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Lam BQ, Srivastava R, Morvant J, Shankar S, Srivastava RK. Association of Diabetes Mellitus and Alcohol Abuse with Cancer: Molecular Mechanisms and Clinical Significance. Cells 2021; 10:cells10113077. [PMID: 34831299 PMCID: PMC8620339 DOI: 10.3390/cells10113077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/28/2021] [Accepted: 11/06/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus (DM), one of the metabolic diseases which is characterized by sustained hyperglycemia, is a life-threatening disease. The global prevalence of DM is on the rise, mainly in low- and middle-income countries. Diabetes is a major cause of blindness, heart attacks, kidney failure, stroke, and lower limb amputation. Type 2 diabetes mellitus (T2DM) is a form of diabetes that is characterized by high blood sugar and insulin resistance. T2DM can be prevented or delayed by a healthy diet, regular physical activity, maintaining normal body weight, and avoiding alcohol and tobacco use. Ethanol and its metabolites can cause differentiation defects in stem cells and promote inflammatory injury and carcinogenesis in several tissues. Recent studies have suggested that diabetes can be treated, and its consequences can be avoided or delayed with proper management. DM has a greater risk for several cancers, such as breast, colorectal, endometrial, pancreatic, gallbladder, renal, and liver cancer. The incidence of cancer is significantly higher in patients with DM than in those without DM. In addition to DM, alcohol abuse is also a risk factor for many cancers. We present a review of the recent studies investigating the association of both DM and alcohol abuse with cancer incidence.
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Affiliation(s)
- Bao Q. Lam
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (B.Q.L.); (S.S.)
| | - Rashmi Srivastava
- Department of Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA;
| | - Jason Morvant
- Department of Surgery, Ochsner Health System, 120 Ochsner Boulevard, Gretna, LA 70056, USA;
- A.B. Freeman School of Business, Tulane University, New Orleans, LA 70118, USA
| | - Sharmila Shankar
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (B.Q.L.); (S.S.)
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
- John W. Deming Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Southeast Louisiana Veterans Health Care System, New Orleans, LA 70119, USA
| | - Rakesh K. Srivastava
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (B.Q.L.); (S.S.)
- A.B. Freeman School of Business, Tulane University, New Orleans, LA 70118, USA
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
- Correspondence:
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López-Pelayo H, Campeny E, Oliveras C, Rehm J, Manthey J, Gual A, Balcells-Olivero MDLM. Early, Chronic, and Acute Cannabis Exposure and Their Relationship With Cognitive and Behavioral Harms. Front Psychiatry 2021; 12:643556. [PMID: 34434125 PMCID: PMC8381725 DOI: 10.3389/fpsyt.2021.643556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Cannabis is the third most consumed drug worldwide. Thus, healthcare providers should be able to identify users who are in need for an intervention. This study aims to explore the relationship of acute, chronic, and early exposure (AE, CE, and EE) to cannabis with cognitive and behavioral harms (CBH), as a first step toward defining risky cannabis use criteria. Methods: Adults living in Spain who used cannabis at least once during the last year answered an online survey about cannabis use and health-related harms. Cannabis use was assessed in five dimensions: quantity on use days during the last 30 days (AE), frequency of use in the last month (AE), years of regular use (YRCU) (CE), age of first use (AOf) (EE), and age of onset of regular use (AOr) (EE). CBH indicators included validated instruments and custom-made items. Pearson correlations were calculated for continuous variables, and Student's t-tests for independent samples were calculated for categorical variables. Effect sizes were calculated for each of the five dimensions of use (Cohen's d or r Pearson correlation) and harm outcome. Classification and Regression Trees (CART) analyses were performed for those dependent variables (harms) significantly associated with at least two dimensions of cannabis use patterns. Lastly, logistic binary analyses were conducted for each harm outcome. Results: The mean age of participants was 26.2 years old [standard deviation (SD) 8.5]. Out of 2,124 respondents, 1,606 (75.6%) reported at least one harm outcome (mean 1.8 and SD 1.5). In our sample, using cannabis on 3 out of 4 days was associated with an 8-fold probability of scoring 4+ on the Severity Dependence Scale (OR 8.33, 95% CI 4.91-14.16, p <0.001), which is indicative of a cannabis use disorder. Also, a start of regular cannabis use before the age of 25 combined with using cannabis at least once per month was associated with a higher probability of risky alcohol use (OR 1.33, 95% CI 1.12-1.57, p = 0.001). Besides, a start of regular cannabis use before the age of 18 combined with a period of regular use of at least 7.5 years was associated with a higher probability of reporting a motor vehicle accident (OR 1.81, 95% CI 1.41-2.32, p < 0.0001). Results were ambiguous regarding the role that age of first use and milligrams of THC per day of use might play regarding cannabis-related harms. Conclusions: The relationship among AE, CE, and EE with CBH indicators is a complex phenomenon that deserves further studies. The pattern of cannabis use should be carefully and widely evaluated-(not just including frequency but also other dimensions of pattern of use)-in research (preferably in longitudinal studies) to assess cannabis-related harms.
