Serving Substance Abuse Professionals Since 1993

Last Update: 27.11.11

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Drug Laws

95 citations. January 2010 to present

Prepared: December 2011

Amirav I; Luder A; Viner Y; Finkel M. Decriminalization of cannabis: Potential risks for children? Acta Paediatrica 100(4): 618-619, 2011. (9 refs.)

The legalization of cannabis for medicinal purposes is becoming increasingly widespread worldwide. The anticipated growing ease of access to cannabis may create an increased risk for passive and/or active ingestion by children. We report a case of a 1.5-year-old infant who presented with unexplained coma that was later proved to be associated with the ingestion of cannabis. This case highlights the importance of considering cannabis ingestion in the differential diagnosis of infantile and toddler coma and the need for public education regarding the risks of childhood exposure in the light of the legalization of cannabis for medical purposes and its greater availability.

Anger S; Kvasnicka M; Siedler T. One last puff? Public smoking bans and smoking behavior. Journal of Health Economics 30(3): 591-601, 2011. (28 refs.)

This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany's federal states. We exploit this variation to identify the effect that smoke-free policies had on individuals smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates point to important heterogeneous effects. Individuals who go out more often to bars and restaurants did adjust their smoking behavior. Following the ban, they became less likely to smoke and also smoked less.

Attaran A; Bate R; Kendall M. Why and how to make an international crime of medicine counterfeiting. Journal of International Criminal Justice 9(2): 325-354, 2011. (64 refs.)

The article explores why - when the counterfeiting of medicines is so prevalent, hard to detect and quietly dangerous or fatal - it remains totally unaddressed and therefore legal in international criminal law. It is argued that criminalizing the counterfeiting of medicines on an international scale would present no legally insurmountable barriers, and would offer significant advantages over the current national-scale approaches. The authors propose a legal definition of 'counterfeit', canvass the current legal doctrines that could be arrayed to better criminalize medicine counterfeiting, including classifying the severest instances as crimes against humanity, and explain the mechanisms necessary to close the jurisdictional gaps that are currently exploited by organized criminals who trade in counterfeit medicines across borders. They suggest that a counterfeit medicine treaty should be drafted under the auspices of the World Health Organization, and illustrate the feasibility of doing so with existing and developing treaty law on another health danger, tobacco.

Ayo-Yusuf OA; Connolly GN. Applying toxicological risk assessment principles to constituents of smokeless tobacco products: implications for product regulation. Tobacco Control 20(1): 53-57, 2011. (39 refs.)

Objective To determine how information on chemical constituents of different smokeless tobacco products (STPs) may be used in cancer risk assessment for regulatory purposes. Methods This study investigated select STP constituents potentially associated with significant cancer risk by applying a known toxicological risk assessment framework. Cancer risk estimates were obtained for selected constituents of STPs and a medicinal nicotine gum formulation with comparable toxicity information and also median concentration data on the GothiaTek analytes. The calculated cancer risk was considered 'unacceptable' if it exceeded the US Environmental Protection Agency's (USEPA's) benchmark of an 'acceptable' cancer risk of 10E - 6. Results The cancer risk estimates derived from daily use of 10 g of STPs meeting the industry-set GothiaTek limits exceed the levels generally considered 'acceptable' by the USEPA at least 8000 times. Except for the medicinal nicotine tested, all the STP types, including the relatively lower tobacco specific nitrosamine (TSNA)-containing snus, were found to carry an 'unacceptable' cancer risk. The calculated cancer risks associated with the snus and the US moist snuff products were, respectively, at least 1000 times and 6000 times greater than the minimum acceptable. TSNA and cadmium are associated with the largest estimated cancer risks for all the STPs evaluated. Conclusions This study's findings provide an empirical risk assessment that could guide STP regulation using an existing toxicological assessment framework. The study findings question the scientific rationale of the industry-set standards and highlight the need for regulatory actions to reduce specific toxicants in all STPs.

Bajoga U; Lewis S; McNeill A; Szatkowski L. Does the introduction of comprehensive smoke-free legislation lead to a decrease in population smoking prevalence? Addiction 106(7): 1346-1354, 2011. (22 refs.)

Aims: To investigate changes in population smoking prevalence in jurisdictions which have implemented comprehensive smoke-free legislation, taking into account long-term trends in smoking behaviour. Design Interrupted time series analysis of population-level survey data using segmented regression. Setting Twenty-one countries, American states or Canadian provinces which have implemented comprehensive smoke-free legislation. Participants Respondents sampled in large representative surveys of smoking prevalence. Measurements For each jurisdiction, segmented regression models quantify any upwards or downwards trend in smoking prevalence prior to the introduction of smoke-free legislation, any immediate change in the level of smoking prevalence at the time smoke-free legislation was introduced, and any change in the trend in smoking prevalence post-legislation compared to the pre-legislation period. Findings In all but three locations there was a statistically significant decline in smoking prevalence prior to the introduction of smoke-free legislation. In two locations, Washington and the Republic of Ireland, there was an immediate decline in the level of smoking prevalence at the introduction of legislation. In six American states there was a significant change in the rate of decline in smoking prevalence, with smoking prevalence declining more steeply in the post-legislation period compared to the pre-legislation period. No change in the level or trend of population smoking prevalence was seen in 13 of the 21 locations studied. Conclusions The introduction of comprehensive smoke-free legislation has increased the rate at which smoking prevalence was declining in some locations, but in the majority of jurisdictions had no measureable impact on existing trends in smoking prevalence.

Barry CL; Huskamp HA. Moving beyond parity - Mental health and addiction care under the ACA. (editorial). New England Journal of Medicine 365(11): 973-975, 2011. (5 refs.)

Bogdanovica I; McNeill A; Murray R; Britton J. What factors influence smoking prevalence and smoke free policy enactment across the European Union Member States. PLoS ONE 6(8): article e23889, 2011. (40 refs.)

Background: Smoking prevention should be a primary public health priority for all governments, and effective preventive policies have been identified for decades. The heterogeneity of smoking prevalence between European Union (EU) Member States therefore reflects, at least in part, a failure by governments to prioritise public health over tobacco industry or possibly other financial interests, and hence potentially government corruption. The aims of this study were to test the hypothesis that smoking prevalence is higher in countries with high levels of public sector corruption, and explore the ecological association between smoking prevalence and a range of other national characteristics in current EU Member States. Methods: Ecological data from 27 EU Member States were used to estimate univariate and multivariate correlations between smoking prevalence and the Transparency International Corruption Perceptions Index, and a range of other national characteristics including economic development, social inclusion, quality of life and importance of religion. We also explored the association between the Corruption Perceptions Index and measures of the extent to which smoke-free policies have been enacted and are enforced. Results: In univariate analysis, smoking prevalence was significantly higher in countries with higher scores for corruption, material deprivation, and gender inequality; and lower in countries with higher per capita Gross Domestic Product, social spending, life satisfaction and human development scores. In multivariate analysis, only the corruption perception index was independently related to smoking prevalence. Exposure to tobacco smoke in the workplace was also correlated with corruption, independently from smoking prevalence, but not with the measures of national smoke-free policy implementation. Conclusions: Corruption appears to be an important risk factor for failure of national tobacco control activity in EU countries, and the extent to which key tobacco control policies have been implemented. Further research is needed to assess the causal relationships involved.

Brecht ML; Urada D. Treatment outcomes for methamphetamine users: California proposition 36 and comparison clients. Journal of Psychoactive Drugs 2011(7): 68-76, 2011. (42 refs.)

Methamphetamine (meth) is a major drug of abuse in California and several other states, particularly among criminal offender populations. Over the past decade, substance abuse treatment systems have had to adapt to and accommodate the increasing needs of meth users and, in California, deal with the impact of Proposition 36, which has resulted in a greater number of criminal offenders entering the treatment system. This study examines selected treatment performance and outcome indicators for California Proposition 36 offenders entering substance abuse treatment for meth use and compares their performance and outcomes to other subgroups of California treatment clients differentiated by whether or not they were admitted to treatment through Proposition 36 and whether or not their primary substance was meth. Significant improvements in all outcome domains were seen across the populations, and treatment performance and outcomes were not substantively inferior for the offender or meth-using groups.

Bruintjes G; Bartelson BB; Hurst P; Levinson AH; Hokanson JE; Krantz MJ. Reduction in acute myocardial infarction hospitalization after implementation of a smoking ordinance. American Journal of Medicine 124(7): 647-654, 2011. (27 refs.)

BACKGROUND: Smoking ordinances have been associated with reduced acute myocardial infarction rates, but nearly all studies lack patient-level data. OBJECTIVE: We determined whether a smoking ordinance was associated with a reduction in hospitalizations for acute myocardial infarction, irrespective of smoking status and infarct presentation (ST elevation vs. non-ST elevation). METHODS: Detailed chart abstraction of biomarkers to confirm first acute myocardial infarction events was performed from the single community hospital serving Greeley, Colorado and adjacent zip codes, 17 months before and 31 months after implementing a public smoking ordinance. Poisson regression analysis, adjusted for population growth, was used to assess changes in mean incidence rates. RESULTS: A total of 706 hospitalizations were identified from July 2002 through June 2006: 482 among Greeley city residents and 224 within adjacent zip code areas. A postordinance reduction in hospitalizations was observed in Greeley (relative risk [RR] 0.73; 95% confidence interval [CI], 0.59-0.90). A smaller, nonsignificant decrease was noted in the area immediately surrounding Greeley (RR 0.83; 95% CI, 0.61-1.14). However, the comparison of relative risk reductions between Greeley and the surrounding area was not significant (P = .48). The reduction in Greeley was more pronounced among smokers (RR 0.44; 95% CI, 0.29-0.65) than nonsmokers (RR 0.86; 95% CI, 0.67-1.09) and did not differ by acute myocardial infarction presentation (P = .38). CONCLUSIONS: A smoking ordinance was associated with a decrease in acute myocardial infarction hospitalizations of a magnitude similar to previous reports, but could not be distinguished from the adjacent geographic area. Reductions were greatest among smokers, despite previous studies suggesting that benefits accrue primarily among nonsmokers. Smoke-free policy may therefore exert a beneficial effect among smokers, who are disproportionately exposed to direct and sidestream smoke.

Butler S. Addiction counsellors in the Republic of Ireland: Exploring the emergence of a new profession. Drugs: Education, Prevention and Policy 18(4): 295-302, 2011. (31 refs.)

This article reviews the emergence and expansion of addiction counselling as a specialist form of professional practice with problem drinkers and drug users in Ireland, over the past 30 years. It sees addiction counselling as having its roots in a widely shared disenchantment with the ''medical model'' of addiction treatment, and identifies the main factors which have shaped the growth of this new profession over this period. It is argued that statutory health authorities have largely allowed addiction counselling to evolve in an ad hoc style: ceding maximum discretion to individual counsellors and teams of counsellors, while making minimal efforts to standardize counsellor training or to integrate the counsellors'' work into a broader, coherent health service response. Reference is made to attempts currently under way to establish statutory registration systems for addiction counsellors in this country, which, if successful, should raise standards of practice and provide greater protection for members of the public availing themselves of such services. It is also argued, however, that both statutory registration and implementation of Tiered Care models of service delivery are likely to reduce the level of autonomy which addiction counsellors have traditionally enjoyed vis-a-vis service managers.

Capps B. Libertarianism, legitimation, and the problems of regulating cognition-enhancing drugs. Neuroethics 4(2, special issue): 119-128, 2011. (47 refs.)

Some libertarians tend to advocate the wide availability of cognition-enhancing drugs beyond their current prescription-only status. They suggest that certain kinds of drugs can be a component of a prudential conception of the "good life" they enhance our opportunities and preferences; and therefore, if a person freely chooses to use them, then there is no justification for the kind of prejudicial, authoritative restrictions that are currently deployed in public policy. In particular, this libertarian idea signifies that if enhancements are a prudential 'good' for the user, then this can also be construed as a moral good for all rational agents. If this argument is successful, there can be no substantial distinction between the categorical benefits of enhancement, and what is labeled as an enhancement technology. In this paper, I argue that the exclusivity of egotistical choice, and an uncritical deployment of enhancement as a prudential good, underplays the role of a social and political community when creating a procedurally just and effective public policy. Principally, the argument is devoid of any ethical system to permit the external-and therefore public-appreciation of the social context of moral decisions. In effect, libertarian arguments of this sort must disregard any ideas of public ethics, because the liberty to use whatever means available to gain a socio-economic advantage actually extinguishes any professed legitimation strategy. Escaping the procedural aspects of public policy, which are considered integral to authoritative coherence, results in the erosion of any moral obligations. Thus, in a libertarian society, disenfranchised individuals-such as those harmed through addiction-are the unlucky or superfluous product of a liberal and 'progressive' society.

Cohen BMZ; Butler R. BZP-party pills: A review of research on benzylpiperazine as a recreational drug. (review). International Journal of Drug Policy 22(2): 95- 101, 2011. (41 refs.)

Background: BZP-party pills are yet another 'designer drug' which mimics the stimulant qualities of amphetamines and MDMA/Ecstasy. As legal markets for the substance have developed in the last decade (especially amongst young people) so has public and governmental concern. Methods: This article provides a summary of the available international research on benzylpiperazine (BZP) and its popular use in the compound form known as 'party pills'. Through performing an analysis of the available medical and social scientific literature, the review outlines current knowledge on the compound, the prevalence of usage of BZP-party pills, as well as the associated harms, risks and rationales for use of the drug. Results: Despite moves towards legislative control of BZP-party pills, the evidence presented suggests limited social and health harms associated with the drug, although research on long term effects is a significant gap in the literature. It also remains inconclusive as to whether BZP-party pills act as a 'gateway' to illegal drugs or, conversely, play a role in harm reduction with illegal drug users turning to legal alternatives; there is some evidence for both positions. Conclusion: With increasing controls of BZP-party pills, and with the increasing numbers of 'legal highs' and new designer drugs on the market, we conclude that new legal alternatives will continue to surface to replace the drug in the future. Considering a harm reduction approach to drug taking, it is suggested that policy makers consider the creation of a legal holding category which restricts and regulates the market in legal highs whilst the social and health harms associated with each drug can be thoroughly investigated.

