stimulant addiction. Preclinical and clinical studies suggest a facilitatory role of nicotinic agonists for stimulant addiction. Smoking appears to be associated with more severe stimulant use and poorer treatment outcomes.

CONCLUSIONS

It is important to assess smoking and smoking-related variables within stimulant research studies to more fully understand the comorbidity. Integrating smoking cessation into stimulant treatment may improve nicotine and stimulant treatment outcomes.

Does smoking intervention influence adolescent substance use disorder treatment outcomes?

Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking part in a cigarette smoking intervention efficacy study, assessed at baseline and followed up at 3- and 6-months post-intervention. Analyses compared treatment and control groups on days using alcohol and drugs and proportion abstinent from substance use at follow up assessments. Adolescents in the treatment condition reported significantly fewer days of substance use and were somewhat more likely to be abstinent at 3-month follow up. These findings suggest that tobacco focused intervention may enhance SUD treatment outcome. The present study provides further evidence for the value of addressing tobacco use in the context of treatment for adolescent SUD's.

Relationship Between Ethanol Consumption Level and Lifestyle Status: Excessive Ethanol Consumption Can Account for the Prevalence of Lifestyle-Related Diseases

BACKGROUND

Diseases caused by unhealthful lifestyles, namely lifestyle-related diseases demands prompt solutions including preventive measures and effective treatment, especially in the developed countries. To that effect, clear understandings of such syndromes are required. Our recent observations have indicated that insulin resistance could, at least in part, account for the pathogenesis of lifestyle-related diseases. The aim of this study was to clarify whether excessive ethanol consumption could also be another cause of such diseases.

METHOD

Lifestyle status was assessed based on Breslow's questionnaires of lifestyle index in 519 Japanese males aged 30 to 65 years. Averaged ethanol consumption level was determined by additional questionnaires and insulin resistance level was estimated by homeostasis model assessment.

RESULTS

Ethanol consumption level was inversely associated with the total score on Breslow's lifestyle index. Improper drinking manner was associated with improper habit of smoking and proper habit of eating snacks among six lifestyle factors induced in Breslow's index.

CONCLUSION

Subjects with more unhealthful lifestyles consumed greater amount of ethanol, suggesting that excessive ethanol consumption could be one of causes of lifestyle-related diseases. In addition to insulin resistance syndrome, alcohol-related diseases should be cared to address the issues of lifestyle-related diseases.

No increase in long-term risk for nicotine use disorders after treatment with methylphenidate in children with attention-deficit/hyperactivity disorder (ADHD): evidence from a non-randomised retrospective study

OBJECTIVE

To evaluate long-term effects of methylphenidate (MPH) treatment in ADHD children on the development of nicotine use disorders (SUD-N).

METHODS

Multisite retrospective non-randomised longitudinal study with 215 ADHD children (diagnosis at 9.2 years of age; reassessment for SUD-N at 21.9 years of age) strictly parallel allocated to MPH treated (n = 106) and drug naive (n = 109) children.

RESULTS

There was no difference between the groups with respect to frequency (84% MPH; 89% non-MPH; chi(2) = 1.6; p = 0.21) and age of onset for first cigarette smoking (log rank 1.68; p = 0.19). Continuous smoking was reached by 51% (MPH) and 61% (non-MPH) of the patients. Survival analyses revealed a small and nominally significant delay in age of onset for continuous smoking in the MPH-group (log rank = 3.85; p = 0.049). Nicotine dependency was reached by 20% (MPH) and 27% (non-MPH). Age of onset does not differ between groups (log rank = 2.24; p = 0.13).

DISCUSSION

Limited evidence due to the non-randomised nature of the study is given that MPH does not induce SUD-N. The data suggests there may be a beneficial effect of MPH on delay of onset for continuous nicotine consumption in ADHD patients.

Substitute addiction: a concern for researchers and practitioners

An understanding of the role of substitute addictions remains unclear. This article examines the range and possible reward functions of substitute addictions. We suggest that prevention education and treatment need to take into account substitute addictions as an influential aspect ofrecovery. Research is needed to better understand the prevalence and functions of, and solutions to substitute addictions.

Differential effects of nicotinic antagonists perfused into the nucleus accumbens or the ventral tegmental area on cocaine-induced dopamine release in the nucleus accumbens of mice

RATIONALE

The mesolimbic dopamine (DA) system is considered a principal site for nicotine-cocaine interactions.

