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CORK Bibliography: Economic Aspects

47 citations. January 2009 to present

Prepared: June 2009

Ansary NS; Luthar SS. Distress and academic achievement among adolescents of affluence: A study of externalizing and internalizing problem behaviors and school performance. Development and Psychopathology 21(1): 319-341, 2009. (55 refs.)

The main objectives of this study were to prospectively examine the relationship between externalizing (substance use and delinquency) and internalizing (depression and anxiety) dimensions and academic achievement (grades and classroom adjustment), as well as continuity over time in these domains, within a sample of wealthy adolescents followed from 10th to 12th grades (n = 256). In both parts of the study, cluster analyses were used to group participants at 10th grade and then group differences were evaluated on adjustment outcomes over time. In Part 1, problem behavior clusters revealed differences on academic indices with the two marijuana using groups-marijuana users and multiproblem youth-exhibiting the worst academic outcomes at all three waves. For Part 2, the two lowest achieving groups reported the highest distress across all externalizing dimensions over time. Stability across the three waves was found for both personal and academic competence as well as the associations between these two domains. Results are discussed in relation to intervention efforts targeting wealthy students at risk.

Avila-Tang E; Apelberg BJ; Yamaguchi N; Katanoda K; Sobue T; Samet JM. Modelling the health benefits of smoking cessation in Japan. Tobacco Control 18(1): 10-17, 2009. (20 refs.)

Background: In Japan, tobacco smoking is one of the main avoidable causes of disease and death. Although the benefits of smoking cessation for reducing disease risk and increasing longevity have been extensively documented, a relatively low proportion of Japanese smokers currently express a willingness to quit. This study attempted to quantify future reduction in the burden of smoking-attributable disease that could result from increases in smoking cessation. Methods: A simulation model was developed to project changes in mortality in Japan associated with increased quit attempts and use of nicotine replacement therapy (NRT) among smokers, incorporating data on smoking prevalence, cause-specific mortality rates, quitting behaviour and NRT use and effectiveness. Results: Approximately 46 000 lung cancer deaths and 56 000 cardiovascular disease deaths could be avoided over 20 years if the proportion of smokers making a quit attempt per year gradually increased to current US levels over 20 years. If each of these quit attempts were aided by NRT, the estimates of avoidable deaths would increase to 64 000 for lung cancer and 78 000 for cardiovascular disease. In this model, negligible deaths were avoided due to decreased smoking initiation over the 20-year simulation. Conclusion: Smoking cessation can have measurable short-term impacts on the smoking-related mortality burden in Japan. However, to achieve these gains, tobacco control policies should focus both on increasing smokers' willingness to quit and providing the support and therapies to increase the likelihood that smoking cessation attempts will succeed.

Barnett R; Pearce J; Moon G. Community inequality and smoking cessation in New Zealand, 1981-2006. Social Science & Medicine 68(5): 876-884, 2009. (75 refs.)

The overall prevalence of smoking in New Zealand reduced from 32% in 1981 to 23.5% in 2006 but rates of smoking cessation have not been consistent among all social, demographic and ethnic groups. The period 1981-2006 also saw macroeconomic changes in New Zealand that resulted in profound increases in social and economic inequalities. Within this socio-political context we address two questions. First, has there been a social polarisation in smoking prevalence and cessation in New Zealand between 1981 and 2006? Second, to what extent can ethnic variation in rates of quitting be explained by community inequality, independently of socio-economic status? We find that smoking behaviour in New Zealand has become socially and ethnically more polarised over the past two decades, with greater levels of smoking cessation among higher socio-economic groups, and among New Zealanders of European origin. Variations in quit rates between Maori and European New Zealanders cannot be fully accounted for by ethnic differences in socio-economic status. Community inequality exerted a significant influence on Maori (but not European) smoking quit rates. The association with community inequality was particularly profound among women, and for particular age groups living in urban areas. These findings extend the international evidence for a relationship between social inequality and health, and in particular smoking behaviour. The research also confirms the importance of considering the role of contextual factors when attempting to elucidate the mechanisms linking socio-economic factors to health outcomes. Our findings emphasise that, if future smoking cessation strategies are to be successful, attention has to shift from policies that focus solely on engineering individual behavioural change, to an inclusion of the role of environmental stressors such as community inequality

Baum CL. The effects of cigrette costs on BMI and obesity. Health Economics 18(1): 3-19, 2009. (79 refs.)

About 30% of Americans are currently obese, which is roughly a 100% increase from 25 years ago. Public health officials have consequently become alarmed because recent research indicates that societal costs of obesity now exceed those of cigarette smoking and alcoholism. Cigarette taxes may have exacerbated the prevalence of obesity. In 1964, the US Surgeon General issued its first report relating smoking and health, and since that time, federal and state governments have increased cigarette taxes in a successful effort to reduce cigarette smoking. However, because cigarette smoking and obesity seem inversely related, cigarette taxes may have simultaneously increased obesity. This paper examines the effects of cigarette costs on BMI and obesity and finds that they have significant positive effects. This paper attempts to reconcile conflicting evidence in the literature by controlling more carefully for correlation with state-specific time trends using panel data. Results indicate that the net benefit to society of increasing cigarette taxes may not be as large as previously thought, though this research in no way concludes that they, should be decreased to prompt weight loss.

Broman CL. The longitudinal impact of adolescent drug use on socioeconomic outcomes in young adulthood. Journal of Child & Adolescent Substance Abuse 18(2): 131-143, 2009. (37 refs.)

This study investigates how drug use in adolescence contributes to socioeconomic outcomes in young adulthood. Several studies have investigated whether drug problems alter the life course in ways that are detrimental to young adult achievement, but findings are inconsistent. We use data from the National Longitudinal Study of Adolescent Health to investigate this issue. Results show that drug use in adolescence is significantly related to achievement outcomes by young adulthood, though not always in ways that might be predicted. Specifically, where significant, alcohol use is associated with greater socioeconomic achievement by young adulthood, whereas illegal drugs are associated with decreased socioeconomic achievement. Tests of potential mediators largely did not change this relationship. Implications of the results are discussed.