Cohen JE; Planinac L; Lavack A; Robinson D; O'Connor S; DiNardo J. Changes in retail tobacco promotions in a cohort of stores before, during, and after a tobacco product display ban. American Journal of Public Health 101(10): 1879-1881, 2011. (18 refs.)

We used a longitudinal design to investigate the impact of a government policy banning the display of tobacco products at the point of sale. The extent of tobacco promotions in 481 randomly selected stores was documented at 4 points in time (2005-2009). Tobacco promotions were greatly reduced after implementation of the display ban. A ban on the display of tobacco products and other signage and promotions at retail is a critical tobacco-control policy to reduce people's exposure to tobacco marketing.

Corral JE; Cornejo JA; Barnoya J. Bars' and restaurants' compliance with the Guatemalan smoke-free law during the 2010 Soccer World Cup: A missed opportunity. Tobacco Control 20(6): 445-446, 2011. (9 refs.)

On February 2009, the Guatemalan Congress passed a nationwide law that banned smoking in all workplaces, including bars and restaurants. The Ministry of Health (MoH) is responsible for monitoring law compliance and fining violators. Individuals and venues are subject to economic fines when they break the law. The Soccer World Cup is the biggest sporting event worldwide (more than 700 hundred million people watched the televised final match).5 In Guatemala, thousands of soccer fans rush to bars and restaurants to watch the games. Employee absenteeism rate is reported to be 20% and sales in bars and restaurants expected to increase up to 300% during the tournament.6-8 Therefore, this was a great opportunity for the MoH to strengthen law enforcement and collect fines. This study sought to monitor law compliance in bars and restaurants during the 2010 Soccer World Cup. Between two and five research assistants watched each game for customers smoking inside, inappropriate 'No-Smoking' signage and availability of a smoking section. Overall, 114 observations were made during 29 matches (12 venues were visited twice). The mean number of customers per game was 21.4 (SD 3.99) in bars and 56.2 (SD 8.35) in restaurants. The most frequent violation was allowing smoking inside the venue ( while inappropriate 'No Smoking' signage in the venue would have yielded the highest total fine revenue. If appropriately enforced, the MoH could have collected US$88?259 in fines. Funds collected over this 1-month period would have been enough to hire 16 MoH staff to effectively monitor, track and fine the offending businesses for 1 year.

Crosbie E; Sebrie EM; Glantz SA. Strong advocacy led to successful implementation of smokefree Mexico City. Tobacco Control 20(1): 64-72, 2011. (100 refs.)

Objective To describe the approval process and implementation of the 100% smokefree law in Mexico City and a competing federal law between 2007 and 2010. Methods Reviewed smokefree legislation, published newspaper articles and interviewed key informants. Results Strong efforts by tobacco control advocacy groups and key policymakers in Mexico City in 2008 prompted the approval of a 100% smokefree law following the WHO FCTC. As elsewhere, the tobacco industry utilised the hospitality sector to block smokefree legislation, challenged the City law before the Supreme Court and promoted the passage of a federal law that required designated smoking areas. These tactics disrupted implementation of the City law by causing confusion over which law applied in Mexico City. Despite interference, the City law increased public support for 100% smokefree policies and decreased the social acceptability of smoking. In September 2009, the Supreme Court ruled in favour of the City law, giving it the authority to go beyond the federal law to protect the fundamental right of health for all citizens. Conclusions Early education and enforcement efforts by tobacco control advocates promoted the City law in 2008 but advocates should still anticipate continuing opposition from the tobacco industry, which will require continued pressure on the government. Advocates should utilise the Supreme Court's ruling to promote 100% smokefree policies outside Mexico City. Strong advocacy for the City law could be used as a model of success throughout Mexico and other Latin American countries.

Currie LM; Clancy L. The road to smoke-free legislation in Ireland. Addiction 106(1): 15-24, 2011. (26 refs.)

Aim: To describe the process through which Ireland changed its policies towards smoking in work-places and distil lessons for others implementing or extending smoke-free laws. Design, setting, participants, measurements This analysis is informed by a review of secondary sources including a commissioned media analysis, documentary analysis and key informant interviews with policy actors who provide insight into the process of smoke-free policy development. The policy analysis techniques used include the development of a time-line for policy reform, stakeholder analysis, policy mapping techniques, impact analysis through use of secondary data and a review process. The policy analysis triangle, which highlights the importance of examining policy content, context, actors and processes, will be used as an analytical framework. Findings: The importance of the political, economic, social and cultural context emerged clearly. The interaction of the context with the policy process both in identification of need for policy and its formulation demonstrated the opportunity for advocates to exert influence at all points of the process. The campaign to support the legislation had the following characteristics: a sustained consistent simple health message, sustained political leadership/commitment, a strong coalition between the Health Alliance, the Office of Tobacco Control and the Department of Health and Children, with cross-party political support and trade union support. The public and the media support clearly defined the benefit of deliberate and consistent planning and organization of a communication strategy. Conclusions: The Irish smoke-free legislation was a success as a policy initiative because of timing, dedication, planning, implementation and the existence of strong leadership and a powerful convinced credible political champion.

Danishevskiy K; McKee M. Tobacco: A product like any other? Health Economics, Policy and Law 6(2): 265-272, 2011. (20 refs.)

Legislation in most countries regulates trade in poisons and highly addictive products, such as narcotics. The statements that (1) tobacco harms health and (2) causes addiction are established as facts in international and national law. Yet in Russia, and in many other countries, there is a contradiction between the open sale of this addictive poison and basic laws, such as those on product safety. Provisions in both the Russian constitution and the criminal code can be interpreted as making the sale of tobacco illegal, setting out severe penalties for those involved. Yet, remarkably, tobacco is treated quite differently from other products. In this paper, we describe the experience so far in seeking to enforce this legislation in Russia. Attempts to persuade the police to enforce the legislation have been unsuccessful, although they accept that there is a prima facie case for action but, in private, express fear of taking it. The case for action is currently being argued before the Russian Supreme Court but this could take many years to reach a conclusion. In the mean time, new legislation on the regulation of tobacco production has been passed by the State Duma, with the support of the tobacco industry, which implicitly assumes that tobacco is a lawful product, thereby creating legal confusion. We argue that the only way to redress this situation is to recognize that tobacco production and sales must be regulated in the same way as any other harmful and addictive substance.

Dave D; Mukerjee S. Mental health parity legislation, cost-sharing and substance-abuse treatment admissions. Health Economics 20(2): 161-183, 2011. (37 refs.)

Treatment is highly cost-effective in reducing an individual's substance abuse (SA) and associated harms. However, data from Treatment Episodes (TEDS) indicate that per capita treatment admissions substantially lagged behind increases in heavy drug use from 1992 to 2007. Only 10% of individuals with clinical SA disorders receive treatment, and almost half who forgo treatment point to accessibility and cost constraints as barriers to care. This study investigates the impact of state mental health and SA parity legislation on treatment admission flows and cost-sharing. Fixed effects specifications indicate that mandating comprehensive parity for mental health and SA disorders raises the probability that a treatment admission is privately insured, lowering costs for the individual. Despite some crowd-out of charity care for private insurance, mandates reduce the uninsured probability by a net 2.4 percentage points. States mandating comprehensive parity also see an increase in treatment admissions. Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. Supply constraints mute effect sizes, suggesting that demand-focused interventions need to be complemented with policies supporting treatment providers. These results have implications for the effectiveness of the 2008 Federal Mental Health Parity and Addiction Equity Act in increasing SA treatment admissions and promoting cost-sharing.

De Paoli G; Brandt SD; Pounder DJ. Mephedrone: Banned but still available on the internet. (letter). British Medical Journal 342: article no. d1629, 2011. (4 refs.)

Denham BE. When science, politics, and policy collide: On the regulation of anabolic-androgenic steroids, steroid precursors, and "dietary supplements" in the United States. Journal of Sport & Social Issues 35(1): 3-21, 2011. (47 refs.)

Twenty years after policy makers passed the Anabolic Steroid Control Act of 1990, adding steroids to the list of Schedule III Controlled Substances in the United States, illicit use of the drugs continues among both adolescents and adults in American society. Some of the men and women who use steroids seek enhanced athletic performance, whereas others simply want to appear more muscular. But what, exactly, is a "steroid"? The present article examines legislation surrounding actual anabolic-androgenic steroids, steroid precursors, and associated "dietary supplements," exploring how the political interests of policy actors and the economic interests of industry lobbies have compromised regulatory efforts. Among the issues addressed are the arbitrary assignment of substances to (and exemption from) the Omnibus Controlled Substances Act and the retailing of "dietary supplements" that contain widely varying amounts of active ingredients and, in some cases, synthetic steroids. Conceptually, the article draws on the "garbage can" model of policy processes as well as the broader public arenas model of social problems, focusing on subjective issue constructions and symbolic appeals.

Donaldson EA; Waters HR; Arora M; Varghese B; Dave P; Modi B. A cost-effectiveness analysis of india's 2008 prohibition of smoking in public places in Gujarat. International Journal of Environmental Health Research 8(5): 1271- 1286, 2011. (55 refs.)

Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India's Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.

Donnelly JR. The need for ibogaine in drug and alcohol addiction treatment. (editorial). Journal of Legal Medicine 32(1): 93-114, 2011. (53 refs.)

Dunlop SM; Cotter TF; Perez DA. Impact of the 2010 tobacco tax increase in Australia on short-term smoking cessation: A continuous tracking survey. Medical Journal of Australia 195(8): 469-472, 2011

To use population-level data to monitor the impact on smoking cessation activity of the April 2010 Australian tobacco tax increase. The Cancer Institute NSW [New South Wales] Tobacco Tracking Survey (CITTS) is a continuous tracking telephone survey conducting about 50interviews per week. Data from February to September in 2009and 2010were analysed (ie, data on people who quit smoking in the 3months before and 5months after the tax increase in 2010were compared, and quitting activity over the same period in 2009was also analysed). Adult smokers and smokers who had stopped smoking in the previous 12months; 2009(n=1604); 2010(n=1699). Recent quitting (defined as stopping smoking or trying to quit within a 1-month period). 22% of the sample reported that they had quit smoking in May 2010, compared with 13% in April 2010and 12% in May 2009. Respondents interviewed in the 3months after the tax increase (May-July) were significantly more likely to report quitting than those interviewed in the 3months before the tax increase (odds ratio, 1.84; 95% CI, 1.26-2.69; P<0.01). This increase in quitting activity was not sustained in the subsequent months (August-September). The tobacco tax increase was associated with a short-term increase in the rate of smoking cessation among NSW adult smokers and recent quitters, suggesting that regular increases in tobacco tax may further encourage quitting activity.

Dunlop SM; Perez D; Cotter T. Australian smokers' and recent quitters' responses to the increasing price of cigarettes in the context of a tobacco tax increase. Addiction 106(9): 1687-1695, 2011. (44 refs.)

Aims: To track smokers' responses to the increasing price of cigarettes after a tax increase, and assess socio-demographic differences in responses. Design The Cancer Institute NSW's Tobacco Tracking Survey (CITTS) is a continuous tracking telephone survey. Weekly data were collected between May and September 2010. Settings New South Wales, Australia. Participants: A total of 834 smokers and 163 recent quitters (quit in last 12 months). Measurements Responses to the price increase included smoking-related changes (tried to quit, cut down) and product-related changes (changed to lower priced brands, started using loose tobacco, bought in bulk). Recent quitters were asked how much the increasing price of cigarettes influenced them to quit. Findings: Overall, 47.5% of smokers made smoking-related changes and 11.4% made product-related changes without making smoking-related changes. Multinomial logistic regressions showed that younger smokers (versus older) were more likely to make product-related changes and smoking-related changes in comparison to no changes. Low-or moderate-income smokers (versus high-income) were more likely to make smoking-related changes compared to no changes. Highly addicted smokers (versus low addicted) were more likely to make product-related changes and less likely to make smoking-related changes. The proportion of smokers making only product-related changes decreased with time, while smoking-related changes increased. Recent quitters who quit after the tax increase (versus before) were more likely to report that price influenced them. Conclusions: The effect of increasing cigarette prices on smoking does not appear to be mitigated by using cheaper cigarette products or sources. These results support the use of higher cigarette prices to encourage smoking cessation.

Edwards R; Russell M; Thomson G; Wilson N; Gifford H. Daring to dream: Reactions to tobacco endgame ideas among policy-makers, media and public health practitioners. BMC Public Health 11: e-article 580, 2011. (43 refs.)

Background: Tobacco control strategies have mainly targeted reducing demand. Supply-side focused measures, though less familiar, deserve consideration, particularly to achieve 'endgame' tobacco control aims (e. g. achieving close to zero smoking prevalence). We explored attitudes towards supply-side focused 'endgame' tobacco control approaches and how they can be best communicated with senior policymakers, journalists, and public health practitioners. Methods: We identified five supply-side focused approaches which could potentially lead to the tobacco endgame: two structural models and three discrete actions. The structural models were: (i) a Nicotine Authority to coordinate tobacco control activities and regulate the nicotine/tobacco market for public health aims; and (ii) a Tobacco Supply Agency acting as a monopoly purchaser of tobacco products and controlling the tobacco supply for public health aims. The actions were: (a) allocating progressively reducing tobacco product import quotas (the 'sinking lid') until importation and commercial sale of tobacco products ceased; (b) making tobacco companies responsible for reducing smoking prevalence with stringent financial penalties if targets were missed; and (c) new laws to facilitate litigation against tobacco companies. These approaches were presented as means to achieve a tobacco free New Zealand by 2020 to 19 senior policymakers, journalists, and public health physicians in two focus groups and eight interviews, and their reactions sought. Results: The tobacco-free vision was widely supported. Participants engaged fully with the proposed tobacco control approaches, which were viewed as interesting or even intriguing. Most supported increasing the focus on supply-side measures. Views differed greatly about the desirability, feasibility and likely effectiveness of each approach. Participants identified a range of potential barriers to implementation and challenges to successfully advocating and communicating these approaches. The current framing of tobacco as a risky but legal commodity was noted as an important potential barrier to implementing endgame approaches. Conclusions: Endgame tobacco control approaches were considered to be viable policy options. Further policy analysis, research and public discussion are needed to develop endgame approaches. A significant change in the public framing of tobacco may be a prerequisite for implementing endgame solutions.