OBJECTIVES AND METHODS

The aim of this paper is to study the effects of local perfusions (through the microdialysis cannula) of nicotinic acetylcholine receptor (nAChR) antagonists in the ventral tegmental area (VTA, where mesolimbic DA cell bodies are located) or nucleus accumbens (nAc, where mesolimbic DA nerve terminals project) on cocaine-elicited increase in DA levels in the nAc of mice using intracerebral microdialysis.

RESULTS

Intra-nAc perfusion of mecamylamine (a nonselective central nicotinic antagonist) or coperfusion of methyllycaconitine (MLA, 10 nM) and dihydro-beta-erythroidine (DHbetaE, 10-100 muM) decreased cocaine-elicited increase in DA perfusate levels. In contrast, intra-nAc perfusion of MLA alone (a relatively selective antagonist of alpha7 subunit-containing nAChRs) increased, while DHbetaE (a relatively selective antagonist of heteromeric nAChR subtypes) did not alter, cocaine-elicited increase in DA perfusate levels. Intra-VTA perfusion of MLA (100 nM) or DHbetaE (100 micro M) significantly increased the cocaine-elicited increase of DA levels in the nAc or VTA, whereas DHbetaE and MLA coperfusion or mecamylamine perfusion had no significant effect.

CONCLUSIONS

These results show that intra-nAc and intra-VTA perfusion of nAChR antagonists differentially affect cocaine-elicited increase in DA levels in a region and subtype-specific manner. This suggests that multiple cholinergic/nicotinic pathways influence the effects of cocaine on mesolimbic DA neurons in complex, and sometimes opposing, patterns.

Inhibition of both alpha7* and beta2* nicotinic acetylcholine receptors is necessary to prevent development of sensitization to cocaine-elicited increases in extracellular dopamine levels in the ventral striatum

RATIONALE

Several studies have suggested that nicotine treatment can modulate the behavioral and neurochemical responses to other psychostimulants, such as cocaine.

OBJECTIVES

The current study examined the hypothesis that nicotinic acetylcholine receptor (nAChR) blockade influences the ability of cocaine to elicit increases in extracellular dopamine levels.

MATERIALS AND METHODS

Pharmacological studies using nicotinic antagonists as well as genetic inactivation of beta2* nAChRs were used to determine the effect of nAChR blockade on dopamine levels in ventral striatum elicited by acute or repeated administrations of cocaine in mice.

RESULTS

Administration of mecamylamine (a general nicotinic antagonist that is not highly selective for individual nAChR subtypes) or co-administration of methyllycaconitine (a more selective antagonist of alpha7* nAChRs) with dihydro-beta-erythroidine (a more selective antagonist of beta2* nAChRs and other heteromeric nAChR subtypes) prevented sensitization of cocaine-elicited increases in extracellular DA levels in the ventral striatum in wild-type mice. In contrast, neither of the more specific antagonists alone was effective in preventing sensitization. Finally, methyllycaconitine administration prevents sensitization in beta2-/- mice but not in beta2+/+ or wild-type mice.

CONCLUSIONS

These data indicate that inhibition of both alpha7* and beta2* nAChRs is necessary to prevent development of sensitization of cocaine-elicited increases in extracellular dopamine levels in the ventral striatum of mice.

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.

Is cigarette smoking a gateway to alcohol and illicit drug use disorders? A study of youths with and without attention deficit hyperactivity disorder

BACKGROUND

The goal of this study was to assess whether cigarette smoking is a gateway drug for subsequent alcohol and illicit drug abuse and dependence in youth with Attention Deficit Hyperactivity Disorder (ADHD), and to test if this association is stronger in ADHD youth relative to controls.

METHODS

We used data from a case-control family study of female youth with and without ADHD. We studied 97 ADHD and 203 control youth of both sexes, aged at least 12 years. We assessed ADHD, smoking, and substance use status using structured diagnostic interviews. We tested the association between cigarette smoking and subsequent substance use outcomes using Cox proportional hazard regression models.

RESULTS

ADHD youth who smoked cigarettes (n = 15) were significantly more likely to subsequently use alcohol and illicit drugs as well as to develop abuse and dependence compared to ADHD youth who did not smoke (n = 76; p < .05).

CONCLUSIONS

These results extend the gateway hypothesis to an ADHD sample and provide evidence that this effect may be particularly robust in ADHD youth. If replicated in larger, community-based samples, these findings have important public health consequences, and underscore the already pressing need to prevent smoking in ADHD children.