Carballo JL; Fernandez-Hermida JR; Secades-Villa R; Garcia-Rodriguez O. Effectiveness and efficiency of methodology for recruiting participants in natural recovery from alcohol and drug addiction. Addiction Research & Theory 17(1): 80-90, 2009. (35 refs.)

The goal of this descriptive study is to analyse the effectiveness and efficiency in economic and temporal terms of different strategies for the recruitment of participants who have recovered without help from problems with alcohol and other drugs. Diverse recruitment strategies were implemented (press advertisements, publicizing through the media, posters, snowball technique and request for help from healthcare professionals) over a two-year period in two different countries, and the results compared in terms of effectiveness and efficiency in the recruitment of self-changers. This study was carried out in various regions of Spain and in South Florida (USA). With these strategies a total of 54 Spanish-speaking participants were recruited who had changed their consumption habits without therapeutic help, 29 of them in Spain and 25 in Florida. Economic cost and time spent for the implementation of each strategy were assessed. These costs were divided by the number of participants recruited in order to obtain the economic and temporal efficiency of each strategy. Effectiveness was analysed by means of the number of participants recruited. Advertisements emerged as the most effective and efficient strategy in terms of time, while posters was the most efficient strategy in economic terms. The recruitment of self-changers is one of the greatest obstacles facing studies that set out to analyse self-change in drug use. The economic and temporal costs are high. Further work is needed to improve the effectiveness and efficiency of recruitment strategies with the aim of optimizing the resources employed in studies on natural recovery in addictive behaviours.

Chaloupka FJ. Alcoholic beverage taxes, prices and drinking. (commentary). Addiction 104(2): 191-192, 2009. (19 refs.)

Clark RE; Samnaliev M; McGovern MP. Impact of substance disorders on medical expenditures for medicaid beneficiaries with behavioral health disorders. Psychiatric Services 60(1): 35-42, 2009. (27 refs.)

Objective: This study measured the impact of substance use disorders on Medicaid expenditures for behavioral and physical health care among beneficiaries with behavioral health disorders. Methods: Claims for Medicaid beneficiaries with behavioral health diagnoses in 1999 from Arkansas, Colorado, Georgia, Indiana, New Jersey, and Washington were analyzed. Behavioral health and general medical expenditures for individuals with diagnoses of substance use disorders were compared with expenditures for those without such diagnoses. States were analyzed separately with adjustment for confounders. Results: A total of 148,457 beneficiaries met selection criteria, and 43,457 (29.3%) had a substance use diagnosis. Compared with other beneficiaries with behavioral health disorders, individuals with diagnoses of substance use disorders had significantly higher expenditures for physical health problems in five of six states. Approximately half of the additional care and expenditures were for treatment of physical conditions. Differences declined but remained statistically significant after adjustment for higher overall disease burden among beneficiaries with addictions. Medical expenditures for individuals with diagnoses of substance use disorders increased significantly with age in five of six states, whereas behavioral health expenditures were stable or declined. Hospital admissions for psychiatric and general medical reasons were higher for those with diagnoses of substance use disorders. Conclusions: The impact of addiction on Medicaid populations with behavioral health disorders is greater than the direct cost of mental health and addictions treatment. Higher medical expenditures can be partly attributed to greater prevalence of co-occurring physical disorders, but expenditures remained higher after adjustment for disease burden. Spending estimates based only on behavioral health diagnoses may significantly underestimate addictions-related costs, particularly for older adults.

Coffey RM; Levit KR; Kassed CA; McLellan AT; Chalk M; Brady TM et al. Evidence for substance abuse services and policy research: A systematic review of national databases. (review). Evaluation Review 33(2): 103-137, 2009. (22 refs.)

We reviewed 39 national government- and nongovernment-sponsored data sets related to substance addiction policy. These data sets describe patients with substance use disorders (SUDs), treatment providers and the services they offer, and/or expenditures on treatment. Findings indicate the availability of reliable data on the prevalence of SUD and the characteristics of specialty treatment facilities, but meager data on financing and services. Gaps in information might be filled through agency collaboration to redesign, coordinate, and augment existing substance abuse and general health surveys. Despite noted gaps, these data sets represent an unusually rich set of resources for health services and policy research.

Cook JA; Mock LO; Jonikas JA; Burke-Miller JK; Carter TM; Taylor A et al. Prevalence of psychiatric and substance use disorders among single mothers nearing lifetime welfare eligibility limits. Archives of General Psychiatry 66(3): 249-258, 2009. (46 refs.)

Context: In the 1990s, US welfare reform legislation imposed a 5-year lifetime limit on financial support for low-income families with young children (younger than 18 years). With increasing numbers of single mothers and their children reaching the end of their welfare eligibility, there is concern about potentially high rates of untreated psychiatric and substance use disorders in this population. Objective: To determine the prevalence, correlates, and likelihood of treatment for mental and substance use disorders in a population of urban single mothers receiving Temporary Assistance for Needy Families (TANF). Design: In-person diagnostic assessments were conducted from November 1, 2003, to October 31, 2004. Setting: Cook County, Illinois. Participants: Female TANF recipients and residents of Cook County (N = 333) who were randomly sampled during the final 24 months of their eligibility for TANF. Main Outcome Measure: Prevalence rates of DSM-IV mental and substance use disorders using the World Health Organization's Composite International Diagnostic Interview. Results: Lifetime prevalence of Composite International Diagnostic Interview disorders was 61.0% (95% confidence interval [CI], 55.7%-66.3%); 12-month prevalence was 46.8% (41.5%-52.2%). Lifetime prevalence of mental disorders was 53.2% (95% CI, 47.8%-58.5%); 12-month prevalence was 44.1% (38.8%-49.5%). Lifetime prevalence of substance use disorders was 29.1% (95% CI, 23.9%-33.8%); 12-month prevalence was 9.0% (6.8%-12.0%). Lifetime prevalence of comorbid mental/substance use disorders was 21.3% (95% CI, 16.9%-25.7%); 12- month prevalence was 6.3% (3.7%-8.9%). Only 21.7% (95% CI, 14.8%-28.5%) of participants with 12- month mental disorders received treatment for mental disorders; 41.4% (22.3%-60.4%) of participants with 12- month substance abuse disorders received treatment for substance use disorders. Conclusions: Despite the high prevalence of psychiatric and substance use disorders in this population, many remain untreated. The consequences of terminating welfare assistance are worthy of further investigation, given the potential for adverse effects on both mothers and their young children.