Evans E; Anglin MD; Urada D; Yang J. Promising practices for delivery of court-supervised substance abuse treatment: Perspectives from six high-performing California counties operating Proposition 36. Evaluation and Program Planning 34(2): 124-134, 2011. (80 refs.)

Operative for nearly a decade, California's voter-initiated Proposition 36 program offers many offenders community-based substance abuse treatment in lieu of likely incarceration. Research has documented program successes and plans for replication have proliferated, yet very little is known about how the Proposition 36 program works or practices for achieving optimal program outcomes. In this article, we identify policies and practices that key stakeholders perceive to be most responsible for the successful delivery of court-supervised substance abuse treatment to offenders under Proposition 36. Data was collected via focus groups conducted with 59 county stakeholders in six high-performing counties during 2009. Discussion was informed by seven empirical indicators of program performance and outcomes and was focused on identifying and describing elements contributing to success. Program success was primarily attributed to four strategies, those that: (1) fostered program engagement, monitored participant progress, and sustained cooperation among participants; (2) cultivated buy-in among key stakeholders; (3) capitalized on the role of the court and the judge; and (4) created a setting which promoted a high-quality treatment system, utilization of existing resources, and broad financial and political support for the program. Goals and practices for implementing each strategy are discussed. Findings provide a "promising practices" resource for Proposition 36 program evaluation and improvement and inform the design and study of other similar types of collaborative justice treatment efforts.

Fabian LEA; Bernat DH; Lenk KM; Shi Q; Forster JL. Smoke-free laws in bars and restaurants: Does support among teens and young adults change after a statewide smoke-free law? Public Health Reports 126(5): 669-676, 2011. (25 refs.)

Objective. We assessed changes in levels of support for smoke-free bars and restaurants among teens and young adults before and after implementation of a statewide smoke-free law. Methods. We measured support for smoke-free bars and restaurants among teens and young adults aged 16-24 years living in Minnesota (n=2,785) and five comparison states (n=404), up to 12 months before and up to six months after Minnesota's smoke-free law went into effect in October 2007. We compared changes in support among three subgroups Minnesota participants who lived with a previous local smoke-free law, Minnesota participants who did not live with a previous local smoke-free law, and participants from the comparison states before and after Minnesota's statewide smoke-free law went into effect. Results. Support for smoke-free restaurants and bars among participants in Minnesota and comparison states increased after Minnesota's smoke-free law went into effect. Minnesotans, both those living with and without a previous local smoke-free law, showed similar increases in support for smoke-free restaurants as participants in comparison states. However, Minnesotans living without a previous local law showed larger increases in support for smoke-free bars than both those in comparison states and those living in Minnesota with a previous local smoke-free law. Conclusions. Our study employed a more robust design than similar studies and focused on the teen and young adult population. Our results will help advocates and policy makers demonstrate how public support for smoke-free laws increases following smoke-free legislation, particularly among those who were not previously living with a local smoke-free law.

Frohlich S; Lambe E; O'Dea J. Acute liver failure following recreational use of psychotropic "head shop" compounds. Irish Journal of Medical Science 180(1): 263-264, 2011. (4 refs.)

The recreational use of the so-called "legal-highs" has been in both the medical and political arena over the last year as a result of the appearance of "head shops" in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds.

Givel M. In search of the less hazardous cigarette. International Journal of Health Services 41(1): 77-94, 2011. (60 refs.)

Since the 1950s, despite considerable and long-term tobacco industry and government efforts, attempts to develop a less risky cigarette that reduces harmful ingredients, generally or specifically, have failed. Moreover, even under ideal conditions with adequate scientific testing, the efficacy of purportedly reducing the severe health effects cannot be scientifically verified for up to 20 years after introduction of a product on the market. A key and central provision in the 2009 U.S. Food and Drug Administration (FDA) legislation is to reduce the risk or harm of cigarettes. Because creating a less risky cigarette is not currently possible, this renders the efficacy of the 2009 FDA legislation highly uncertain, with a large risk that the proposed program may not reduce harm.

Gjerde H; Normann PT; Christophersen AS; Morland J. Prevalence of driving with blood drug concentrations above proposed new legal limits in Norway: Estimations based on drug concentrations in oral fluid. Forensic Science International 210(1-3): 221-227, 2011. (44 refs.)

Aim: To estimate the prevalence of driving with blood drug concentrations above the recently proposed Norwegian legal limits for drugged driving in random traffic. The results from a roadside survey of 10,816 drivers was used as basis for the estimation, and the most prevalent drugs were included. Methods: Three approaches were used to estimate the prevalence of drug concentrations above the proposed legal limits in blood based on drug concentrations in oral fluid: comparison with drug concentrations observed in oral fluid and blood in pharmacokinetic studies, estimating the prevalence of drug concentrations in blood by calculating the prevalence of drug concentrations in oral fluid that were larger than the limit in blood multiplied with mean oral fluid/blood ratios, and a mathematical simulation mimicking the relationship between drug concentration distributions in blood and oral fluid for populations of drug users. Results: In total, alcohol or drugs were detected in 5.7% of the samples of oral fluid from drivers in normal traffic; 3.8% (n = 410) were positive for the drugs that we included in the assessment. The estimation of drug concentrations in blood suggested that about 1.5% had concentrations above the proposed legal limits in blood for the studied drugs, which is about 40% of those who were positive for the drugs in oral fluid. Conclusion: The estimated prevalence of driving with concentrations of psychoactive drugs in blood above the proposed legal limits was for illegal drugs 0.4% and for medicinal drugs 1.1%. These may be regarded as minimum estimates as some drugs were not included in the assessment. These prevalences are higher than the prevalence of driving with blood alcohol concentrations above the legal limit of 0.2 g/kg in Norway.

Gorini G; Currie L; Spizzichino L; Galeone D; Lopez MJ. Smoke-free policy development in Italy through the legislative process of the ban 2000-2005, and press media review 1998-2008. Annali Dell Istituto Superiore Di Sanita 47(3): 260-265, 2011. (22 refs.)

The objective of this article is to describe the process of approval of the Italian smoking ban, enacted in 2005. The method is to conduct a review of proposed and approved legislation 2000-2005, and of articles published in Italian newspapers, 1998-2008. Enabling factors in the process were: the leadership of two consecutive Health Ministers, both physicians, who introduced the bill four times between 2000-2002; the repeated presentation and final approval of the bill as an amendment within a bill on public administration which enabled timely approval of the ban; and the stringent air quality standards in the 2003 regulation that made building smoking rooms impracticable and prohibitively expensive. Limiting factors in the process were: the 6-month delay in approving the regulation on smoking rooms; the 1.5-year delay in approving the regulation establishing owners' responsibility for enforcing the ban in hospitality premises and the legal action in August 2005, which shifted responsibility for enforcement to police. Eighty-three percent of the 808 articles published on smoking in 1998-2008 were released between 2000-2005, during the policy process. While the press devoted considerable attention to the issues raised by the hospitality sector, the long legislative process of the bill and its regulations also stimulated coverage on tobacco control issues.

Gorun G; Curca GC; Hostiuc S; Buda O. "Legal highs" in Romania: Historical and present facts. Romanian Journal of Legal Medicine 19(1): 73-76, 2011. (7 refs.)

In the modern history of our country, the subject of psychoactive substances was banned as being against the socialist-communist political ideology, and consequently the research and knowledge on the historical evolution of the use of plants and substances for medical, hedonistic and/or ritual purposes in our country was not given any encouragement. In this context of a diluted and outdated knowledge on the psychoactive substances which had been maintained for decades, the explosion of the drug addiction phenomenon encountered an idealistic perception ("it is a problem of the Western world", "we are just a transit country", etc.), which lead to a fast increase in the number of young people who tried to consume illegal drugs. The political/administrative organisations, the civil society, the NGOs and particularly the scientific experts in Romania had all a very slow and laggard response, which has lead to the current situation when drug addiction is finally recognized as a very serious issue. Particular features of the Romanian phenomenon surprisingly not due to the local tradition or spontaneous flora (as long as currently marketed products are imported) are presented in this publication, giving examples from the criminal investigation experience. An alarming issue which has been highlighted by our research points to the fact that "classical drugs", such as opioids, methadone, ketamine, MDMA, are likely to be used in Romania for "spicing up" the so-called "legal" marketed products. In the following, we shall trace the historical evolution of the use of plants and substances for medical, hedonistic and/or ritual purposes in our country. We shall also reflect on the related legislative and medical issues, and the suggested measures.

Green R. The ethics of sin taxes. Public Health Nursing 28(1): 68-77, 2011. (45 refs.)

The current global economic crisis is forcing governments to consider a variety of methods to generate funds for infrastructure. In the United States, smoking-related illness and an obesity epidemic are forcing public health institutions to consider a variety of methods to influence health behaviors of entire target groups. In this paper, the author uses a public health nursing model, the Public Health Code of Ethics Public Health Leadership Society, 2002), the American Nurses' Association (ANA) Code of Ethics (2001), and other relevant ethical theory to weigh and balance the arguments for and against the use of sin taxes. A position advocating the limited use of sin taxes is supported as a reasonable stance for the public health professional.

Hawkins SS; Cole TJ; Law C. Examining smoking behaviours among parents from the UK Millennium Cohort Study after the smoke-free legislation in Scotland. Tobacco Control 20(2): 112-118, 2011. (35 refs.)

Objectives: To investigate parental smoking behaviours between England and Scotland after the smoke-free legislation in Scotland came into effect in 2006 and examine inequalities in maternal smoking behaviours between countries. Methods: 5954 white mothers and 3757 fathers resident in England and 1522 white mothers and 904 fathers resident in Scotland who participated in the Millennium Cohort Study (a prospective nationally representative cohort study) when the cohort child was age 9 months (before legislation) and 5 years (after legislation in Scotland but not in England). The main outcome measures were smoking at 9 months and 5 years, quitting smoking by 5 years, starting smoking by 5 years. Results: In England and Scotland approximately 30% of parents reported smoking at 9 months with only a slight decrease in smoking at 5 years. There were no differences between countries in parental smoking after the smoke-free legislation in Scotland came into effect, taking into account prior smoking levels. Light smokers (1-9 cigarettes/day) from Scotland were less likely to quit by 5 years than those from England, but there were no differences between countries among heavy smokers (10+ cigarettes/day). Non-smoking mothers from Scotland (6.2%) were less likely to start smoking by 5 years than mothers from England (7.3%). Mothers from more disadvantaged circumstances in both countries were more likely to report that they smoked or started smoking. In England quitting was also socially patterned, but in Scotland, after the legislation was introduced, the gradients in quitting smoking were flatter across social groups. Conclusions: Smoking behaviours among parents with young children remained relatively stable, highlighting the need for additional tobacco control efforts to support smoking cessation. However, the smoke-free legislation does not appear to widen health inequalities and may even help reduce them by encouraging quitting across socioeconomic groups.

Henningfield JE; Hatsukami DK; Zeller M; Peters E. Conference on abuse liability and appeal of tobacco products: Conclusions. and recommendations. (editorial). Drug and Alcohol Dependence 116(1-3): 1-7, 2011. (54 refs.)

The rate of initiation and progression to dependence and premature mortality are higher for tobacco products than for any other dependence producing substance. This is not explained simply by the addictiveness ("abuse liability") or by enticing product designs ("product appeal") alone, but rather by both of these factors in combination with marketing and social influences that also influence "product appeal". A working meeting of leading experts in abuse liability (AL) and product appeal was convened to examine how these disciplines could be more effectively applied to the evaluation of tobacco products for the purposes of regulation that would include setting standards for designs and contents intended to reduce the risk of initiation and dependence. It was concluded that abuse liability assessment (ALA) is a validated approach to testing pharmaceutical products but has not been extensively applied to tobacco products: such application has demonstrated feasibility, but special challenges include the diverse range of products, product complexity, and the absence of satisfactory placebo products. Consumer testing for product appeal is widely used by consumer product marketers as well as by researchers in their efforts to understand consumer product preferences and use but has not been extensively applied to tobacco products except by the tobacco industry. Recommendations for testing, methods development, and research were developed. A major recommendation was that tobacco products should be tested for AL and product appeal, and the results integrated and evaluated so as to more accurately predict risk of initiation, dependence, and persistence of use.

Higashi H; Khuong TA; Ngo AD; Hill PS. The development of tobacco harm prevention law in Vietnam: Stakeholder tensions over tobacco control legislation in a state owned industry. Substance Abuse Treatment, Prevention and Policy 6: 24, 2011. (47 refs.)

Background: Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process. Methods: Several qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey. Findings: The Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted. Conclusion: The state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged.

Hymowitz N. Smoking and cancer: A review of public health and clinical implications. (review). Journal of the National Medical Association 103(8): 695-700, 2011. (21 refs.)