Harm reduction--the cannabis paradox

This article examines harm reduction from a novel perspective. Its central thesis is that harm reduction is not only a social concept, but also a biological one. More specifically, evolution does not make moral distinctions in the selection process, but utilizes a cannabis-based approach to harm reduction in order to promote survival of the fittest. Evidence will be provided from peer-reviewed scientific literature that supports the hypothesis that humans, and all animals, make and use internally produced cannabis-like products (endocannabinoids) as part of the evolutionary harm reduction program. More specifically, endocannabinoids homeostatically regulate all body systems (cardiovascular, digestive, endocrine, excretory, immune, nervous, musculo-skeletal, reproductive). Therefore, the health of each individual is dependant on this system working appropriately.

Applying a behavioral economic framework to understanding adolescent smoking

Adolescents' choice to smoke may depend on substitute reinforcers for smoking, complementary activities to smoking, and individual differences in reinforcer value. The influence of these variables on smoking was determined among 983 adolescents. Substitutes were school involvement, academic performance, physical activity, and sports team participation: complements were peer smoking and substance use; delay discounting assessed individual differences in reinforcer value. Latent growth modeling indicated that substitute reinforcers reduced the odds of smoking progression almost two-fold, complementary reinforcers increased the odds by 1.14. and delay discounting indirectly influenced the odds of smoking progression through complementary reinforcers. Adolescents who smoke may have fewer reinforcers that protect against smoking and more reinforcers that promote smoking. Discounting of future rewards affects smoking through reinforcer type.

Messages influencing college women's tanning bed use: statistical versus narrative evidence format and a self-assessment to increase perceived susceptibility

Understanding the effect of messages and other influences on health decision-making has the potential to decrease risky behavior such as tanning bed use. This study explores the effect of type of evidence, self-assessments of risk for skin cancer, and personality factors on intention to use and use of tanning beds among Caucasian female college students. Specifically, it targeted the perceived susceptibility component of the Health Belief Model and its impact on intention to tan as well as changes in actual tanning behavior. College students (N=141) in the southeast United States read randomly assigned messages and self-assessments, filled out surveys, and were later contacted for a follow-up telephone survey. The statistical message was rated higher on information value and also resulted in decreased intention to tan, decreased tanning behavior, and increased perceived susceptibility to skin cancer. The narrative message, in contrast, increased perceptions of realism and also worked to decrease intentions to tan. Additionally, the self-assessment manipulation resulted in increased susceptibility and decreased intention to tan and post tanning behavior. Personality factors explained small portions of variance. Key limitations and directions for future research are also addressed.

Estimating the health consequences of replacing cigarettes with nicotine inhalers

BACKGROUND

A fast acting, clean nicotine delivery system might substantially displace cigarettes. Public health consequences would depend on the subsequent prevalence of nicotine use, hazards of delivery systems, and intrinsic hazards of nicotine.

METHODS

A spreadsheet program, DEMANDS, estimates differences in expected mortality, adjusted for nicotine delivery system features and prevalence of nicotine use, by extending the data and methods of the SAMMEC 3 software from the US Centers for Disease Control and Prevention. The user estimates disease risks attributable to nicotine, other smoke components, and risk factors that coexist with smoking. The public health consequences of a widely used clean nicotine inhaler replacing cigarettes were compared to historical observations and public health goals, using four different risk attribution scenarios and nicotine use prevalence from 0-100%.

MAIN OUTCOME MEASURES

Changes in years of potential life before age 85 (YPL85).

RESULTS

If nicotine accounts for less than a third of smokers' excess risk of SAMMEC diseases, as it most likely does, then even with very widespread use of clean nicotine DEMANDS predicts public health gains, relative to current tobacco use. Public health benefits accruing from a widely used clean nicotine inhaler probably equal or exceed the benefits of achieving Healthy People 2010 goals.

CONCLUSIONS

Clean nicotine inhalers might improve public health as much as any feasible tobacco control effort. Although the relevant risk estimates are somewhat uncertain, partial nicotine deregulation deserves consideration as part of a broad tobacco control policy.

Factors associated with volatile solvent use among junior high school students in Kanto, Japan

AIMS

To estimate the relative association between life-time volatile solvent use and risk factors for usage.

DESIGN

Cross-sectional anonymous questionnaire survey.

SETTING

Junior high schools in Kanto, Japan.

PARTICIPANTS

Junior high school students (n = 7744).