Daniel JZ; Hickman M; Macleod J; Wiles N; Lingford-Hughes A; Farrell M et al. Is socioeconomic status in early life associated with drug use? A systematic review of the evidence. (ediorial). Drug and Alcohol Review 28(2): 142-153, 2009. (27 refs.)

Aim. To conduct a systematic review of longitudinal studies that examined the association between childhood socioeconomic status (SES) and illegal drug use in later life. Design and Methods. Systematic search with an agreed list of search items was used to identify all longitudinal population-based studies that examined the association between childhood SES and later drug use. These included MEDLINE (1966-2005), EMBASE (1990-2005), CINAHL (1982-2005) and PsychInfo (1806-2005), and specialist databases of the Lindesmith Library, Drugscope and Addiction Abstracts. Foreign-language papers were included. Abstracts were screened independently by two reviewers. If there was disagreement to accept or reject the abstract, then a third reviewer acted as arbiter. Data were extracted by one of the authors. Results. Eleven relevant papers were identified (two birth cohorts and nine papers on school-aged cohorts). There was consistent evidence to support an association between lower childhood SES and later drug use, primarily cannabis use. However, few studies examined cannabis dependence, and studies of more problematic forms of drug use gave contradictory results. Discussion and Conclusions. We found consistent, though weak, evidence to support the assumption that childhood disadvantage is associated with later cannabis use. Further research is needed to clarify this issue and to inform future policies and public health messages.

DeBeck K; Wood E; Montaner J; Kerr T. Canada's new federal 'National Anti-Drug Strategy': An informal audit of reported funding allocation. International Journal of Drug Policy 20(2): 188-191, 2009. (15 refs.)

Background: While there is mounting international acceptance of harm reduction approaches and growing support for policies that balance enforcement with more health-focused interventions, in many settings these developments are not reflected in policy. In October 2007, the Canadian federal government launched a new $64 million dollar 'National Anti-Drug Strategy' in which two-thirds of the new monies was reportedly directed towards drug prevention and treatment initiatives. Methods: However, contrary to the impression left by a host of federal politicians, including the Prime Minister, that this new strategy was investing significantly in drug prevention and drug treatment, this analysis finds that when base funding is considered additional monies provided through the new federal National Anti-Drug Strategy only marginally shifts the allocation of funds within each category. Results: Specifically, law enforcement initiatives continue to receive the overwhelming majority of drug strategy funding (70%) while prevention (4%), treatment (17%) and harm reduction (2%) combined continue to receive less than a quarter of the overall funding. Conclusion: These findings suggest that the Canadian government is failing to invest resources in evidence-based drug policies.

Della Valle E; Stranges S; Trevisan M; Krogh V; Fusconi E; Dorn JM et al. Drinking habits and health in Northern Italian and American men. Nutrition, Metabolism and Cardiovascular Diseases 19(2): 115-122, 2009. (35 refs.)

Background and aim: The aim of this study was to investigate alcohol drinking habits in two male cohorts, one Italian and one American, and to investigate whether cardiovascular disease risk factors are related to different drinking patterns. Furthermore, socio-demographic characteristics were taken into account. Methods: The Italian sample was drawn from the National Alpines Association. A dietary questionnaire was sent to the members of this association as an additional supplement to their monthly magazine. Eleven thousand one hundred and thirty-four men, 18-94 years, from Northern Italy were included in this analysis. The American sample is part of the Western New York Health Study (WNYHS) including 1927 mate participants. Results: In both populations, those who drank more than 4 drinks/day were the least educated and showed the highest percentage of current smokers; the highest prevalence of hypertension occurred in heavier drinkers and those who mostly drank without food. By contrast, lifetime abstainers exhibited the lowest percentage of hypertension and the highest level of serum cholesterol; in both populations the highest prevalence of diabetes was present in lighter drinkers. Conclusions: The current study shows that drinking habits are quite different in the two countries and are basically linked with socio-demographic and behavioral variables and support the notion that excess volume of alcohol consumed, and drinking without food, are associated with a higher risk of hypertension and hyperlipidaemia, particularly for Italians.

Dietze PM; Jolley DJ; Chikritzhs TN; Clemens S; Catalano P; Stockwell T. Income inequality and alcohol attributable harm in Australia. BMC Public Health 9: e-article 70, 2009. (26 refs.)