The cultivation of tobacco dates backwards to 6000 BC. Use of tobacco for spiritual, euphoric, and medicinal purposes, and its ultimate spread to the 4 corners of the globe, lay at the heart of the current pandemic of tobacco-related disease, including lung, head and neck, and many other forms of cancer. While evidence for the carcinogenic properties of tobacco was documented as early as the 1800s, it was not until the 20th century that the role of tobacco use and smoke exposure in the growing pandemic of lung and other cancers was fully appreciated. The evidence is now indisputable, and current research and intervention activities center on mechanisms by which tobacco use and smoke cause cancer, ways of stemming the worldwide pandemic of tobacco-related disease, and how to help people with cancer quit smoking. With respect to the latter, approaches to smoking cessation that are effective for the general population of smokers are equally applicable to cancer patients, thrusting physicians and other health professionals to the forefront of the antismoking arena. However, the scale of the tobacco pandemic has grown so large that it literally will take a village, complete with heads of nations, world-governing bodies, local leaders, physicians, and many others, to pass and enforce legislation and policies necessary to stem the worldwide tobacco pandemic and to implement cessation programs for smokers and users of other forms of tobacco across the globe.

Issa JS; Abe TMO; Pereira AC; Megid MC; Shimabukuro CE; Valentin LSO et al. The effect of Sao Paulo's smoke-free legislation on carbon monoxide concentration in hospitality venues and their workers. Tobacco Control 20(2): 156-162, 2011. (21 refs.)

Background Studies have shown that there is no safe level of secondhand smoke (SHS) exposure and there is a close link between SHS and the risk of coronary heart disease and stroke. Carbon monoxide (CO) is one of the most important components present in SHS. Objective To evaluate the impact of the smoking ban law in the city of Sao Paulo, Brazil, on the CO concentration in restaurants, bars, night clubs and similar venues and in their workers. Methods In the present study we measured CO concentration in 585 hospitality venues. CO concentration was measured in different environments (indoor, semi-open and open areas) from visited venues, as well as, in the exhaled air from approximately 627 workers of such venues. Measurements were performed twice, before and 12 weeks after the law implementation. In addition, the quality of the air in the city during the same period of our study was verified. Results The CO concentration pre-ban and pot-ban in hospitality venues was indoor area 4.57 (3.70) ppm vs 1.35 (1.66) ppm (p<0.0001); semi-open 3.79 (2.49) ppm vs 1.16 (1.14) ppm (p<0.0001); open area 3.31 (2.2) ppm vs 1.31 (1.39) ppm (p<0.0001); smoking employees 15.78 (9.76) ppm vs 11.50 (7.53) ppm (p<0.0001) and non-smoking employees 6.88 (5.32) ppm vs 3.50 (2.21) ppm (p<0.0001). The average CO concentration measured in the city was lower than 1 ppm during both pre-ban and post-ban periods. Conclusion Sao Paulos smoking-free legislation reduced significantly the CO concentration in hospitality venues and in their workers, whether they smoke or not.

Jemal A; Thun M; Yu XQ; Hartman AM; Cokkinides V; Center MM et al. Changes in smoking prevalence among U.S. adults by state and region: Estimates from the Tobacco Use Supplement to the Current Population Survey, 1992-2007. BMC Public Health 11: e-article 512, 2011. (38 refs.)

Background: Tobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. We examine the association between recent changes in smoking prevalence and state-specific tobacco control policies and activities in the entire U. S. Methods: We analyzed the 1992-93, 1998-99, and 2006-07 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) by state and two indices of state tobacco control policies or activities [initial outcome index (IOI) and the strength of tobacco control (SOTC) index] measured in 1998-1999. The IOI reflects cigarette excise taxes and indoor air legislation, whereas the SOTC reflects tobacco control program resources and capacity. Pearson Correlation coefficient between the proportionate change in smoking prevalence from 1992-93 to 2006-07 and indices of tobacco control activities or programs was the main outcome measure. Results: Smoking prevalence decreased from 1992-93 to 2006-07 in both men and women in all states except Wyoming, where no reduction was observed among men, and only a 6.9% relative reduction among women. The percentage reductions in smoking in men and women respectively were the largest in the West (average decrease of 28.5% and 33.3%) and the smallest in the Midwest (18.6% and 20.3%), although there were notable exceptions to this pattern. The decline in smoking prevalence by state was correlated with the state's IOI in both women and men (r = -0.49, p < 0.001; r = -0.31, p = 0.03; respectively) and with state's SOTC index in women(r = -0.30, p = 0.03 0), but not men (r = -0.21, p = 0.14). Conclusion: State level policies on cigarette excise taxes and indoor air legislation correlate strongly with reductions in smoking prevalence since 1992. Strengthening and systematically implementing these policies could greatly accelerate further reductions in smoking.

Johnson LA; Johnson RL; Alfonzo C. Spice: A legal marijuana equivalent. Military Medicine 176(6): 718-720, 2011. (21 refs.)

Spice, an herbal mixture containing synthetic cannabinoids, is a legal drug increasingly abused by adolescents and young adults for its narcotic-like effects. A paucity of English language literature exists on the clinical effects of Spice use. A case report of substance-induced psychosis and a summary of available literature follows later.

Kanda H; Osaki Y; Ohida T; Kaneita Y; Munezawa T. Age verification cards fail to fully prevent minors from accessing tobacco products. Tobacco Control 20(2): 163-165, 2011. (14 refs.)

Background: Proper age verification can prevent minors from accessing tobacco products. For this reason, electronic locking devices based on a proof-of age system utilising cards were installed in almost every tobacco vending machine across Japan and Germany to restrict sales to minors. Objective: We aimed to clarify the associations between amount smoked by high school students and the usage of age verification cards by conducting a nationwide cross-sectional survey of students in Japan. Methods This survey was conducted in 2008. We asked high school students, aged 13-18 years, in Japan about their smoking behaviour, where they purchase cigarettes, if or if not they have used age verification cards, and if yes, how they obtained this card. Results As the amount smoked increased, the prevalence of purchasing cigarettes from vending machines also rose for both males and females. The percentage of those with experience of using an age verification card was also higher among those who smoked more. Somebody outside of family was the top source of obtaining cards. Surprisingly, around 5% of males and females belonging to the group with highest smoking levels applied for cards themselves. Conclusions: Age verification cards cannot fully prevent minors from accessing tobacco products. These findings suggest that a total ban of tobacco vending machines, not an age verification system, is needed to prevent sales to minors.

Kempinen B. Problem-solving courts and the defense function: the wisconsin experience. Hastings Law Journal 62(5): 1349-1375, 2011. (31 refs.)

Problem-solving courts have emerged as one of the fastest growing innovations in the criminal justice system. Their growth has not been without controversy, given their dramatic departure from a traditional adversary model in favor of a collaborative approach in dealing with offenders with serious alcohol or substance abuse, or mental health issues. The most outspoken criticism of this approach has come from the defense bar. This Essay suggests much of the criticism is misplaced, and, that if care is exercised in separating the roles that defense counsel plays in communities with problem-solving courts the promise of this approach for appropriate offenders can be realized without compromising the core duties that counsel owes her client. The template proposed here for reconciling these conflicting interests is based in large part on the work and experiences of shareholders in Wisconsin problem-solving courts. It is further suggested that the proposed ABA Criminal Justice Standards for the Defense Function fail to address most, if not all, of the unique defense function issues presented by the problem-solving court model.

Kerr JR; Davis LS. Benzylpiperazine in New Zealand: Brief history and current implications. Journal of the Royal Society of New Zealand 41(1): 155-164, 2011. (63 refs.)

Over the last decade, New Zealand has led the world in the legal sale and uncontrolled use of the recreational drug benzylpiperazine (BZP), the active ingredient of 'party pills'. One survey found that 40% of 18-29-year-olds admitted to using BZP-based party pills while, in another study, 44% of first-year university students had used the drug. During the period it was legally available for sale, BZP usage in New Zealand far exceeded the usage of any illicit drugs other than cannabis. In 2005 the New Zealand government created legislation intended to regulate the drug, but as potential health risks from BZP consumption became apparent, subsequent legislation was introduced to prohibit the substance. In 2008, the sale and possession of BZP was criminalized, with the result that (a) some users possibly switched to other illegal drugs, and (b) a market developed for alternative party pills that are BZP-free but contain unregulated substances that may themselves pose a health risk. The following review briefly covers the scientific and legal background of benzylpiperazine with particular reference to New Zealand, the country in which it was most popular.

Klein CA; Kandel S. www.mydrugdealer.com: Ethics and legal implications of internet-based access to substances of abuse. Journal of the American Academy of Psychiatry and The Law 39(3): 407-411, 2011. (20 refs.)

The Internet has increasingly become an intrinsic part of everyday life, offering countless possibilities for education, services, recreation, and more. In fact, an entire virtual life within the digitalized World Wide Web is possible and common among many Internet users. Today's psychiatrists must therefore incorporate this dimension of human life into clinical practice, to achieve an adequate assessment of the tools and risks available to the patient. We focus on the Internet as a portal for the trade of and access to substances of abuse. We review the legal regulations that may inform care and standards of practice and analyze the difficulties that arise in assessment and monitoring of the current situation. We consider the potential impact of Internet-based narcotics trade on addiction morbidities and the practice of clinical psychiatry, as well as on the potential legal implications that the forensic expert may face.

Kosman MAH. Falling through the crack: How courts have struggled to apply the crack amendment to "nominal career" and "plea bargain" defendants. Michigan Law Review 109(5): 785- 812, 2011. (9 refs.)

In 2007, after a decade of debate, the U.S. Sentencing Commission instituted an amendment that decreased the sentences of some defendants who had been convicted of crack-cocaine-related offenses. A few months later, the Sentencing Commission passed another amendment that rendered it retroactive. Nearly three years after the passage and retroactive application of the "crack amendment," however, two separate circuit splits have emerged as courts have struggled to uniformly interpret and apply the Sentencing Commission's directives. The first circuit split emerged regarding the eligibility of a subset of "career offenders" to the benefits of the retroactive application of the crack amendment. The second circuit split emerged over the question whether a subset of defendants who pled guilty to crack offenses pursuant to Federal Rule of Criminal Procedure 11(c)(1)(C) prior to the passage of the crack amendment are eligible to receive the benefits of its retroactive application. This Note first argues that the language of the applicable statutes and policy statements and the specific actions taken by the Sentencing Commission indicate that the subset of "career offenders" in the first circuit split are not eligible for a subsequent reduction in the sentence pursuant to the crack amendment. This Note argues, however, that the lack of explicit directives from the Sentencing Commission regarding the "plea bargain" defendants in the second circuit split indicates that these defendants are eligible to receive the benefits of the retroactive application of the amendment. Because the Sentencing Commission instituted and rendered retroactive the crack amendment to decrease the disparity in sentence between defendants convicted of crack and powder cocaine offenses, it would be contrary to the purpose of the amendment to exclude these defendants from its benefits.

Lal PG; Wilson NC; Singh RJ. Compliance surveys: An effective tool to validate smoke-free public places in four jurisdictions in India. (editorial). International Journal of Tuberculosis and Lung Disease 15(4): 565-566, 2011. (4 refs.)

Smoke-free initiatives have gained significant momentum since India enacted comprehensive smoke-free legislation in October 2008. The International Union Against Tuberculosis and Lung Disease has actively supported various levels of government, legislators, civil society, and communities across the country to implement smoke-free public places and comply with the law. On World No Tobacco Day 2010, four jurisdictions demonstrated that public places within their jurisdictions were smoke-free. These jurisdictions cover a wide spectrum of demographic and geographic variation and include an entire state. The demonstration of being 'smoke-free' in these jurisdictions was supported by a simple survey that documented compliance with the smoke-free law in the country.

Le Houezec J; McNeill A; Britton J. Tobacco, nicotine and harm reduction. Drug and Alcohol Review 30(2): 119-123, 2011. (28 refs.)

Issues. Tobacco smoking, sustained by nicotine dependence, is a chronic relapsing disorder, which in many cases results in lifelong cigarette use and consequent death of one out of two lifelong smokers from a disease caused by their smoking. Most toxicity due to cigarette smoking is related to the burning process. Approach. Models of harm reduction applied to tobacco suggest that use of non-combustible, less toxic, nicotine-containing products as a substitute for cigarette smoking would reduce the death toll arising from tobacco use. Available options include medicinal nicotine and smokeless tobacco products. Key Findings. The potential role of nicotine replacement therapy (NRT) products in a harm reduction strategy is currently severely restricted by strict regulations on dose, safety and potential addictiveness. As a result, NRT products are designed to provide much less nicotine, and deliver it to the brain more slowly, than cigarettes, which are widely accessible and poorly regulated. Smokeless tobacco (snus) has proved to be an acceptable reduced hazard alternative to smoking in Sweden, but supply of snus is illegal elsewhere in the European Union. Implications. To increase accessibility and reach more smokers, barriers to the use of NRT use need to be removed and more effective NRTs need urgently to be developed. Smokeless tobacco could also play an important role in harm reduction, but current European Union regulations and concerns over exploitation by tobacco companies currently preclude wider use. Conclusion. To improve public health there is an urgent need for an appropriate regulatory framework and regulatory authority at the European level, controlling both tobacco and nicotine products to ensure that the least harmful products are the most accessible.

Lee JT; Glantz SA; Millett C. Effect of smoke-free legislation on adult smoking behaviour in England in the 18 months following implementation. PLoS ONE 6(6): e-article e20933, 2011. (32 refs.)