MEASUREMENTS

Data on life-time and past-year solvent use, demographic variables, urbanization, regularity of waking patterns, school life, family life, peer relationships, prior alcohol and cigarette use and knowledge on harmful effects of solvent use.

FINDINGS

Uni- and multivariate logistic regression analyses were conducted to estimate crude and adjusted odds ratios for each index. The primary findings were (1) 'smoking cigarettes nearly every day' (adjusted OR = 9.88, 95% Cl = 3.74, 26.12) and peer pressure measured by 'been tempted to use solvents' (adjusted OR = 9.53, 95% Cl = 4.84, 18.74) demonstrated the highest adjusted odds ratios; (2) being male (adjusted OR = 2.56, 95% Cl = 1.37, 4.76), seeing school life as 'not at all enjoyable' (adjusted OR = 2.69, 95% Cl = 1.03, 7.01) and family environment as 'neither good nor bad' (adjusted OR = 2.15, 95% Cl = 1.19, 3.88) also showed significant association; (3) life-time alcohol use did not show a significant association in the multivariate model (adjusted OR = 0.80, 95% Cl = 0.30, 2.12); and (4) solvent use appeared independent of knowledge regarding its effects ('death by acute intoxication', 'psychotic symptoms', 'amotivational syndrome', 'flashbacks' adjusted ORs all non-significant).

CONCLUSION

Alcohol use may not function as a gateway to solvent use in Japan. The reasons may be culture-bound. A longitudinal study is required to test this hypothesis.

Evidence of cross-tolerance between behavioural effects of nicotine and cocaine in mice

RATIONALE

Studies have reported that chronic exposure to nicotine does not alter the effects of cocaine on locomotor activity, and vice versa. However, the apparent lack of effect of one drug on the behavioural response to the other may be due to an exclusive focus on locomotor activity as the target behaviour.

OBJECTIVE

To test whether repeated pretreatment with nicotine causes tolerance or sensitization to cocaine's effects on diverse behaviours: locomotion, rearing, grooming, and immobility. Similarly, the effects of repeated cocaine treatment on the acute response to nicotine were also tested.

METHODS

Mice were pretreated with 14 injections of nicotine (0.3 mg/kg), cocaine (5 mg/kg) or saline, the injections being given once daily, except for three breaks of two days each. Two days after the final pretreatment injection, mice were given a challenge injection of saline, cocaine (3 or 5 mg/kg) or nicotine (0.3 or 1 mg/kg), and observed in a large test cage for 40 min using a time-sampling procedure.

RESULTS

Repeated administration of either drug produced some tolerance to subsequent challenge with the same dose of the drug. Prior nicotine exposure significantly attenuated cocaine-induced decreases in grooming and increases in rearing, but did not significantly affect other behaviours. In contrast, prior cocaine exposure failed to alter nicotine's effects on any behaviour.

CONCLUSIONS

Cross-tolerance between nicotine and cocaine (but not vice-versa) can be demonstrated if several behaviours are observed; measures of locomotor activity are less sensitive to the effect. The asymmetrical pattern of cross-tolerance may be due to differential inhibition of dopamine uptake by the two drugs.

Struggling to understand: the experience of nonsmoking parents with adolescents who smoke

Smoking among adolescents is a major public health concern. Most parents would not want their children engaged in this risk-taking behavior. Although a majority of parents of smokers are themselves smokers, many are nonsmokers. The purpose of this grounded theory study was to understand what nonsmoking parents experience due to their adolescent children 's smoking behavior. The purposive sample consisted of 25 parents. The interview data generated the theory that nonsmoking parents struggle to understand their adolescents' smoking. They experienced four stages: discovering the smoking, facing the problem, reflecting, and waiting it out. Their experience can be examined from a stress paradigm. Programs are needed that provide parents with the knowledge and skills required for effective prevention and intervention strategies.