Background: There is little research on the relationship between key socioeconomic variables and alcohol related harms in Australia. The aim of this research was to examine the relationship between income inequality and the rates of alcohol-attributable hospitalisation and death at a local-area level in Australia. Method: We conducted a cross sectional ecological analysis at a Local Government Area (LGA) level of associations between data on alcohol caused harms and income inequality data after adjusting for socioeconomic disadvantage and remoteness of LGAs. The main outcome measures used were matched rate ratios for four measures of alcohol caused harm; acute (primarily related to the short term consequences of drinking) and chronic (primarily related to the long term consequences of drinking) alcohol-attributable hospitalisation and acute and chronic alcohol-attributable death. Matching was undertaken using control conditions (non-alcohol-attributable) at an LGA level. Results: A total of 885 alcohol-attributable deaths and 19467 alcohol-attributable hospitalisations across all LGAs were available for analysis. After weighting by the total number of cases in each LGA, the matched rate ratios of acute and chronic alcohol-attributable hospitalisation and chronic alcohol-attributable death were associated with the squared centred Gini coefficients of LGAs. This relationship was evident after adjusting for socioeconomic disadvantage and remoteness of LGAs. For both measures of hospitalisation the relationship was curvilinear; increases in income inequality were initially associated with declining rates of hospitalisation followed by large increases as the Gini coefficient increased beyond 0.15. The pattern for chronic alcohol-attributable death was similar, but without the initial decrease. There was no association between income inequality and acute alcohol-attributable death, probably due to the relatively small number of these types of death. Conclusion: We found a curvilinear relationship between income inequality and the rates of some types of alcohol-attributable hospitalisation and death at a local area level in Australia. While alcohol-attributable harms generally increased with increasing income inequality, alcohol-attributable hospitalisations actually showed the reverse relationship at low levels of income inequality. The curvilinear patterns we observed are inconsistent with monotonic trends found in previous research making our findings incompatible with previous explanations of the relationship between income inequality and health related harms.

Dobkin C; Nicosia N. The war on drugs: Methamphetamine, public health, and crime. American Economic Review 99(1): 324-349, 2009. (59 refs.)

In mid-1995, a government effort to reduce the supply of methamphetamine precursors successfully disrupted the methamphetamine market and interrupted a trajectory of increasing usage. The price of methamphetamine tripled and purity declined from 90 percent to 20 percent. Simultaneously, amphetamine-related hospital and treatment admissions dropped 50 percent and 35 percent, respectively. Methamphetamine use among arrestees declined 55 percent. Although felony methamphetamine arrests fell 50 percent, there is no evidence of substantial reductions in property or violent crime. The impact was largely temporary. The price returned to its original level within four months; purity, hospital admissions, treatment admissions, and arrests approached preintervention levels within eighteen months.

Flynn PM; Broome KM; Beaston-Blaakman A; Knight DK; Horgan CM; Shepard DS. Treatment Cost Analysis Tool (TCAT) for estimating costs of outpatient treatment services. Drug and Alcohol Dependence 100(1-2): 47-53, 2009. (28 refs.)

A Microsoft (R) Excel-based workbook designed for research analysts to use in a national study was retooled for treatment program directors and financial officers to allocate, analyze, and estimate outpatient treatment costs in the U.S. This instrument can also be used as a planning and management tool to optimize resources and forecast the impact of future changes in staffing, client flow, program design, and other resources. The Treatment Cost Analysis Tool (TCAT) automatically provides feedback and generates summaries and charts using comparative data from a national sample of non-methadone outpatient providers. TCAT is being used by program staff to capture and allocate both economic and accounting costs, and outpatient service costs are reported for a sample of 70 programs. Costs for an episode of treatment in regular, intensive, and mixed types of outpatient treatment were $882, $1310, and $1381 respectively (based on 20% trimmed means and 2006 dollars). An hour of counseling cost $64 in regular, $85 intensive, and $86 mixed. Group counseling hourly costs per client were $8, $11, and $10 respectively for regular, intensive, and mixed. Future directions include use of a web-based interview version, much like some of the commercially available tax preparation software tools; and extensions for use in other modalities of treatment.

Gartner CE; Barendregt JJ; Hall WD. Multiple genetic tests for susceptibility to smoking do not outperform simple family history. Addiction 104(1): 118-126, 2009. (60 refs.)

Aims: To evaluate the utility of using predictive genetic screening of the population for susceptibility to smoking. Methods: The results of meta-analyses of genetic association studies of smoking behaviour were used to create simulated data sets using Monte Carlo methods. The ability of the genetic tests to screen for smoking was assessed using receiver operator characteristic curve analysis. The result was compared to prediction using simple family history information. To identify the circumstances in which predictive genetic testing would potentially justify screening we simulated tests using larger numbers of alleles (10, 15 and 20) that varied in prevalence from 10 to 50% and in strength of association [relative risks (RRs) of 1.2-2.1] Results: A test based on the RRs and prevalence of five susceptibility alleles derived from meta-analyses of genetic association studies of smoking performed similarly to chance and no better than the prediction based on simple family history. Increasing the number of alleles from five to 20 improved the predictive ability of genetic screening only modestly when using genes with the effect sizes reported to date. Conclusions: This panel of genetic tests would be unsuitable for population screening. This situation is unlikely to be improved upon by screening based on more genetic tests. Given the similarity with associations found for other polygenic conditions, our results also suggest that using multiple genes to screen the general population for genetic susceptibility to polygenic disorders will be of limited utility.

Goel RK. Cigarette prices and illicit drug use: is there a connection? Applied Economics 41(9): 1071-1076, 2009. (14 refs.)

Using cross-sectional data from the United States, this study examines the effects of cigarette prices on the use of marijuana and illicit drugs (including marijuana, cocaine, heroin, inhalants, hallucinogens or any prescription drugs for nonmedical use). Five primary contributions of this work are: First, it provides evidence on the cross-relation between cigarettes and marijuana and illicit drugs. Second, besides the 'standard' control variables used in demand studies (namely, price, education and income), we also control for the influence of employment status and health insurance coverage. Third, this research provides new evidence on the price elasticity of cigarette demand for a recent time period. Fourth, the data used in this study are the latest available. Five, based on our results, implications for drug use policy are provided. Several key points may be noted from our results: (i) Cigarette demand seems to have become elastic in recent years. This is in contrast to findings in earlier years; (ii) Consumers seem to view cigarettes and marijuana as substitutes and cigarettes and illicit drugs as substitutes. (iii) Greater consumer income increases illegal drug use, but does not seem to have a significant impact on smoking and marijuana use; (iv) The unemployment rate and health insurance converge do not seem to significantly affect smoking or drug use; and (v) Policymakers should pay attention to the cross effects among drugs in framing drug use policies.