Background: Comprehensive smoke-free legislation covering all enclosed public places and workplaces was implemented in England on 1 July 2007. This study examines the impact of this legislation on smoking prevalence, number of cigarettes smoked and location of smoking, controlling for secular trends through the end of 2008. Method and Findings: Repeat cross sectional survey using nationally representative data from the Health Survey for England (HSE). In total there are 54,333 respondents from 2003-2008. Logit and linear regression models were used to examine the effect of the legislation on smoking prevalence and the number of cigarettes smoked daily among continuing smokers which took the underlying trend into account. Our finding suggest that smoking prevalence (current smoker) decreased from 25% in 2003 to 21% in 2008 (AOR = 0.96 per year, 95% CI = 0.95-0.98, P < 0.01) and the mean number of cigarettes consumed daily by smokers decreased from 14.1 in 2003 to 13.1 in 2008 (coefficient for time trend = -0.28 +/- 0.06 SE cig/day per year, P < 0.01). After adjusting for these trends the introduction of smoke-free legislation was not associated with additional reductions in smoking prevalence (AOR = 1.02, 95% CI = 0.94-1.11, P = 0.596) or daily cigarette use in smokers (0.42 +/- 0.28 SE; P = 0.142). The percentage of respondents reporting smoking 'at work' and 'inside pubs or bars' decreased significantly from 14% to 2% (p < 0.001) and from 34% to 2% (p < 0.001), respectively, after the legislation. The percentage reporting smoking 'inside restaurants, cafes, or canteens' decreased significantly from 9% to 1% (p < 0.001) and 'inside their home' decreased significantly from 65% to 55% (p < 0.01). Conclusion: There is widespread compliance with the smoke-free legislation in England, which has led to large drops in indoor smoking in all venues, including at home. Declines in smoking prevalence and consumption continued along existing trends; they did not accelerate during the 18 months immediately following implementation.

Lencucha R; Kothari A; Labonte R. The role of non-governmental organizations in global health diplomacy: Negotiating the Framework Convention on Tobacco Control. Health Policy and Planning 26(5): 405-412, 2011. (21 refs.)

The Framework Convention on Tobacco Control (FCTC) is an exemplar result of global health diplomacy, based on its global reach ( binding on all World Health Organization member nations) and its negotiation process. The FCTC negotiations are one of the first examples of various states and non-state entities coming together to create a legally binding tool to govern global health. They have demonstrated that diplomacy, once consigned to interactions among state officials, has witnessed the dilution of its state-centric origins with the inclusion of non-governmental organizations (NGOs) in the diplomacy process. To engage in the discourse of global health diplomacy, NGO diplomats are immediately presented with two challenges: to convey the interests of larger publics and to contribute to inter-state negotiations in a predominantly state-centric system of governance that are often diluted by pressures from private interests or mercantilist self-interest on the part of the state itself. How do NGOs manage these challenges within the process of global health diplomacy itself? What roles do, and can, they play in achieving new forms of global health diplomacy? This paper addresses these questions through presentation of findings from a study of the roles assumed by one group of non-governmental actors (the Canadian NGOs) in the FCTC negotiations. The findings presented are drawn from a larger grounded theory study. Qualitative data were collected from 34 public documents and 18 in-depth interviews with participants from the Canadian government and Canadian NGOs. This analysis yielded five key activities or roles of the Canadian NGOs during the negotiation of the FCTC: monitoring, lobbying, brokering knowledge, offering technical expertise and fostering inclusion. This discussion begins to address one of the key goals of global health diplomacy, namely 'the challenges facing health diplomacy and how they have been addressed by different groups and at different levels of governance'.

Lewis P; O'Connor C. My war on drug laws. Forbes 188(6): 181-181, 2011. (0 refs.)

The government has a marijuana problem it-doesn't realize the benefits or the harm caused policing it. I'm devoting my time and money to making it legal.

Lyons A; Britton J. Protecting young people from smoking imagery in films: Whose responsibility? (editorial). Thorax 66(10): 844-846, 2011. (20 refs.)

Mackay DF; Irfan MO; Haw S; Pell JP. Republished paper: Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events. (review). Postgraduate Medical Journal 87(1026): 311-316, 2011. (28 refs.)

Objective To assess the evidence for a reduced risk of acute coronary events following comprehensive smoke-free legislation. Methods Two independent systematic reviews were undertaken using PubMedicine, Embase and Science Direct with no date restrictions imposed. Meta-analysis was undertaken using a random effects model to obtain a pooled estimate of the relative risk. Linear regression was used to examine possible bias and meta-regression was used to investigate possible causes of heterogeneity. Main outcome measure Acute coronary events. Results The 17 eligible studies (10 from North America, 6 from Europe and 1 from Australasia) provided 35 estimates of effect size. Apart from five subgroup analyses, all of the published results suggested a reduction in the incidence of acute coronary events following the introduction of smoke-free legislation. Meta-analysis produced a pooled estimate of the relative risk of 0.90 (95% CI 0.86 to 0.94). There was significant heterogeneity (overall I-2=95.1%, p<0.001) but there was no evidence of small study bias (p=0.714). On univariate random effects meta-regression analysis, studies with longer data collection following legislation produced greater estimates of risk reduction and remained significant after adjustment for other study characteristics (adjusted coefficient -0.005, 95% CI -0.007 to -0.002, multiplicity adjusted p=0.006). Conclusions There is now a large body of evidence supporting a reduction in acute coronary events following the implementation of comprehensive smoke-free legislation, with the effect increasing over time from implementation. Countries that have not yet adopted smoke-free legislation should be encouraged to do so.

Mackenzie R. The neuroethics of pleasure and addiction in public health strategies moving beyond harm reduction: Funding the creation of non-addictive drugs and taxonomies of pleasure. Neuroethics 4(2, special issue): 103-117, 2011. (119 refs.)

We are unlikely to stop seeking pleasure, as this would prejudice our health and well-being. Yet many psychoactive substances providing pleasure are outlawed as illicit recreational drugs, despite the fact that only some of them are addictive to some people. Efforts to redress their prohibition, or to reform legislation so that penalties are proportionate to harm have largely failed. Yet, if choices over seeking pleasure are ethical insofar as they avoid harm to oneself or others, public health strategies should foster ethical choice by moving beyond current risk management practices embodied in the harm reduction movement. The neuroscience of pleasure has much to offer neuroethics and public health strategies. Distinguishing between 'wanting' and 'liking' fosters new understandings of addiction. These hold promise for directing the search for pharmacotherapies which prevent addiction and relapse or disrupt associated neuromechanisms. They could inform new research into creating lawful psychoactive substances which give us pleasure without provoking addiction. As the health and well being of human and other animals rests upon the experience of pleasure, this would be an ethical objective within public health strategy. Were ethical and neurobiological obstacles to ending addiction to be overcome, problems associated with excessive consumption, the lure of unlawful psychoactive substances and the paucity of lawful means to achieve pleasurable altered states would remain. Non-addictive designer drugs, which reliably provided lawful access to pleasures and altered states, would ameliorate these public health concerns insofar as they fostered citizens' informed, ethical choices according to a neurobiological taxonomy of pleasures.

Manubay JM; Muchow C; Sullivan MA. Prescription drug abuse: Epidemiology, regulatory issues, chronic pain management with narcotic analgesics. Primary Care 38(1): 71+, 2011. (52 refs.)

The epidemic of prescription drug abuse has reached a critical level, which has received national attention. This article provides insight into the epidemiology of prescription drug abuse, explains regulatory issues, and provides guidelines for the assessment and management of pain, particularly with long-term opioid therapy. Using informed consent forms, treatment agreements, and risk documentation tools and regularly monitoring the 4 A's help to educate patients and guide management based on treatment goals. By using universal precautions, and being aware of aberrant behaviors, physicians may feel more confident in identifying and addressing problematic behaviors.

McElrath K; O'Neill C. Experiences with mephedrone pre- and post-legislative controls: Perceptions of safety and sources of supply. International Journal of Drug Policy 22(2): 120- 127, 2011. (32 refs.)

Background: Drug scenes within several countries have changed in recent years to incorporate a range of licit psychoactive products, collectively known as "legal highs." Hundreds of different legal high products have been described in the literature. Many of these products contain synthetic stimulants that allegedly "mirror" the effects of some illicit drugs. In 2009-2010, growing concern by the UK and Irish governments focused on mephedrone, a synthetic stimulant that had become embedded within several drug scenes in Britain and Ireland. In April 2010, mephedrone and related cathinone derivatives were banned under the UK's Misuse of Drugs Act 1971. Setting aside "worse case scenarios" that have been portrayed by UK and Irish media, little is known about mephedrone use from the consumer's perspective. The purpose of this paper was to (1) explore respondents' experiences with mephedrone, (2) examine users' perceptions about the safety of mephedrone, and primarily to (3) examine sources of mephedrone supply during the pre- and post-ban periods. Methods: Semi-structured interviews were conducted with 23 adults who had used mephedrone during 2009-2010. Data collection occurred in May and June 2010, following the ban on mephedrone. A total of 20/23 respondents had used mephedrone during the post-ban period, and the vast majority had prior experience with ecstasy or cocaine. Respondents' ages ranged from 19 to 51, approximately half of the sample were female and the majority (19 of 23) were employed in full- or part-time work. Results: Most respondents reported positive experiences with mephedrone, and for some, the substance emerged as a drug of choice. None of the respondents reported that the once-legal status of mephedrone implied that it was safe to use. Very few respondents reported purchasing mephedrone from street-based or on-line headshops during the pre-ban period, and these decisions were guided in part by respondents' attempts to avoid "drug user" identities. Most respondents purchased or obtained mephedrone from friends or dealers, and mephedrone was widely available during the 10-week period following the ban. Respondents reported a greater reliance on dealers and a change in mephedrone packaging following the criminalisation of mephedrone. Conclusion: The findings are discussed in the context of what appears to be a rapidly changing mephedrone market. We discuss the possible implications of criminalising mephedrone, including the potential displacement effects and the development of an illicit market.

McNeill A; Lewis S; Quinn C; Mulcahy M; Clancy L; Hastings G et al. Evaluation of the removal of point-of-sale tobacco displays in Ireland. Tobacco Control 20(2): 137-143, 2011. (36 refs.)

Aim: To evaluate the short-term impacts of removing point-of-sale tobacco displays in Ireland, implemented in July 2009. Methods: Retailer compliance was assessed using audit surveys in 2007, 2008 and 2009. Using a monthly survey of 1000 adults carried out since 2002, changes in smoking prevalence were assessed; attitudes were measured using extra questions added for a 10-month period before and after the law. Youth responses were assessed using a cohort of 180 13-15 year olds, interviewed in June and August 2009. Results Immediately following implementation, compliance was 97%. Support for the law increased among adults after implementation (58% Apr-Jun vs 66% Jul-Dec, p<0.001). Recall of displays decreased significantly for adults (49% to 22%; p<0.001), more so among teenagers (81% to 22%; p<0.001). There were no significant short-term changes in prevalence among youths or adults. The proportion of youths believing more than a fifth of children their age smoked decreased from 62% to 46%, p<0.001). Post-legislation, 14% of adult smokers thought the law had made it easier to quit smoking and 38% of teenagers thought it would make it easier for children not to smoke. Conclusions: Compliance was very high and the law was well supported. Recall of displays dropped significantly among adults and teenagers post-legislation and there were encouraging signs that the law helped de-normalise smoking.

Measham F; Wood, DM; Dargan PI; Moore K. The rise in legal highs: Prevalence and patterns in the use of illegal drugs and first- and second-generation "legal highs" in South London gay dance clubs. Journal of Substance Use 16(4): 263-272, 2011. (35 refs.)

Aim: To assess the prevalence of use of established illegal psychoactive drugs and emergent psychoactive drugs, the so-called "legal highs", amongst gay club-goers who are considered to be "early adopters" of drug trends. Design: Three in situ surveys were conducted in July 2010 with customers at two dance clubs (nightclubs) in an area known for its "gay-friendly" night time economy. The surveys assessed the prevalence of self-reported lifetime, past year, past month, fieldwork day use and planned use of illegal drugs and "legal highs". Setting: This is a field study. Participants: The participants were 308 customers in two "gay-friendly" clubs in South London, United Kingdom. Measurements: Two-page research instrument was designed for in situ drug surveys. Findings: Our sample had higher rates of self-reported lifetime and recent use of established illegal drugs than the general population. Mephedrone emerged from near obscurity to become the most popular illegal drug in this survey, with 41% having taken it in the past month and 27% having either taken and/or planning to take it on the fieldwork night. Regarding second-generation "legal highs", 11% of the sample had taken NRG-1 in the past month and 3% had taken and/or planned to take it on the fieldwork night. Conclusions: This survey suggests that the popularity of mephedrone surpasses other drugs, both legal and illegal, despite having been banned by the UK government prior to this survey being conducted. "Early adopters" of drug trends appear to be undeterred by the legal classification of emergent psychoactive substances. Given the global nature of the trade in "legal highs", this study has implications for other countries where mephedrone use is emerging.

Informa Healthcare

Millett C; Lee JT; Gibbons DC; Glantz SA. Increasing the age for the legal purchase of tobacco in England: Impacts on socio-economic disparities in youth smoking. Thorax 66(10): 862-865, 2011. (20 refs.)

Background: The minimum age for the legal purchase of tobacco increased from 16 to 18 years in England, Scotland and Wales on 1 October 2007. The authors examined the impact of this legislation on disparities in smoking behaviour and access to cigarettes among youth in England. Methods A multivariate logistic regression analysis was carried out adjusting for secular trends in regular smoking using data from the Smoking, Drinking and Drug Use Survey, a national survey of 11-15 year olds. The primary outcome measure was regular smoking and the predictor variables were the law increasing the minimum age for purchase and eligibility for free school meals (FSM). Results: Increasing the minimum age for purchase was associated with a significant reduction in regular smoking among youth (adjusted OR 0.67; 95% CI 0.55 to 0.81, p=0.0005). This effect was not significantly different in pupils eligible for FSM compared with those that were not (adjusted OR 1.29; 95% CI 0.95 to 1.76, p=0.10 for interaction term). The percentage of pupils who stated that they found it difficult to buy cigarettes from a shop did not increase in those eligible for FSM (25.2% to 33.3%; p=0.21) but did increase significantly in others (21.2% to 36.9%; p<0.01) between 2006 and 2008. No differences in ease of purchase were found between pupils eligible for FSM and those not before or after the legislation (2006: p=0.34, 2008: p=0.55). Conclusions: Increasing the age for the legal purchase of tobacco was associated with reduced regular smoking among youth in England and appeared to have a similar impact in different socio-economic groups.