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Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Eugènia Campeny
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Clara Oliveras
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jürgen Rehm
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Dalla Lana School of Public Health, University of Toronto (UofT), Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jakob Manthey
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Antoni Gual
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria de Las Mercedes Balcells-Olivero
- Grup Recerca en Addiccions Clinic (GRAC), Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Psychiatry Department, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
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Estévez-Lamorte N, Foster S, Eich-Höchli D, Moggi F, Gmel G, Mohler-Kuo M. Adult attention-deficit/hyperactivity disorder, risky substance use and substance use disorders: a follow-up study among young men. Eur Arch Psychiatry Clin Neurosci 2019; 269:667-679. [PMID: 30483874 DOI: 10.1007/s00406-018-0958-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
We investigated whether adult attention-deficit/hyperactivity disorder (ADHD) predicts risky substance use and substance use disorders (SUDs), and its impact on the course of these problematic substance use patterns. Our sample included 4975 Swiss men (mean age 20 ± 1.2 years) who participated in the baseline and 15-month follow-up assessments of the Cohort Study on Substance Use Risk Factors. We examined: (1) the contribution of ADHD, as assessed at baseline, on the risky use of alcohol, nicotine and cannabis, and their corresponding use disorders (AUD, NUD, CUD) at follow-up; and (2) the association between ADHD and the course of outcomes (i.e., absence, initiation, maturing out, persistence) over 15 months. All analyses were adjusted for socio-demographics and co-morbidity. Men with ADHD were more likely to exhibit persistent risky alcohol and nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively linked to AUD and negatively to CUD at follow-up, but not to NUD. For all SUDs, ADHD had a positive association with use persistence and maturing out. Comparing these two trajectories revealed that early age of alcohol use initiation distinguished between persistence and maturing out of AUD, while the course of NUD and CUD was related to ADHD symptoms and SUD severity at baseline. Already in their early twenties, men with ADHD are especially likely to exhibit persistent problematic substance use patterns. Substance-specific prevention strategies, particularly implemented before early adulthood, may be crucial to reducing the development and persistence of pathological patterns in such individuals.
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Affiliation(s)
- Natalia Estévez-Lamorte
- La Source, School of Nursing Sciences, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland. .,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland. .,Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland. .,Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland.
| | - Simon Foster
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland.,Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | | | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of the West of England, Frenchay Campus Coldharbour Lane, Bristol, UK
| | - Meichun Mohler-Kuo
- La Source, School of Nursing Sciences, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland.,Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
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Casajuana C, López-Pelayo H, Balcells MM, Miquel L, Colom J, Gual A. Definitions of Risky and Problematic Cannabis Use: A Systematic Review. Subst Use Misuse 2016; 51:1760-70. [PMID: 27556867 DOI: 10.1080/10826084.2016.1197266] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Although cannabis is widely used, it remains unclear which consumption patterns are more likely to produce future consequences (risky/hazardous use) or current damage (problematic/harmful use). This unresolved issue contributes to cannabis public health implications. In order to facilitate further consensus, this review analyzes previously used definitions in the literature. METHODS This systematic review was performed following the PRISMA guidelines. Articles published before October 2015 in the Medline, Scopus-Elsevier, ISI-Web of Knowledge and Cochrane databases and fulfilling a-priori decided criteria were retrieved. Definitions in preselected websites of national and international organizations addressing drug problems were also included. RESULTS Definitions identified in articles (n = 46) and official websites (n = 3) widely varied from each other. Weekly cannabis use was mostly considered risky. Problematic cannabis use was mostly described with the Cannabis Abuse and Screening Test. Evidence-based definitions as well as information on quantities consumed, time-frames and special considerations for risky groups were very limited. CONCLUSIONS Working on official definitions is highly necessary as criteria used remain incomplete, leading to increased confusion in the field. Recommendations to improve existing definitions are given.