Gospodinov N; Irvine I. Tobacco taxes and regressivity. Journal of Health Economics 28(2): 375-384, 2009. (32 refs.)

Recent literature on tobacco taxation Suggests that optima I tax rates should be very high. But Such high taxes raise concerns over regressivity. Most econometric estimates of elasticities by income group use historic price data that are low, and the usefulness Of Such estimates is therefore questionable on account of the serious 'out of sample' prediction problem. To address that problem, this paper estimates price elasticities for different socioeconomic groups using recent Canadian survey data for a period during which prices rose to a level of about $7 per pack. The results provide little reason to overturn the traditional concerns about regressivity.

Gulbinat W. Discussion paper on alcohol and the burden of disease: Reply to Rehm and Frick. (editorial). Addiction Research & Theory 17(1): 104-108, 2009. (9 refs.)

Hodgkin D; Horgan CM; Garnick DW; Merrick EL. Benefit limits for behavioral health care in private health plans. Administration and Policy in Mental Health Services Research 36(1): 15-23, 2009. (36 refs.)

Data from a nationally representative sample of private health plans reveal that special lifetime limits on behavioral health care are rare (used by 16% of products). However, most plans have special annual limits on behavioral health utilization; for example, 90% limit outpatient mental health and 93% limit outpatient substance abuse treatment. As a result, enrollees in the average plan face substantial out-of-pocket costs for long-lasting treatment: a median of $2,710 for 50 mental health visits, or $2,400 for 50 substance abuse visits. Plans' access to new managed care tools has not led them to stop using benefit limits for cost containment purposes.

Jansen PW; Tiemeier H; Looman CWN; Jaddoe VWV; Hofman A; Moll HA et al. Explaining educational inequalities in birthweight: the Generation R Study. Paediatric and Perinatal Epidemiology 23(3): 216-228, 2009. (54 refs.)

Although low socio-economic status has consistently been associated with lower birth-weight, little is known about the factors whereby socio-economic disadvantage influences birthweight. We therefore examined explanatory mechanisms that may underlie the association between the educational level of pregnant women, as an indicator of socio-economic status, and birthweight. The study was embedded within a population-based cohort study in the Netherlands. Information on maternal education, offspring's birthweight and several determinants of birthweight was available for 3546 pregnant women of Dutch origin. Infants of the lowest educated women had a statistically significantly lower birthweight than infants of the highest educated women [difference adjusted for gender and gestational age: -123 g (95% CI -167, -79)]. Parity, age of the pregnant women, hypertension, parental height and parental birthweight, marital status, pregnancy planning, financial concerns, number of people in household, weight gain and smoking habits individually explained part of the differences in birthweight, while adjustment for working hours and body mass index resulted in increases in birthweight differences between the educational levels. After full adjustment, the difference in birthweight between lowest and highest education was reduced by 66%. Our study confirmed remarkable educational inequalities in birthweight, a large part of which was explained by pregnancy characteristics, anthropometrics, the psychosocial and material situation, and lifestyle-related factors. Altering smoking habits may be an option to reduce educational differences in birthweight, as many lower-educated women tend to continue smoking during pregnancy. In order to tackle inequalities in birthweight, it is important that interventions are accessible for pregnant women in lower socioeconomic strata.

Jernigan DH. The global alcohol industry: An overview. (review). Addiction 104(Supplement 1): 6-12, 2009. (40 refs.)

To describe the globalized sector of the alcoholic beverage industry, including its size, principal actors and activities. Market research firms and business journalism are the primary sources for information about the global alcohol industry, and are used to profile the size and membership of the three main industry sectors of beer, distilled spirits and wine. Branded alcoholic beverages are approximately 38% of recorded alcohol consumption world-wide. Producers of these beverages tend to be large multi-national corporations reliant on marketing for their survival. Marketing activities include traditional advertising as well as numerous other activities, such as new product development, product placement and the creation and promotion of social responsibility programs, messages and organizations. The global alcohol industry is highly concentrated and innovative. There is relatively little public health research evaluating the impact of its many marketing activities.

John RM; Sung HY; Max W. Economic cost of tobacco use in India, 2004. Tobacco Control 18(2): 138-143, 2009. (36 refs.)

Objective: To estimate the tobacco-attributable costs of diseases separately for smoked and smokeless tobacco use in India. Methods: The prevalence-based attributable-risk approach was used to estimate the economic cost of tobacco using healthcare expenditure data from the National Sample Survey, a nationally representative household sample survey conducted in India in 2004. Four major categories of tobacco-related disease-tuberculosis, respiratory diseases, cardiovascular diseases and neoplasms-were considered. Results: Direct medical costs of treating tobacco related diseases in India amounted to $907 million for smoked tobacco and $285 million for smokeless tobacco. The indirect morbidity costs of tobacco use, which includes the cost of caregivers and value of work loss due to illness, amounted to $398 million for smoked tobacco and $104 million for smokeless tobacco. The total economic cost of tobacco use amounted to $1.7 billion. Tuberculosis accounted for 18% of tobacco-related costs ($311 million) in India. Of the total cost of tobacco, 88% was attributed to men. Conclusions: The cost of tobacco use was many times more than the expenditures on tobacco control by the government of India and about 16% more than the total tax revenue from tobacco. The tobacco-attributable cost of tuberculosis was three times higher than the expenditure on tuberculosis control in India. The economic costs estimated here do not include the costs of premature mortality from tobacco use, which is known to comprise roughly 50% to 80% of the total economic cost of tobacco in many countries.

Jones ES; Moore BA; Sindelar JL; O'Connor PG; Schottenfeld RS; Fiellin DA. Cost analysis of clinic and office-based treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients. Drug and Alcohol Dependence 99(1-3): 132-140, 2009. (47 refs.)