Monshouwer K; Van Laar M; Vollebergh WA. Buying cannabis in 'coffee shops'. Drug and Alcohol Review 30(2): 148-156, 2011. (27 refs.)

Issues. The key objective of Dutch cannabis policy is to prevent and limit the risks of cannabis consumption for users, their direct environment and society ('harm reduction'). This paper will focus on the tolerated sale of cannabis in 'coffee shops'. Approach. We give a brief overview of Dutch policy on coffee shops, its history and recent developments. Furthermore, we present epidemiological data that may be indicative of the effects of the coffee shop policy on cannabis and other drug use. Key Findings. Dutch coffee shop policy has become more restrictive in recent years and the number of coffee shops has decreased. Cannabis prevalence rates in the adult population are somewhat below the European average; the rate is relatively high among adolescents; and age of first use appears to be low. On a European level, the use of hard drugs in both the Dutch adult and adolescent population is average to low (except for ecstasy among adults). Implications and Conclusions. International comparisons do not suggest a strong, upward effect of the coffee shop system on levels of cannabis use, although prevalence rates among Dutch adolescents give rise to concern. Furthermore, the coffee shop system appears to be successful in separating the hard and soft drugs markets. Nevertheless, in recent years, issues concerning the involvement of organised crime and the public nuisance related to drug tourism have given rise to several restrictive measures on the local level and have sparked a political debate on the reform of Dutch drug policy.

Moore GF; Holliday JC; Moore LAR. Socioeconomic patterning in changes in child exposure to secondhand smoke after implementation of smoke-free legislation in Wales. Nicotine & Tobacco Research 13(10): 903-910, 2011. (33 refs.)

Introduction: Secondhand smoke (SHS) exposure is higher among children from lower socioeconomic status (SES) households. Legislation banning smoking in public places has been linked with reduced SHS exposure in children. However, socioeconomic patterning in responses to legislation has been little explored. Methods: A total of 3,083 children aged 10-11 years, within 75 Welsh primary schools, completed questionnaires either before legislation or 1 year later. Saliva samples were provided by 2,787 of these children for cotinine assay. Regression analyses assessed socioeconomic differences in SHS exposure, and associations of legislation with exposure among children from low, medium, and high SES households. Changes in parental smoking in the home, car-based exposure, and perceived norms were assessed. Results: SHS exposure was highest among children from lower SES households. The likelihood of providing a sample containing an undetectable level of cotinine increased significantly after legislation among children from high [relative risk ratio (RRR) = 1.44, 95% CI = 1.04-2.00] and medium SES households (RRR = 1.66, 95% CI = 1.20-2.30), while exposure among children from lower SES households remained unchanged. Parental smoking in the home, car-based SHS exposure, and perceived smoking prevalence were highest among children from low SES households. Parental smoking in the home and children's estimates of adult smoking prevalence declined only among children from higher SES households. Conclusions: Post-legislation reductions in SHS exposure were limited to children from higher SES households. Children from lower SES households continue to have high levels of exposure, particularly in homes and cars, and to perceive that smoking is the norm among adults.

Murphy J. Drug court as both a legal and medical authority. Deviant Behavior 32(3): 257-291, 2011. (26 refs.)

This article explores how addiction is conceptualized in a drug court program. Through observations and interviews in a drug court in a large northeastern city, the author reveals how the court uses ambiguous and inconsistent medicalized language to describe addiction, extending the label of addiction to behaviors not just associated with using drugs, but with selling drugs as well. Ultimately, drug courts incorporate a medicalized notion of addiction to further their own control over drug-related issues, since they become the authority of both the client's treatment and their punishment.

Nagelhout GE; Mons U; Allwright S; Guignard R; Beck F; Fong GT et al. Prevalence and predictors of smoking in "smoke-free" bars. Findings from the International Tobacco Control (ITC) Europe Surveys. Social Science & Medicine 72(10): 1643-1651, 2011. (32 refs.)

National level smoke-free legislation is implemented to protect the public from exposure to second-hand tobacco smoke (SHS). The first aim of this study was to investigate how successful the smoke-free hospitality industry legislation in Ireland (March 2004), France (January 2008), the Netherlands (July 2008), and Germany (between August 2007 and July 2008) was in reducing smoking in bars. The second aim was to assess individual smokers' predictors of smoking in bars post-ban. The third aim was to examine country differences in predictors and the fourth aim was to examine differences between educational levels (as an indicator of socioeconomic status). This study used nationally representative samples of 3147 adult smokers from the International Tobacco Control (ITC) Europe Surveys who were surveyed pre- and post-ban. The results reveal that while the partial smoke-free legislation in the Netherlands and Germany was effective in reducing smoking in bars (from 88% to 34% and from 87% to 44%, respectively), the effectiveness was much lower than the comprehensive legislation in Ireland and France which almost completely eliminated smoking in bars (from 97% to 3% and from 84% to 3% respectively). Smokers who were more supportive of the ban, were more aware of the harm of SHS, and who had negative opinions of smoking were less likely to smoke in bars post-ban. Support for the ban was a stronger predictor in Germany. SHS harm awareness was a stronger predictor among less educated smokers in the Netherlands and Germany. The results indicate the need for strong comprehensive smoke-free legislation without exceptions. This should be accompanied by educational campaigns in which the public health rationale for the legislation is clearly explained.

Nonnemaker J; Engelen M; Shive D. Are methamphetamine precursor control laws effective tools to fight the methamphetamine epidemic? Health Economics 20(5): 519-531, 2011. (27 refs.)

One of the most notable trends in illegal substance use among Americans over the past decade is the dramatic growth and spread of methamphetamine use. In response to the dramatic rise in methamphetamine use and its associated burden, a broad range of legislations has been passed to combat the problem. In this paper, we assess the impact of retail-level laws intended to restrict chemicals used to manufacture methamphetamine (methamphetamine precursor laws) in reducing indicators of domestic production, methamphetamine availability, and the consequences of methamphetamine use. Specifically, we examine trends in these indicators of methamphetamine supply and use over a period spanning the implementation of the federal Methamphetamine Anti-Proliferation Act (MAPA) (October 2000) and a more stringent state-level restriction enacted in California (January 2000). The results are mixed in terms of the effectiveness of legislative efforts to control methamphetamine production and use, depending on the strength of the legislation (California Uniform Controlled Substances Act versus federal MAPA), the specification of the comparison group, and the particular outcome of interest. Some evidence suggests that domestic production was impacted by these legislative efforts, but there is also evidence that prices fell, purities rose, and treatment episodes increased.

O'Connor AB. Nurse practitioners' inability to prescribe buprenorphine: Limitations of the Drug Addiction Treatment Act of 2000. Journal of The American Academy of Nurse Practitioners 23(10): 542-545, 2011. (27 refs.)

Purpose: To identify the limitations of the Drug Addiction Treatment Act of 2000 (DATA 2000) and to discuss the merits of one possible solution: granting nurse practitioners (NPs) the authority to prescribe buprenorphine. Data sources: The DATA 2000 and related literature. Conclusions: Abuse of prescription opioid medications is a significant economic and public health burden. Buprenorphine is a highly effective medication that is used in the outpatient treatment of opioid-dependent patients. However, the DATA 2000 permits only physicians to prescribe this medication, substantially reducing patient access to potentially life-sustaining treatment. Implications for practice: Like diabetes and cardiovascular disease, addiction is a chronic condition that can be treated with lifestyle modifications, patient education, and appropriate medication. NPs are highly effective care-givers to patients with chronic disease. Granting NPs prescriptive authority for buprenorphine will improve access to treatment and patient outcomes. It will also enhance NP autonomy and authority, especially in states in which NPs practice independently.

Olmstead SB; McWey LM; Henderson T. In the child's best interest: Terminating the rights of fathers with children in foster care. Journal of Family Issues 32(1): 31-54, 2011. (48 refs.)

The authors conducted a content analysis of appellate court foster care cases in which fathers appealed the termination of their parental rights. Applying the Responsible Fathering framework to organize the contextual issues that impede men from responsibly fathering, the authors sought to learn what factors affect decisions regarding the termination of their parental rights. Multiple risk factors emerged including lack of social support, financial resources, and opportunities. Implications for practitioners include attending to father's mental health, alcohol and/or substance abuse, issues surrounding incarceration, and the coparental relationship.

Ozturk A; Poyrazoglu S; Sarli S. The short term effect of the law prohibiting smoking in enclosed areas upon the smoking conditions of employees in Kayseri, Turkey. Turkish Journal of Medical Sciences 41(1): 165-171, 2011. (16 refs.)

Aim: A law prohibiting smoking in the enclosed areas of public and private workplaces was put into effect in Turkey on 19 May 2008. The objective of this study was to evaluate the effect of this law upon the smoking habits of the employees in this short period of 3 months. Materials and methods: This study was performed in Kayseri, in 3 public and 3 private workplaces, comprising 868 employees. A questionnaire was filled out, face-to-face, in the second week of August. Results: The ratio of the people supporting this smoke-free law was 68.7%. Among the employees who were smoking when the law was put into effect, 5 (1.5%) of them have stated that they quit smoking because of the law, within 3 months. Among employees still smoking, 54.1% stated that the number of cigarettes they smoked in the workplace had decreased following this law, and 43.4% stated that the number of cigarettes smoked during the entire day had decreased. The mean number of cigarettes smoked had decreased from 10.8 to 8.1 in the workplace and from 15.6 to 13.0 during the entire day. Conclusion: It was revealed that this new smoke-free law has been effective in decreasing the number of cigarettes smoked, both in the workplace and during the day.

Pacheco J. Trends: Public opinion on smoking and anti-smoking policies. Public Opinion Quarterly 75(3): 576-592, 2011. (10 refs.)

This article traces public opinion toward tobacco use and anti-smoking legislation over time. Public views on the health effects of tobacco use have changed such that now a majority of individuals believe that smoking and secondhand smoke are harmful. While the public tends to blame the smoker for health problems, there is strong support for restrictions on tobacco advertising, although support is lower in tobacco-producing states. Generally, the public has become more supportive of smoking restrictions in various public domains, although there are important differences across states depending on tobacco production. Evidence suggests that trends in opinion toward tobacco use and anti-smoking legislation have coincided with the decline in smoking prevalence and the increase in anti-smoking policies and public health awareness reports at the federal, state, and local levels.

Palamar J. How ephedrine escaped regulation in the United States: A historical review of misuse and associated policy. (review). Health Policy 99(1): 1-9, 2011. (97 refs.)

Objective: Ephedrine is not only efficacious in the treatment of numerous ailments, but also has a long history of misuse. Research was needed to examine ephedrine policy over time in order to determine potential regulatory flaws that allowed misuse to continue. Methods: This review is based on primary literature derived from systematic searches of historical and scientific archives, as well as grey literature. Results: Ephedrine managed to pass through numerous regulatory loopholes within seventy years. Despite warnings of misuse over the latter half of the century, ephedrine, and its herbal source, ephedra, were regulated in a piecemeal fashion and remained easily available to the public. Health authorities have struggled to control ephedrine, as an amphetamine "look-alike," as a methamphetamine precursor, as a dietary supplement, and as a medication. Despite being a potentially dangerous stimulant, under-regulation was perhaps more problematic than the substance itself. Conclusions: Tighter control of all ephedrine products, drugs and dietary supplements alike, might have prevented adverse outcomes and allowed this substance to remain available in a safer manner. Stringent regulation of all ephedrine products is necessary to prevent misuse and to protect the public's health.

Pierce JP; Messer K. Commentary on White et al. (2011): Smoke-free policies within a comprehensive program coincident with major declines in teen smoking. (editorial). Addiction 106(8): 1503-1504, 2011. (11 refs.)

Quinn C; Lewis S; Edwards R; McNeill A. Economic evaluation of the removal of tobacco promotional displays in Ireland. Tobacco Control 20(2): 151-155, 2011. (25 refs.)

Aim: To evaluate the short-term economic impact of legislation removing point of sale tobacco promotional displays (ie, tobacco displays and other point of sale tobacco advertising) in Ireland, implemented July 2009, on cigarette sales across a range of categories of retail outlets. Methods: Cigarette sales were evaluated using scanning (weekly data since January 2006) and audit data (bimonthly since November 2007) within different retail categories using data sourced from AC Nielsen, Ireland. Visual inspection and time-series regression techniques were used where appropriate to assess changes in sales over time and in relation to the legislation. Results: No change was observed in sales data in any retail category over and above seasonal patterns and an underlying downward trend over time. Similarly, where available data enabled statistical analysis, there was no significant effect in the short term (up to 12 months after implementation) on retail sales of tobacco products, over and above seasonal and long-term trends. Conclusions: Recent claims of substantial revenue losses and closures of small retailers as a direct result of the removal of point of sale tobacco promotional displays in Ireland are not borne out by these data. The removal of point of sale displays is aimed at reducing the pernicious effects of tobacco advertising on children and is therefore likely to have an impact on sales over a much more protracted time period. This should enable retailers to adapt over time, perhaps using such regulations as an opportunity to play a role in promoting healthier products in the local community.

Racz J; Melles K; Marvanykovi F; Lencse M; Petke Z. Communicating the principle of 'treatment instead of punishment' in Hungary on the basis of an examination of the patients at a drug outpatient clinic. Drugs: Education, Prevention and Policy 18(3): 207-218, 2011. (52 refs.)