Prior cigarette smoking initiation predicting current alcohol use: evidence for a gateway drug effect among California adolescents from eleven ethnic groups

Gateway drug theory provides a useful framework for understanding drug use among adolescent populations. Studies have reported a gateway effect of cigarette smoking on alcohol use among adolescents; but there is a lack of knowledge regarding ethnic differences in this effect. Using data from a cross-sectional survey in California, 11,239 subjects (46.3% male) from 31 high schools with at least 25% of total enrollment of Asian and at least 200 students with Asian ancestry entered the analysis. Among them, 6016 were ninth graders (mean age=14.3, S.D.=0.49) and 5223 were twelfth graders (mean age=17.3, S.D.=0.54). After controlling for seven variables, the risk ratio of last 30-day alcohol use among prior smoking initiators vs. noninitiators was 5.82 for non-Hispanic Whites, 4.25 for Blacks, 8.37 for Asian Indians, 3.99 for Chinese, 3.45 for Filipinos, 3.48 for Japanese, 5.41 for Koreans, 7.57 for Vietnamese, 4.02 for Mexicans, 2.64 for South/Central Americans, and 5.95 for adolescents with multiethnic background. Comparison of the 11 ethnic groups indicated that adolescents from different ethnic groups but with similar cultural background had a similar risk level; such pattern existed after controlling for acculturation, parents' monitoring, and school performance. The risk ratio did not differ by gender and grade. There is an association between prior cigarette smoking initiation and current alcohol use among adolescents from different ethnic backgrounds, including those of multiethnicity, which supports the generalizability of gateway drug effect of cigarette smoking on alcohol use. Studies should be conducted to investigate factors attributable to the ethnic variations of this association.

Developmental trajectories of cigarette use from early adolescence into young adulthood

This study identified developmental trajectories of cigarette smoking from early adolescence into young adulthood, and delineated whether risk factors derived from a social learning-problem behavior framework could differentiate among trajectories. Participants (N=374) were interviewed five times from age 12 until age 30/31. Using growth mixture modeling, three trajectory groups were identified--heavy/regular, occasional/maturing out, and non/experimental smokers. Being a female, having higher disinhibition, receiving lower grades, and more frequent use of alcohol or drugs significantly increased the probability of belonging to a smoking trajectory group compared with being a nonsmoker. Higher disinhibition and receiving lower grades also differentiated regular smokers from the rest of the sample. None of the risk factors distinguished occasional from regular smokers. When models were tested separately by sex, disinhibition, other drug use, and school grades were associated with smoking for both sexes. On the other hand, environmental factors, including socioeconomic status, parent smoking and friend smoking, were related to smoking for females but not for males. Sex differences in developmental trajectories and in smoking behavior among regular smokers were notable. Future research should examine transitions and turning points from adolescence to adulthood that may affect cessation and escalation differently for males and females.

Adolescent smoking cessation: how effective have we been?

Adolescent smoking, at its current rate, is considered a pediatric epidemic, with 3,000 youths less than 18 years of age becoming regular smokers each day (Johnson, O'Malley, & Bachman, 1998). The reasons adolescents begin and continue to smoke are multifactorial. There is a paucity of research describing effective adolescent smoking-cessation programs. Much of the research on adolescent tobacco use has focused on correlates and prevention of onset, rather than on intervention with active smokers. Current research indicates that 75% of adolescents who currently smoke want to quit. It is essential that nurses involved with adolescent health promotion become active in smoking-cessation efforts. This article describes the risk factors for adolescent smoking and identifies smoking-cessation strategies, with interventions specific to the adolescent population.

Relationship between cigarette, smokeless tobacco, and cigar use, and other health risk behaviors among U.S. high school students

This study examined relationships between tobacco use and use of other substances, intentional injury risk behaviors, and sexual risk behaviors among US high school students. Data about tobacco use and other health risk behaviors were analyzed from the 1997 national Youth Risk Behavior Survey implemented by the Centers for Disease Control and Prevention. One-fourth of students (24%) reported current use of a single tobacco product (i.e., cigarettes, smokeless tobacco, or cigars during the 30 days preceding the survey), and 19.5% reported currently using more than one tobacco product. Generally, students who reported current tobacco use also reported engaging in other substance use, intentional injury risk behaviors, and sexual risk behaviors. For many risk behaviors, these results were especially pronounced among students who reported using two or all three tobacco products. Programs designed to prevent tobacco use should consider that such use often occurs concomitantly with other health risk behaviors.

Context Dissonance in Tobacco Education Literature

Tobacco education has gained widespread popular and political support and Is incorporated into many public schools' curricula. However, evaluation studies indicate that such programs do not decrease adolescents' smoking rates because program content is often dissonant with adolescents' interpretations of smoking. This study uses social constructionism and content analysis to explore tobacco education literature used in an alternative high school for at-risk youths. Findings indicate that the content's construction of smoking and cessation is dissonant with adolescents' subcultural social contexts. Dissonance-generating elements include decontextualization of smoking; suggested alternatives that are Improbable in adolescents' social contexts; and image biases that reflect stereotypes of age, class, and gender. The conclusion suggests ways to eliminate context dissonance in order to increase adolescents' receptivity to intervention efforts.