The cost of providing and receiving treatment for opioid dependence can determine its adoption. To compare the cost of clinic-based methadone (MC, n = 23), office-based methadone (MO, it = 2 1), and office-based buprenorphine (130, it = 34) we performed an analysis of treatment and patient costs over 6 months of maintenance in patients who had previously been stabilized for at least I year. We performed statistical comparisons using ANOVA and chi-square tests and performed a sensitivity analysis varying cost estimates and intensity of clinical contact. The cost of providing I month of treatment per patient was $147 (MC), $220 (MO) and $336 (130) (p < 0.001). Mean monthly medication cost was $93 (MC), $86 (MO) and $257 (130) (1), < 0.001). The cost to patients was $92 (MC), $63 (MO) and $38 (130) (P = 0.102). Sensitivity analyses, varying cost estimates and clinical contact, result in total monthly costs of $117 to $183 (MC), $149 to $279 (MO), $292 to $499 (BO). Monthly patient costs were $84 to $133 (MC), $55 to $105 (MO) and $34 to $65 (130). We conclude that providing clinic-based methadone is least expensive. The price of buprenorphine accounts for a major portion of the difference in costs. For patients, office-based treatment may be less expensive.

Khang YH; Yun SC; Cho HJ; Jung-Choi K. The impact of governmental antismoking policy on socioeconomic disparities in cigarette smoking in South Korea. Nicotine & Tobacco Research 11(3): 262-269, 2009. (38 refs.)

With enactment of the 1995 Health Promotion Act, the Korean government has developed numerous antismoking policies, including smoke-free buildings and zones, a public media campaign, and tobacco taxation. The present study examined whether governmental antismoking policy during the past decade was associated with reduced socioeconomic differentials in cigarette smoking in South Korea. Data from 99,980 men and 105,193 women aged 25-64 years were analyzed from four rounds of Social Statistical Surveys of Korea between 1995 and 2006. Socioeconomic position (SEP) indicators were education, occupational class, employment status, and household income. Age-adjusted prevalence of smoking was calculated. Prevalence ratios and the relative index of inequality (RII) were estimated using log-binomial regression analysis. Absolute socioeconomic differentials in age-adjusted prevalence of smoking increased between 1995 and 2006. Increases were found in both men and women. Prevalence ratios and RIIs also showed widening relative inequalities in smoking in all four SEP indicators in men. For women, increases in RIIs for education and income were statistically significant. The magnitude of change in prevalence ratios and RIIs by SEP indicators between 1999 and 2003 was statistically significant, whereas the difference between 2003 and 2006 was not. Despite reducing overall cigarette smoking rates in males, the governmental antismoking policies of South Korea did not reduce socioeconomic inequalities in smoking in both genders. However, the recent tobacco taxation policy is likely to dampen the ever-increasing trends in smoking inequalities. More progressive antismoking policies to reduce socioeconomic inequalities in smoking are warranted in South Korea.

King K; Martynenko M; Bergman MH; Liu YH; Winickoff JP; Weitzman M. Family composition and children's exposure to adult smokers in their homes. Pediatrics 123(4): E559-E564, 2009. (46 refs.)

OBJECTIVE. Smoking behavior is strongly influenced by the social environment. More information is needed about how the composition of households with children is associated with adult smoking behavior so that more effective interventions to reduce children's secondhand smoke exposure can be devised and implemented. METHODS. Using data from the Medical Expenditure Panel Survey 2000-2004, we conducted cross-sectional analyses to assess how adult smoking behavior is associated with household characteristics, including the number of adults and smokers present, the relationship of the child to the head of household, and relationships between adult members of the household. RESULTS. More than one third (34.4%) of children lived with >= 1 adult smoker. Almost half (49.4%) of poor children lived with a smoker, and they were more likely to live with multiple smokers compared with those who lived at >400% of the federal poverty level (21.2% vs 7.8%). Approximately 5 million children lived in households headed by an adult other than their parent, and they were significantly more likely to live with smokers: 53.4% of children who lived in their grandparents' homes and 46.2% of children in homes of other adults lived with at least 1 adult smoker, compared with 33.3% who lived in their parents' home. A total of 59.4% of all children who lived with a smoker had a smoking mother, and 56.7% of those children lived with >= 2 smokers, whereas only 17.0% of children whose mother did not smoke had smoking adults in the home. CONCLUSIONS. These findings demonstrate the significant influence of household composition on children's likelihood to live in homes with adult smokers.

la Cour L; Milhoj A. The sale of alcohol in Denmark - recent developments and dependencies on prices/taxes. Applied Economics 41(9): 1089-1103, 2009. (24 refs.)

How do prices affect the choice of types of alcohol in Denmark? We study the Danish sale of alcoholic beverages in a time series framework. First, we look at annual data from 1980 investigating the hypothesis of a fairly stable level of sales. We conclude stationarity of sales and we also find that the income elasticity of total sales has been zero. Second, we analyse the composition of the alcohol sale between beer, wine and spirits in a multivariate model conditional on the development in prices. For this analysis we use Johansen cointegration techniques. Again we test that income can be omitted from the model and we use the model to derive the effects on the composition of alcohol sales of three different sets of changes in the alcohol taxation.

Larimer ME; Malone DK; Garner MD; Atkins DC; Burlingham B; Lonczak HS et al. Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems. Journal of the American Medical Association 301(13): 1349-1357, 2009. (38 refs.)

Context Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates. Objective To evaluate association of a "Housing First" intervention for chronically homeless individuals with severe alcohol problems with health care use and costs. Design, Setting, and Participants Quasi-experimental design comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007 in Seattle, Washington. Main Outcome Measures Use and cost of services (jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services, and Medicaid-funded services) for Housing First participants relative to wait-list controls. Results Housing First participants had total costs of $8 175 922 in the year prior to the study, or median costs of $4066 per person per month (interquartile range [IQR], $2067-$8264). Median monthly costs decreased to $1492 (IQR, $337-$5709) and $958 (IQR, $98-$3200) after 6 and 12 months in housing, respectively. Poisson generalized estimating equation regressions using propensity score adjustments showed total cost rate reduction of 53% for housed participants relative to wait-list controls (rate ratio, 0.47; 95% confidence interval, 0.25-0.88) over the first 6 months. Total cost offsets for Housing First participants relative to controls averaged $2449 per person per month after accounting for housing program costs. Conclusions In this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months. These benefits increased to the extent that participants were retained in housing longer.