Aims: Drug use is an indictable offence in Hungary, but there is an opportunity to suspend the criminal proceedings if a small quantity of drugs is involved. However, the principle of 'treatment instead of punishment' (TIP) is heavily disputed in the professional literature. This study addresses the impact of the legal implementation of TIP on the practices of an institution that treats drug patients. Methods: Data were analysed on the basis of addiction severity index (ASI) interviews conducted with individuals (n = 628) who applied for treatment at a Budapest drug outpatient clinic between 2001 and 2005. The ASIs of individuals who chose TIP were compared with those of other drug patients using cluster analysis and a two-sample statistical t-test. Findings: After 2003, when the criminal law changed, the share of participants in TIP increased from 24%% to 72.6%%. Approximately, half the sample required treatment but did not have any problems. From 2003, the share of patients ''without problems'' who chose TIP was high (60%%). Conclusions: A modification of the TIP framework is justified for Hungary's criminal administration policy, which should consider the severity of the condition of the person utilizing the service in connection with drug use.

Ravara SB; Calheiros JM; Aguiar P; Barata LT. Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: A cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban. BMC Public Health 11: 720, 2011. (72 refs.)

Background: Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008. Methods: Questionnaire-based cross-sectional study, including all eligible staff. Sample: 52.9% of the 1, 112 staff; mean age 38.3 +/- 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes. Results: Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes. Conclusions: Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.

Regidor E; de Mateo S; Ronda E; Sanchez-Paya J; Gutierrez-Fisac JL; de la Fuente L et al. Heterogeneous trend in smoking prevalence by sex and age group following the implementation of a national smoke-free law. Journal of Epidemiology and Community Health 65(8): 702-708, 2011. (33 refs.)

Objective. Given the limited evidence available about the effects of clean indoor air laws on smoking behaviour in the general population, the impact of national smoke-free workplace, bar and restaurant legislation, implemented on 1 January 2006, on smoking prevalence in Spain was assessed in this study. Methods. Population-based trend analysis using estimates for 27 periods from the beginning of 2000 to the end of 2008-three periods per year. To calculate the period per cent change in smoking prevalence, the permutation test for joinpoint regression to detect significant changes was used. Results. In men and women aged 15-24 years, the prevalence of smoking declined between the first period in 2000 and the third period in 2008, whereas in women aged 45-64 years, it increased by 1.7% per period. A declining trend was detected up to the first period in 2006 in men and women aged 25-44 years and in men aged 45-64 years, but between the beginning of 2006 and the end of 2008 the prevalence of smoking increased by 1.2%, 0.7% and 2.0% per period in men aged 25-44 years, in women aged 25-44 years and in men aged 45-64 years, respectively. Conclusions. 3 years after a national smoke-free law was implemented, the trend in smoking prevalence in some population groups was unchanged; however, in others, the declining trend of previous years was reversed. The similarity of these findings to those observed in other countries suggests that clean indoor air laws, although effective in reducing exposure to second-hand smoke, may not achieve the secondary objective of reducing the prevalence of smoking in the population.

Rieckmann T; Bergmann L; Rasplica C. Legislating clinical practice: Counselor responses to an evidence-based practice mandate. Journal of Psychoactive Drugs 2011(7): 27-39, 2011. (66 refs.)

The demand to connect research findings with clinical practice for patients with substance use disorders has accelerated state and federal efforts focused on implementation of evidence-based practices (EBPs). One unique state driven strategy is Oregon's Evidence-Based Practice mandate, which ties state funds to specific treatment practices. Clinicians play an essential role in implementation of shifts in practice patterns and use of EBPs, but little is understood about how legislative efforts impact clinicians' sentiments and decision-making. This study presents longitudinal data from focus groups and interviews completed during the planning phase (n = 66) and early implementation of the mandate (n = 73) to investigate provider attitudes toward this policy change. Results reflect three emergent themes: (1) concern about retaining individualized treatment and clinical latitude, (2) distrust of government involvement in clinical care, and (3) the need for accountability and credibility for the field. We conclude with recommendations for state agencies considering EBP mandates.

Romano E; Voas RB. Drug and alcohol involvement in four types of fatal crashes. Journal of Studies on Alcohol and Drugs 72(4): 567-576, 2011. (22 refs.)

Objective: The aim of this study was to explore the relationship of drunk and drugged driving to the occurrence of fatal crashes associated with speeding, failure to obey/yield, inattention, and seat belt nonuse. Method: We examined data for fatally injured drivers involved in single-vehicle crashes killed in states in which more than 79% of the drivers were tested for drugs other than alcohol and had a known result. Results: About 25% of the drivers tested positive for drugs, a figure almost double that estimated by the 2007 National Roadside Survey. Cannabinoids and stimulants each contributed to about 23% of the drug-positive results (6% among all fatally injured single-vehicle drivers). Stimulants more than cannabinoids were found to be associated with the four types of crashes under study. Some drugs showed a protective effect over the four crash types under study. Significant interactions between drugs and alcohol were observed. Stimulants contributed to the different types of fatal crashes irrespective of the levels of alcohol consumed by the drivers. Conclusions: This study provides further evidence of a link between drug consumption and fatal crashes. It also opens the door to some interesting and sometimes unexpected questions regarding the way drugs contribute to crashes, which we found varies depending on the type of crash considered, the class of drug, and the presence of alcohol. Research is also needed on drugs that could have a protective effect on the occurrence of fatal crashes. These findings could be highly relevant to the design of drug-related traffic laws and programs targeted at curbing drugged driving.

Santali EY; Cadogan AK; Daeid NN; Savage KA; Sutcliffe OB. Synthesis, full chemical characterisation and development of validated methods for the quantification of (+/-)-4 '-methylmethcathinone (mephedrone): A new "legal high". Journal of Pharmaceutical and Biomedical Analysis 56(2): 246-255, 2011. (23 refs.)

The recent global increase in the abuse of 4'-methylmethcathinone and related compounds has developed a requirement for full chemical characterisation of these products. In this work we present full synthetic and chemical characterisation data and supplemental information for mephedrone synthesised as both the hydrobromide and hydrochloride salt. Additionally we report the first fully validated chromatographic methods for the detection and quantitative analysis of the substance both in its pure form and in the presence of a number of common adulterants used in illicit drug manufacture.

Sare J. Medicine and the media: How the media helped ban mephedrone. (editorial). British Medical Journal 342: e-article d1138, 2011. (0 refs.)

Schifano F; Albanese A; Fergus S; Stair JL; Deluca P; Corazza O et al. Mephedrone (4-methylmethcathinone; 'meow meow'): Chemical, pharmacological and clinical issues. (review). Psychopharmacology 214(3): 593-602, 2011. (62 refs.)

Recently, those substances deriving from the active ingredient of the Khat plant, cathinone, have been rising in popularity. Indeed, 4-methylmethcathinone (mephedrone; 'meow meow' and others) has been seen by some as a cheaper alternative to other classified recreational drugs. We aimed here at providing a state-of-the-art review on mephedrone history and prevalence of misuse, chemistry, pharmacology, legal status, product market appearance, clinical/management and related fatalities. Because of the limited evidence, some of the information here presented has been obtained from user reports/drug user-orientated web sites. The most common routes for mephedrone recreational use include insufflation and oral ingestion. It elicits stimulant and empathogenic effects similar to amphetamine, methylamphetamine, cocaine and MDMA. Due to its sympathomimetic actions, mephedrone may be associated with a number of both physical and psychopathological side effects. Recent preliminary analysis of recent UK data carried out in 48 related cases have provided positive results for the presence of mephedrone at postmortem. Within the UK, diffusion of mephedrone may have been associated with an unprecedented combination of a particularly aggressive online marketing policy and a decreasing availability/purity of both ecstasy and cocaine. Mephedrone has been recently classified in both the UK and in a number of other countries as a measure to control its availability. Following this, a few other research psychoactives have recently entered the online market as yet unregulated substances that may substitute for mephedrone. Only international collaborative efforts may be able to tackle the phenomenon of the regular offer of novel psychoactive drugs.

Seidenberg AB; Rees VW; Alpert HR; O'Connor RJ; Connolly GN. Ignition strength of 25 international cigarette brands. Tobacco Control 20(1): 77-80, 2011. (22 refs.)

Background: Cigarette-ignited fires are a leading cause of fire death and injury throughout the world and remain a global public health and safety problem. To reduce this harm, a small number of countries now require cigarettes to have reduced ignition propensity (RIP). It is not known if cigarette manufacturers are voluntarily introducing RIP cigarettes in other countries to help save lives. Methods Using the ASTM E2187-04 test method, per cent full length burn (%FLB) was measured for three popular brands from each of seven countries that did not have RIP legislation at the time of purchase. Results were compared with %FLB measurements from four popular US brands purchased in a jurisdiction (Vermont) with an RIP law. SRM 1082 reference cigarette was also tested to assure laboratory quality control. Results: All cigarette brands purchased in countries not requiring fire safety standards for cigarettes exceeded 75% FLB. In contrast, none of the cigarette brands from the USA exceeded 10% FLB. The SRM 1082 reference cigarette demonstrated 5% FLB. Conclusion Cigarette ignition propensity can be greatly reduced through legislation that requires cigarette fire safety standards. RIP cigarettes have the potential to significantly decrease the number of fire deaths, injuries and destruction of property caused by cigarette-ignited fires. Appropriate standards should be applied in cigarette markets globally.

Stocks G. Abuse of propofol by anesthesia providers: The case for re-classification as a controlled substance. Journal of Addictions Nursing 22(1-2): 57-62, 2011. (29 refs.)

Propofol was first reported as a drug of abuse in 1992 after a New York anesthesiologist became addicted to the then recently approved medication. Abuse of propofol, primarily among anesthesia providers, has since been reported around the world. As an uncontrolled substance, propofol is seldom kept in locked storage, nor is it inventoried or accounted for similar to other potential drugs of abuse found in most operating rooms. Rarely identified as a preferred drug of choice for abuse, ease of access appears to be a primary factor in propofol abuse, as well as its use as a drug of substitution for unavailable controlled drugs. Rather than contributing to the rate of substance abuse in anesthesia providers, most concerning is the high rate of accidental fatal overdose in individuals who abuse propofol. When propofol is controlled in a manner similar to more familiar drugs of abuse, specifically Scheduled drugs found in the operating room, the incidence of propofol abuse falls dramatically along with corresponding fatal outcomes. This dramatic decrease in abuse due to control is an attribute unique to propofol. As this journal goes to press the DEA has published a Proposed Rule for Placement of Propofol Into Schedule IV of the U.S. Controlled Substance Act. Control of propofol will not decrease the overall incidence of substance abuse among health professionals, but it will prevent many accidental deaths.

Syamial G; Mazurek JM; Malarcher AM. Current cigarette smoking prevalence among working adults --- United States, 2004--2010. MMWR. Morbidity and Mortality Weekly Report 60(38): 1305-1309, 2011. (10 refs.)

Cigarette smoking is among the most important modifiable risk factors for adverse health outcomes and a major cause of morbidity and mortality (1). Current cigarette smoking prevalence among all adults aged �18 years has decreased 42.4% since 1965, but declines in current smoking prevalence have slowed during the past 5 years (declining from 20.9% in 2005 to 19.3% in 2010) and did not meet the Healthy People 2010 (HP2010) objective to reduce cigarette smoking among adults to �12% (1--3). Targeted workplace tobacco control interventions have been effective in reducing smoking prevalence and exposure to secondhand smoke (4,5); therefore, CDC analyzed National Health Interview Survey (NHIS) data for 2004--2010 to describe current cigarette smoking prevalence among currently working U.S. adults by industry and occupation. This report describes the results of that analysis, which found that, overall, age-adjusted cigarette smoking prevalence among working adults was 19.6% and was highest among those with less than a high school education (28.4%), those with no health insurance (28.6%), those living below the federal poverty level (27.7%), and those aged 18--24 years (23.8%). Substantial differences in smoking prevalence were observed across industry and occupation groups. By industry, age-adjusted cigarette smoking prevalence among working adults ranged from 9.7% in education services to 30.0% in mining; by occupation group, prevalence ranged from 8.7% in education, training, and library to 31.4% in construction and extraction. Although some progress has been made in reducing smoking prevalence among working adults, additional effective employer interventions need to be implemented, including health insurance coverage for cessation treatments, easily accessible help for those who want to quit, and smoke-free workplace policies.

Public Domain

Szatkowski L; Coleman T; McNeill A; Lewis S. The impact of the introduction of smoke-free legislation on prescribing of stop-smoking medications in England. Addiction 106(10): 1827-1834, 2011. (27 refs.)

Aims: To investigate whether there were changes in the rate of prescribing of smoking cessation medications in the months leading up to, and after, the introduction of smoke-free legislation in England. Design: Interrupted time-series analysis of prescribing rates using Autoregressive Integrated Moving Average (ARIMA) models. Setting A total of 350 general practices in England who contribute data to The Health Improvement Network (THIN) database. Participants Patients in THIN aged 16+ identified from their medical records as smokers. Measurements Monthly rates of prescribing of nicotine replacement therapy (NRT), bupropion and varenicline were calculated from THIN from 2000 to 2009 for all smokers and for subgroups defined by patient sex, age group, history of chronic disease and quintile of the Townsend Index of Deprivation. ARIMA models were built to assess whether there were changes in prescribing before or after the introduction of smoke-free legislation over and above any long-term and seasonal trends. Findings There was a 6.4% (0.7-12.1) increase in prescribing of all smoking cessation medications in the 9 months before the introduction of smoke-free legislation and a 6.4% (1.1-11.7) reduction in the 9-month period afterwards. A 6.2% (1.4-11.0) increase in NRT prescribing and a 13.2% (4.3-22.2) increase in bupropion prescribing occurred in the 6- and 3-month periods, respectively, before smoke-free legislation was introduced, and a 5.5% (2.3-8.7) decline in NRT prescribing and a 13.7% (4.6-22.8) decline in bupropion prescribing in the 9 months post-legislation. The patterns of change in prescribing did not vary with patient demographics. Conclusions: Numbers of primary care prescriptions for smoking cessation medications increased prior to the introduction of smoke-free legislation but decreased afterwards, suggesting a temporal displacement in prescribing activity rather than a change in the overall volume of prescribing. Effects observed were consistent across all population subgroups, suggesting that the changes in prescribing will neither widen nor reduce smoking-related health inequalities.