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Affiliation(s)
- Cristina Casajuana
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,d Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Hugo López-Pelayo
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,e Fundació Clínic per la Recerca Biomédica , Barcelona , Spain
| | - María Mercedes Balcells
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain
| | - Laia Miquel
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,d Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
| | - Joan Colom
- f Departament de Drogodependències , Agència de Salut Pública de Catalunya , Barcelona , Spain
| | - Antoni Gual
- a Addictions Unit, Universitat de Barcelona , Barcelona , Spain.,b Grup de Recerca en Adiccions Clínic (GRAC) , Barcelona , Spain.,c Red de Trastornos Adictivos (RTA) , Barcelona , Spain.,d Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain
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Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men. Epidemiol Psychiatr Sci 2016; 25:255-66. [PMID: 25989844 PMCID: PMC6998734 DOI: 10.1017/s2045796015000360] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Functional and mental health impairments that adults with attention-deficit/hyperactivity disorder (ADHD) experience may be exacerbated by regular substance use and co-morbidity with substance use disorders (SUD). This may be especially true during young adulthood, which represents a critical stage of life associated with increased substance use and associated problems. However, previous studies investigating the association between ADHD and substance use and SUD have demonstrated inconsistent results, probably due to methodological limitations (e.g., small and non-representative samples). Thus, the relationship of ADHD with substance use and related disorders remains unclear. The aim of the present study was to examine the association between ADHD and both the use of licit and illicit substances and the presence of SUD in a large, representative sample of young men. METHOD The sample included 5677 Swiss men (mean age 20 ± 1.23 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed using the adult ADHD Self Report Screener (ASRS). The association between ADHD and substance use and SUD was assessed for alcohol, nicotine, cannabis and other illicit drugs, while controlling for socio-demographic variables and co-morbid psychiatric disorders (i.e., major depression (MD) and anti-social personality disorder (ASPD)). RESULTS Men with ADHD were more likely to report having used nicotine, cannabis and other illicit drugs at some time in their life, but not alcohol. ADHD was positively associated with early initiation of alcohol, nicotine and cannabis use, the risky use of these substances, and the presence of alcohol use disorders, and nicotine and cannabis dependence. Additionally, our analyses revealed that these patterns are also highly associated with ASPD. After adjusting for this disorder, the association between ADHD and licit and illicit substance use and the presence of SUDs was reduced, but remained significant. CONCLUSIONS Our findings suggest that adult ADHD is significantly associated with a propensity to experiment with licit and illicit substances, especially at earlier ages, to exhibit risky substance use patterns, and to subsequently develop SUDs. Preventive strategies that include early intervention and addressing co-morbidity with ASPD may be crucial to reducing substance use and the development of pathological substance use patterns in young men affected by ADHD and, thus, helping to prevent further illness burden later in life.
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Gmel G, Mohler-Kuo M, Dermota P, Gaume J, Bertholet N, Daeppen JB, Studer J. Religion is good, belief is better: religion, religiosity, and substance use among young Swiss men. Subst Use Misuse 2013; 48:1085-98. [PMID: 24041170 DOI: 10.3109/10826084.2013.799017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We examined the influence of religious denomination (RD) and religiosity/spirituality on licit and illicit substance use beyond the potential impact of parental variables. Data from a representative sample of Swiss men (n = 5,387) approximately 20 years old were collected between August 2010 and November 2011. We asked single item questions about RD and religious self-description (RSD) (including aspects of spirituality). Alcohol use, smoking, and illicit drug use was measured as outcome variables. Logistic regressions (adjusting for parenting and socioeconomic background) revealed that religiosity/spirituality was inversely associated with substance use and that it was more strongly associated than denomination. RD, particularly having no denomination, was independently associated with the use of most substances. The study's limitations, and the implications for future work are noted.