Lemstra M; Neudorf C; Nannapaneni U; Bennett N; Scott C; Kershaw T. The role of economic and cultural status as risk indicators for alcohol and marijuana use among adolescents. Paeditrics & Child Health 14(4): 225-230, 2009. (32 refs.)

INTRODUCTION: A number of reports suggest that Aboriginal cultural status is a major risk indicator for drug and alcohol use. The primary purpose of the present paper was to determine whether Aboriginal Cultural status is independently associated with risk behaviours, such as marijuana use and alcohol abuse, among Youth after multivariate adjustment for other factors, such as socioeconomic status. METHODS: Every student between grades 5 and 8 in Saskatoon, Saskatchewan, was asked to complete a questionnaire in February 2007. Logistic regression was used to determine the independent risk indicators associated with alcohol abuse and marijuana use. RESULTS: Four thousand ninety-three youth participated in the school health survey. At the cross-tabulation level, cultural status and neighbourhood income were both strongly associated with alcohol and marijuana use. After multivariate adjustment, the association between Aboriginal cultural status and alcohol abuse was not statistically significant (crude OR=3.52 to adjusted OR=0.80). For marijuana use, the association was significantly reduced (crude OR=9.91 to adjusted OR=2.79). After controlling for all other variables, results showed that low-income youth were 103% more likely to get drunk at least once and were 163% more likely to have tried marijuana at least once. CONCLUSION: To be more successful, future policies directed toward reducing risk behaviours among Youth should consider neighbourhood income characteristics.

London JA; Utter GH; Battistella F; Wisner D. Methamphetamine use is associated with increased hospital resource consumption among minimally injured trauma patients. Journal of Trauma, Injury, Infection and Critical Care 66(2): 485-490, 2009. (20 refs.)

Background: The clinical effects of methamphetamines (MA) may complicate medical management, potentially increasing resource utilization and hospital costs out of proportion to the patient's severity of injury. We hypothesize that minimally injured (MI) patients testing positive for MA consume more resources than patients testing negative for MA. Methods: Adult trauma patients were identified from 4 years of registry data, which was linked to cost data from our center's financial department. Patients were classified as MI (Injury Severity Score <9) or severely injured (Injury Severity Score >9). Primary outcome was total direct costs for the inpatient hospital stay. Secondary outcomes included direct costs by cost center, contribution margin, and hospital length of stay. Results: Sixty-five percent (n 6,193) of the 10,663 adult patients during the study period were admitted with MI. Nine percent (n = 557) of those tested were positive for MA. Total direct costs were higher in MI MA patients compared to nonusers ($2,998 vs. $2.,667, p < 0.001), and users consumed more resources in all 10 cost centers. The same multivariate model showed marginally increased costs with MI alcohol users, but not with MI cocaine users or severely injured MA users. Conclusion: MI MA patients consume more resources than patients testing negative for MA. Although MA use complicates the initial evaluation of patients, resource consumption was increased for all cost centers representing the entirety of a patients hospital stay, suggesting that the influence of MA is not limited to the initial diagnostic workup. Centers with high proportions of MA users may realize significant losses if compensation contracts are inadequate.

Luk R; Cohen JE; Ferrence R; McDonald PW; Schwartz R; Bondy SJ. Prevalence and correlates of purchasing contraband cigarettes on First Nations reserves in Ontario, Canada. Addiction 104(3): 488-495, 2009. (27 refs.)

Non-First Nations people purchasing cigarettes on First Nations reserves do not pay applicable taxes. We estimated prevalence and identified correlates of purchasing contraband cigarettes on reserves; we also quantified the share of contraband purchased on reserves relative to reported total cigarette consumption and the associated financial impact on taxation revenue. Data from the Ontario Tobacco Survey, a regionally stratified representative population telephone survey that over-samples smokers. Ontario, Canada. A total of 1382 adult current smokers. Reported status of purchasing cigarettes on reserves and the quantity of cigarettes bought on reserves. The prevalence of purchasing cigarettes on reserves was assessed with descriptive statistics. A two-part model was used to analyse correlates of having recently purchased contraband. A total of 25.8% reported recent purchasing and 11.5% reported usual purchasing. Heavy smoking, having no plans to quit and lower education were correlated with recent purchasing. Heavy smoking and not having plans to quit were also correlated with buying more packs of cigarettes on reserves. Contraband purchases on reserves accounted for 14.0% of the reported total cigarette consumption and resulted in an estimated tax loss of $122.2 million. There was substantial purchasing of contraband cigarettes on reserves in Ontario, resulting in significant losses in tax revenues. The availability of these cheap cigarettes undermines the effectiveness of tobacco taxation to reduce smoking. Wherever indicated, governments should strengthen their contraband prevention and control measures, as recommended by the Framework Convention on Tobacco Control, to ensure that tobacco taxation achieves its intended health benefits and that tax revenues are protected.

Mangeloja E; Pehkonen J. Availability and consumption of alcoholic beverages: Evidence from Finland. Applied Economics Letters 16(4): 425-429, 2009. (12 refs.)

The study examines the consumption of alcoholic beverages in Finland over the period 1960 to 2004. Consumption is explained by its own real price, relative prices, expenditure and variables measuring the availability of alcohol. The empirical analysis utilizes information on linkages across different beverages and uses co-integration techniques. The study finds that changes in the availability of alcohol, typically related to institutional changes, have played an important role in determining consumption, especially of beer.

McCollister KE; French MT; Sheidow AJ; Henggeler SW; Halliday-Boykins CA. Estimating the differential costs of criminal activity for juvenile drug court participants: Challenges and recommendations. Journal of Behavioral Health Services & Research 36(1): 111-126, 2009. (45 refs.)