Thrasher JF; Huang LL; Perez-Hernandez R; Niederdeppe J; Arillo-Santillan E; Alday J. Evaluation of a social marketing campaign to support Mexico City's comprehensive smoke-free law. American Journal of Public Health 101(2): 328-335, 2011. (41 refs.)

Objectives. We aimed to assess the level of awareness and impact of a social marketing campaign to promote Mexico City's 2008 comprehensive smoke-free law. Methods. Four months after the smoke-free law was implemented but before the campaign launch, we collected data from a population-based, random sample of 961 inhabitants of Mexico City. We analyzed data from 786 respondents who completed follow-up at the end of the campaign to determine campaign exposure and the association between campaign exposure and changes in campaign-targeted knowledge and attitudes. Results. Recall of any of the 5 campaign materials was 69%, with a uniform distribution of exposure to 1, 2, and 3 or more campaign materials (25%, 25%, and 19%, respectively). Exposure to a greater number of campaign materials was associated in a monotonic relation with campaign-targeted knowledge of ammonia and arsenic in cigarette smoke. In models assessing support for, perceived benefits of, and perceived right to smoke-free places, campaign exposure accounted for a positive change in half of the indicators within each of these domains. Conclusions. Social marketing campaigns can reinforce knowledge and attitudes that favor smoke-free laws, thereby helping to establish smoke-free norms.

Trtchounian A; Talbot P. Electronic nicotine delivery systems: is there a need for regulation? Tobacco Control 20(1): 47-52, 2011. (14 refs.)

Purpose Electronic nicotine delivery systems (ENDS) purport to deliver nicotine to the lungs of smokers. Five brands of ENDS were evaluated for design features, accuracy and clarity of labelling and quality of instruction manuals and associated print material supplied with products or on manufacturers' websites. Methods ENDS were purchased from online vendors and analysed for various parameters. Results While the basic design of ENDS was similar across brands, specific design features varied significantly. Fluid contained in cartridge reservoirs readily leaked out of most brands, and it was difficult to assemble or disassemble ENDS without touching nicotine-containing fluid. Two brands had designs that helped lessen this problem. Labelling of cartridges was very poor; labelling of some cartridge wrappers was better than labelling of cartridges. In general, packs of replacement cartridges were better labelled than the wrappers or cartridges, but most packs lacked cartridge content and warning information, and sometimes packs had confusing information. Used cartridges contained fluid, and disposal of nicotine-containing cartridges was not adequately addressed on websites or in manuals. Orders were sometimes filled incorrectly, and safety features did not always function properly. Print and internet material often contained information or made claims for which there is currently no scientific support. Conclusions Design flaws, lack of adequate labelling and concerns about quality control and health issues indicate that regulators should consider removing ENDS from the market until their safety can be adequately evaluated.

van Amsterdam J; Opperhuizen A; van den Brink W. Harm potential of magic mushroom use: A review. (review). Regulatory Toxicology and Pharmacology 59(3): 423-429, 2011. (65 refs.)

In 2007, the Minister of Health of the Netherlands requested the CAM (Coordination point Assessment and Monitoring new drugs) to assess the overall risk of magic mushrooms. The present paper is an updated redraft of the review, written to support the assessment by CAM experts. It summarizes the literature on physical or psychological dependence, acute and chronic toxicity, risk for public health and criminal aspects related to the consumption of magic mushrooms. In the Netherlands, the prevalence of magic mushroom use was declining since 2000 (last year prevalence of 6.3% in 2000 to 2.9% in 2005), and further declined after possession and use became illegal in December 2008. The CAM concluded that the physical and psychological dependence potential of magic mushrooms was low, that acute toxicity was moderate, chronic toxicity low and public health and criminal aspects negligible. The combined use of mushrooms and alcohol and the quality of the setting in which magic mushrooms are used deserve, however, attention. In conclusion, the use of magic mushrooms is relatively safe as only few and relatively mild adverse effects have been reported. The low prevalent but unpredictable provocation of panic attacks and flash-backs remain, however, a point of concern.

Van Hout MC; Brennan R. Plant food for thought: A qualitative study of mephedrone use in Ireland. Drugs: Education, Prevention and Policy 18(5): 371-381, 2011. (38 refs.)

The synthetic cathinone derivative club drug 'mephedrone' [4-methylmethcathinone (4MMC)] has been recognized in the EMCDDA early warning system since 2008 [EMCDDA (2010a). 'Article 5 of the Council Decision' council decision 2005/387/JHA of 10 May 2005 on the information exchange, risk assessment and control of new psychoactive substances. Official Journal, L 127. Retrieved from http://eur-lex.europa.eu/LexUriServ/LexUriServ.do? uri=CELEX:32005D0387:EN:HTML] and is currently under legislative control in Ireland. Research on this drug remains scant, and primarily UK based. This exploratory research aimed to present a 'consumptive snapshot' of this emerging drug in the Irish drug scene, with specific focus on mephedrone user experiences, social situatedness of use and risk discourses. Twenty two in-depth interviews were undertaken with young Irish people aged 18-35 years, who had used mephedrone in the 6 months prior to fieldwork. The resulting narratives were phenomenologically and thematically analysed; and identified unique mephedrone user decision-making processes, particular drug effects and outcomes, socially contextualized mephedrone use and user harm reducing strategies grounded in prior illicit and poly drug taking careers. The research supports UK-based findings, which suggested the presence of drug displacement patterns between licit and illicit, with Irish mephedrone user preferences centralized in mephedrone availability, competitive pricing and general lack of quality illicit stimulants in the street trade. Policy makers and drug educational specialists are dealing with rapid metamorphoses and re-branding of cathinone derivatives circumventing legislation amid widespread internet availability.

Taylor & Francis

Viswanathan B; Gedeon J; Bovet P. Impact of a smoking ban in public places: A rapid assessment in the Seychelles. Tobacco Control 20(6): 427-430, 2011

Background: We assessed the impact of a smoking ban in hospitality venues in the Seychelles 9 months after legislation was implemented. Methods: Survey officers observed compliance with the smoking ban in 38 most popular hospitality venues and administered a structured questionnaire to two customers, two workers and one manager in each venue. Results: Virtually no customers or workers were seen smoking in the indoor premises. Patrons, workers and managers largely supported the ban. The personnel of the hospitality venues reported that most smokers had no difficulty refraining from smoking. However, a third of workers did not systematically request customers to stop smoking and half of them did not report adequate training. Workers reported improved health. No substantial change in the number of customers was noted. Conclusion: A ban on public smoking was generally well implemented in hospitality venues but some less than optimal findings suggest the need for adequate training of workers and strengthened enforcement measures. The simple and inexpensive methodology used in this rapid survey may be a useful approach to evaluate the implementation and impact of clean air policy in low and middle-income countries.

Voon T; Mitchell A. Time to quit? Assessing international investment claims against plain tobacco packaging in Australia. Journal of International Economic Law 14(3): 515-552, 2011. (65 refs.)

The Australian federal government recently introduced into Parliament legislation mandating the plain packaging of all tobacco products. Tobacco companies and others have raised various legal concerns with this tobacco control scheme, both at a domestic level in relation to constitutional and intellectual property law, and at an international level in relation to international economic law. Some Members of the World Trade Organization (WTO) have asked questions about the scheme in the WTO's Committee on Technical Barriers to Trade and Council for Trade-Related Intellectual Property Rights. In addition, Philip Morris (Asia) Limited has given notice of an investor-State dispute settlement claim against Australia regarding plain packaging pursuant to the Hong Kong-Australia Bilateral Investment Treaty. This article considers the merits of that claim as well as certain related procedural issues. It also compares Australia's investment obligations with respect to plain packaging under the Australia-United States Free Trade Agreement, as some allegations have been made that plain packaging may be inconsistent with those obligations.

Wackowski OA; Lewis MJ; Hrywna M. Banning smoking in New Jersey casinos: A content analysis of the debate in print media. Substance Use & Misuse 46(7): 882-888, 2011. (24 refs.)

New Jersey's (NJ's) 2006 statewide smoking ban controversially exempted Atlantic City casinos. This study presents a content analysis of 210 NJ newspaper articles printed between November 2005 and February 2007, and describes the different frames and supporting information used to argue for or against exempting casinos from the smoking ban. Those in favor of exempting casinos framed the issue in terms of economics and compromise, while those opposing it framed the issue in terms of equity and health. Implications for policy initiatives and media advocacy are discussed. This work was supported in part by funding from the NJ Department of Health & Senior Services.

Weeks MO. Tobacco and media exposure in poor neighbourhoods: Implications for the incidence of smoking among community residents. International Journal of Nursing Practice 17(5): 534-538, 2011. (12 refs.)

It is an accepted truth that tobacco, as well as second-hand smoke, causes lung and other cancers. This health policy fact sheet examines the need and implications for tobacco control legislation in the United States. Major stakeholders and special interest groups influence whether or not further tobacco control legislation can be passed and who it affects. This paper will review not only the ethical implications, such as the ethical theory, ethical principles and ethical rules of conduct that support tobacco control legislation, but also its legal and economic implications as well as media influences. This paper concludes with the authors' assessment that the United States is in fact in need of more tobacco control legislation.

Wilson H; Thomson G. 'Balancing acts': The politics and processes of smokefree area policymaking in a small state. Health Policy 101(1): 79-86, 2011. (53 refs.)

Objective: To examine the influences on contemporary smokefree area policy development in New Zealand. Method: Semi-structured interviews were conducted with 62 New Zealand politicians and senior officials. They were asked about their views of possible interventions to reduce smoking around children, and how to achieve progress on smokefree homes, cars and public places. Transcribed data were analysed for themes, some of which were determined by the questions asked, and some emerged from the dynamic nature of the interviews. Results: Policymaking for smokefree areas was seen by participants as a complex, highly politicised activity, concerned with balancing a number of factors including evidence, personal experience, concern for smokers, and the desire for public support for policy. The majority of participants were cautious about making substantive policy moves on smokefree places because of their perception of the issue as highly controversial, their wish to avoid public resistance and their desire for community engagement. Preference was shown for a policy approach based on persuasion rather than legislation, as a means to make progress on smokefree cars and outdoor spaces. Conclusions: The results indicate the need for good communication of the acceptability and benefits of legislative smokefree changes to both the political and public arena.

Wipfli H; Huang G. Power of the process: Evaluating the impact of the Framework Convention on Tobacco Control negotiations. Health Policy 100(2-3): 107-115, 2011. (31 refs.)

Objective: Evaluate the impact of the FCTC negotiations on the diffusion of tobacco control policies. Methods: Analyzed country characteristics to determine their effects on the frequency, type and strength of tobacco control policies adopted among WHO Member States. Bivariate analyses were conducted for each characteristic to compare the frequency and strength of control policies adopted between pre-negotiation and negotiation periods. Multivariate regression analyses were performed to determine the predictive nature of these variables. Results: The frequency of policy adoption intensified during the years the FCTC negotiations were most intense. The strength of policies adopted also shifted significantly towards policies promoted by WHO. The average strength of policies adopted varied significantly according to country characteristics. All characteristics, with the exception of total and male smoking prevalence, were significantly associated with the number of policy types adopted. Conclusions: This study suggests that investments in international legal processes can be effective, even when the outcomes are unclear from the start. The FCC negotiation process coincided with a rise in domestic policy adoption in the direction advocated by WHO. However, there remains a need to improve outreach and diffusion to lower-income countries in tobacco control, as well as other areas of chronic disease control.

Wu F; Hser YI. Workforce professionalism in drug treatment services: Impact of California's Proposition 36. Journal of Substance Abuse Treatment 40(1): 44-55, 2011. (61 refs.)

This article investigates whether California's Proposition 36 has promoted the workforce professionalism of drug treatment services during its first 5 years of implementation. Program surveys inquiring about organizational information, Proposition 36 implementation, and staffing were conducted in 2003 and 2005 among all treatment providers serving Proposition 36 clients in five selected California counties (San Diego, Riverside, Kern, Sacramento, and San Francisco). A I-hour self-administered questionnaire was completed by 118 treatment providers representing 102 programs. This article examines five topics that are relevant to drug treatment workforce professionalism: resources and capability, standardized intake assessment and outcome evaluation, staff qualification, program accreditation, and information technology. Results suggest that Proposition 36 had a positive influence on the drug treatment workforce's professionalism. Improvements have been observed in program resources, client intake assessment and outcome evaluation databases, staff professionalization, program accreditation, and information technology system. However, some areas remain problematic, including, for example, the consistent lack of adequate resources serving women with children.

Yandle B; Dorchak A; Morriss AP. Regulation by litigation. (review). Regulation & Governance 5(2): 241-249, 2011. (8 refs.)

We believe that careful application of the logic of economics and public choice shines important light on regulation through litigation and can explain at least partly why regulators choose the litigation route, when they choose it, and how the choice may or may not achieve broad goals of efficiency and fairness. We present three case studies: heavy-duty diesel engines, silica and asbestos, and the tobacco industry's Master Settlement Agreement (MSA).

Yang TZ; Xu XC; Rockett IRH; Guo W; Zhou H. Effects of household, workplace, and public place smoking restrictions on smoking cessation. Health & Place 17(4): 954-960, 2011. (33 refs.)

The aim of this study was to evaluate the association between environmental smoking restrictions, distinguished by site, and smoking cessation by Chinese urban residents. Recruited through multi-stage quota-sampling, residents in six Chinese cities were surveyed. Data were both individual-level and city-level. Among 4735 respondents, 715 were identified as successful quitters and 405 as unsuccessful. Multilevel logistic regression analysis showed smoking cessation to be associated with city-level public place and workplace restrictions and individual-level workplace and household restrictions. Results offer justification for decision-makers to implement environmental tobacco control policies and related public health interventions aimed at markedly diminishing the high smoking prevalence in China.