Epidemiology of substance use in adolescence: prevalence, trends and policy implications

This paper reviews the epidemiology of substance use among adolescents. There is a public health imperative in all countries to assess the population rates of tobacco, alcohol and illicit drug use among adolescents. In addition, monitoring trends over time may reflect the net effects of activities and programs carried out to prevent adolescent substance use. School based surveys provide prevalence estimates of substance use, but do not capture street and homeless youth and other high risk adolescents not found in the school environment. Overall, the results of this review suggest that tobacco, hazardous alcohol use, and most categories of illicit drug use have shown consistent increases in prevalence since about 1990 in most developed countries, for school-based adolescents, suggesting that the substance use problem among adolescents remains unsolved. These trends are remarkably similar across substance use behaviours, and among most developed countries, although limited data has emanated from adolescents in the developing world. Interventions to reduce or prevent substance use have shown mixed results, with those focusing on the adolescents' social environment showing the most promise. Broader public health approaches, including the linkage to community-wide prevention, and greater enforcement or regulatory and legislative approaches to tobacco and alcohol access are future directions for research and practice.

Other substance use among high school students who use tobacco

PURPOSE

To examine relationships between tobacco use and use of other substances among U.S. high school students, by gender and racial/ethnic subgroups.

METHODS

Data about tobacco and other substance use were analyzed from the 1995 national Youth Risk Behavior Survey implemented by the Centers for Disease Control and Prevention.

RESULTS

Compared to nonsmokers, current smokers were significantly more likely to report use of all other substances we examined, including lifetime use of cocaine, inhalants, other illegal substances, and multiple substances and current alcohol use, episodic heavy drinking, marijuana use, and cocaine use. A strong dose-dependent relationship between current cigarette smoking and other substance use was identified. Among smokeless tobacco users, a strong dose-dependent relationship was found for all examined substances with the exception of lifetime and current cocaine use. Finally, a pattern of risk emerged suggesting that the likelihood of other substance use increases as students move from no tobacco use to smokeless tobacco use only, to cigarette smoking only, and to use of both smokeless tobacco and cigarettes.

CONCLUSIONS

Programs designed to prevent tobacco or other substance use should consider that such use often occurs concomitantly.

[Health-related behaviors in secondary-school students: sexual relations and tobacco, alcohol and cannabis consumption]

BACKGROUND AND OBJECTIVES

The main premature mortality causes among youngsters are related to risk behaviors, usually initiated in adolescence. The study objective is to describe substance use and sexual behaviours among 10th-grade Barcelona students in 1996 (last year of compulsory education), as well as the interrelations between these variables and several sociodemographic variables.

METHODS

Cross sectional study. Random sample including 35 10th grade classrooms (958 students whose mean age is 15.8 years old) stratified by academic or vocational studies, public or private school, school neighbourhood socioeconomical level and school size. Measurement instrument is a previously validated questionnaire. Tobacco, alcohol, and cannabis consumption, sexual intercourse as well as gender, age, weekly available money, parental instruction and type of studies are studied. Bivariate chi 2 analysis and multivariate gender specific log-linear model are performed.

RESULTS

27% of the students smoke daily and 31% drink alcohol weekly. 15% have had sexual intercourse, and among those 79% use always or almost always condoms. Among girls tobacco consumption is related to alcohol (OR = 4.2), to cannabis (OR = 5.9) and sexual intercourse (OR = 3.9), and, less strongly, with age, available money and vocational studies. Alcohol is associated with tobacco and cannabis use (OR = 4.2). Having had sexual intercourse is related to tobacco use, age (OR = 3.4), vocational studies (OR = 2.4) and cannabis experience (OR = 2.8). Among boys tobacco consumption is related to alcohol, (OR = 2.7), to cannabis (OR = 7.6) and sexual intercourse (OR = 4.4), and, less strongly, to available money and type of studies. Alcohol consumption is associated with tobacco and cannabis use (OR = 5.5). Sexual intercourse is related to tobacco use and age (OR = 2.5).

DISCUSSION

Risk behaviors among final year secondary school students are strongly and significantly interrelated, both among boys and among girls, and are more frequent among older students, those with more money available and those in vocational curricula.