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Affiliation(s)
- Gerhard Gmel
- 1Alcohol Treatment Centre, Lausanne University Hospital CHUV , Lausanne , Switzerland
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Fischer R, Clair C, Studer J, Cornuz J, Gmel G. Prevalence and factors associated with use of smokeless tobacco in young Swiss men. Eur J Public Health 2013; 24:459-64. [PMID: 23813708 DOI: 10.1093/eurpub/ckt086] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Smokeless tobacco is of increasing interest to public health researchers and policy makers. This study aims to measure prevalence of smokeless tobacco use (nasal dry snuff, snus and chewing tobacco) among young Swiss men, and to describe its correlates. METHODS We invited 13 245 young men to participate in this survey on socio-economic and substance use data. Response rate was 45.2%. We included 5720 participants. Descriptive statistics and multivariable-adjusted logistic regression were performed. RESULTS Mean age of participants was 19.5 years. Self-reported use once a month or more often was 8% for nasal dry snuff, 3% for snus and negligible for chewing tobacco. In multivariable-adjusted logistic regression, the odds for nasal dry snuff use increased in non daily smokers [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.90-3.05], compared with non smokers, participants reporting risky weekly drinking volume (OR 3.93, 95% CI 1.86-8.32), compared with abstinents, and binge drinking once a month or more often (OR 7.41, 95% CI 4.11-13.38), compared with never binge drinking. Nasal dry snuff use was positively associated with higher BMI, average or above family income and German language, compared with French, and negatively associated with academic higher education, compared with non higher education, and occasional cannabis use, compared with no cannabis use. Correlates of snus were similar to those of nasal dry snuff. CONCLUSION One in 12 young Swiss men use nasal dry snuff and 3% use snus. Consumption of smokeless tobacco is associated with a cluster of other risky behaviours, especially binge drinking.
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Affiliation(s)
- Roland Fischer
- 1 Department for Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Carole Clair
- 1 Department for Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Joseph Studer
- 2 Alcohol Treatment Centre, Lausanne University Hospital CHUV, Switzerland
| | - Jacques Cornuz
- 1 Department for Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Gerhard Gmel
- 2 Alcohol Treatment Centre, Lausanne University Hospital CHUV, Switzerland3 Addiction Suisse, Lausanne, Switzerland
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Gmel G, Gaume J, Bertholet N, Flückiger J, Daeppen JB. Effectiveness of a brief integrative multiple substance use intervention among young men with and without booster sessions. J Subst Abuse Treat 2013; 44:231-40. [DOI: 10.1016/j.jsat.2012.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 05/27/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
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Bélanger RE, Akre C, Kuntsche E, Gmel G, Suris JC. Adding tobacco to cannabis--its frequency and likely implications. Nicotine Tob Res 2011; 13:746-50. [PMID: 21454910 DOI: 10.1093/ntr/ntr043] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
INTRODUCTION Young cannabis users are at increased risk of later cigarette initiation and progression to nicotine addiction. The present study addresses the frequency at which mulling (adding tobacco to cannabis smoked as joints) is performed and in which way this practice varies according to cigarette smoking status. METHODS Data were issued from the Swiss 2007 European School Survey Project on Alcohol and other Drugs (ESPAD). A total of 881 past month cannabis users (mean age 15 years, boys 60.1%) were inquired on mulling using an anonymous self-administered questionnaire. Participants were further grouped according to their cigarette smoking status (daily, occasional, former, and never-smokers). RESULTS Four of every 5 cannabis users depicted mulling as frequently performed. The highest occurrence was found among daily cigarette smokers (DSC; 90.3%), while former cigarette smokers reported the lowest (58.9%). The multinomial logistic regression showed DSC more likely reporting mulling as frequent compared with never-smokers (risk ratio = 3.56 [95% CI 1.55-8.21]). CONCLUSIONS Mulling appears to be a very common process among young cannabis users, especially among concomitant cigarette smokers. Nevertheless, the majority of cigarette abstainers also reported frequently adding tobacco to the cannabis they smoke. Because it may represent a significant exposition to nicotine, mulling should be taken into account when assessing substance use among adolescents and in supporting their quitting attempts.
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Affiliation(s)
- Richard E Bélanger
- Research Group on Adolescent Health, Institute for Social and Preventive Medicine, Rte de la Corniche 2, Bâtiment Biopôle 1, Epalinges, Switzerland
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