Juvenile drug court (JDC) programs have expanded rapidly over the past 20 years and are an increasingly popular option for rehabilitating juvenile offenders with substance use problems. Given the high cost of crime to society, an important economic question is whether and to what extent JDC programs reduce criminal activity among juvenile offenders. To address this question, the present study added an economic cost analysis to an ongoing randomized trial of JDC conducted in Charleston, South Carolina. Four treatment conditions were included in the parent study: Family Court with usual community-based treatment (FC, the comparison group), Drug Court with usual community-based treatment (DC), DC with Multisystemic Therapy (DC/MST), and DC/MST enhanced with Contingency Management (DC/MST/CM). The economic study estimated the cost of criminal activity for nine specific crimes at baseline (pretreatment) and 4 and 12 months thereafter. A number of methodological challenges were encountered, suggesting that it may be more difficult to economically quantify frequency and type of criminal activity for adolescents than for adults. The present paper addresses methodological approaches and challenges, and proposes guidelines for future economic evaluations of adolescent substance abuse and crime prevention programs.

Munaf MR. The clinical utility of genetic tests. Addiction 104(1): 127-128, 2009. (7 refs.)

Rosen MI; Carroll KM; Stefanovics E; Rosenheck RA. A randomized controlled trial of a money management-based substance use intervention. Psychiatric Services 60(4): 498-504, 2009. (31 refs.)

Objective: Money management has been implemented, often in bundled interventions, as a strategy to counteract spending of public support checks and other funds on drugs and alcohol. The authors conducted a randomized controlled trial of a voluntary money management program as an adjunctive treatment for patients in treatment for mental illness, substance use disorders, or both. In the advisor-teller money manager (ATM) intervention, a money manager stores patients' checkbooks and automated bank cards, trains patients to manage their own funds, and links spending to activities related to their treatment goals. Methods: Eighty-five veterans with recent use of alcohol or cocaine were randomly assigned to 36 weeks of the ATM intervention or a control intervention (completion of a simple financial workbook). Results: With ATM, 75% of veterans gave their checkbook to their money manager to hold, and participants attended significantly more therapy sessions than those assigned to the control therapy (mean of 20.6 versus 8.1 sessions). Although participants assigned to ATM did not show significantly greater improvement over time on the primary outcomes (self-reported abstinence from alcohol and cocaine and negative urine tests for cocaine metabolite), they reduced their Addiction Severity Index drug and alcohol use composite scale scores more rapidly than the control group. High rates of abstinence in both groups created a ceiling effect, limiting the power to detect improved abstinence rates. Conclusions: In this relatively small trial, ATM, a money management intervention, showed promise in engaging patients, improving their money management, and improving some substance abuse outcomes.

Saar I. The social costs of alcohol misuse in Estonia. European Addiction Research 15(1): 56-62, 2009. (42 refs.)

The aim of this study was to estimate the social costs of alcohol misuse in Estonia in 2006. Using a prevalence-based cost-of-illness approach, both direct and indirect costs were considered, including tangible costs associated with health care, criminal justice, rescue services, damage to property, premature mortality, incarceration, incapability of working due to illnesses, and lower labor productivity. The results show that alcohol misuse cost Estonia more than EUR 200 million in 2006. The costs involved are estimated to represent 1.6% of the gross domestic product (GDP), which is relatively high in comparison with many other countries. In addition, the state receives less receipts from the alcohol excise tax than the costs that it incurs as a consequence of alcohol misuse, which points to the existence of economic inefficiency with respect to the alcohol market. The results of this study suggest that there is definitely a need for further cost-benefit analysis to reach a conclusion regarding the possible utility of government intervention.

Salize HJ; Merkel S; Reinhard I; Twardella D; Mann K; Brenner H. Cost-effective primary care-based strategies to improve smoking Cessation: More value for money. Archives of Internal Medicine 169(3): 230-235, 2009. (26 refs.)

Background: Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. Methods: In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. Results: Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95% level of certainty of cost-effectiveness against TAU, (sic)9.80 or (sic)6.96, respectively, had to be paid for each additional 1% of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, (sic)92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to (sic)39.10 paid per patient during the trial). In intervention 2, the cost was (sic)82.82, as opposed to (sic)50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; (sic)1 = $1.17.) Conclusions: Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy.

Single E. Why we should still estimate the costs of substance abuse even if we needn't pay undue attention to the bottom line. Drug and Alcohol Review 28(2): 117-121, 2009. (14 refs.)

A coalition of provincial, national and international addictions agencies has sponsored a series of symposia leading to the developing of international guidelines for estimating the costs of substance abuse. These guidelines have now been used in national studies in four continents, with more consistent and comparable results than in previous studies. Although the bottom-line results have been used to argue for alcohol and drug issues having a higher place on the public policy agenda, the real value in such studies lies in the detailed results regarding mortality and morbidity attributable to substance abuse, the relative contribution of acute versus chronic conditions to overall problem levels and the role of substance misuse in adverse social consequences, such as crime and economic productivity. There is a variety of factors which undermine the robustness of the findings, including lack of data, layering of assumptions and changes in the epidemiological knowledge base. It is argued that economic cost estimates should nonetheless be conducted and continually refined, as the detailed findings are of great utility to the design and targeting of prevention programming and policy. The presentation concludes on a personal note of farewell, as this is the author's final conference presentation.

Slatore CG; Au DH; Hollingworth W. Cost-effectiveness of a smoking cessation program implemented at the time of surgery for lung cancer. Journal of Thoracic Oncology 4(4): 499-504, 2009. (41 refs.)

Background: Many patients are active smokers at the time of a diagnosis Of Surgically resectable lung cancer. Perioperative smoking cessation is associated with improved survival, but the cost-effectiveness of a smoking cessation program initiated immediately before surgery is unknown. Methods: We developed a decision analytic Markov model to evaluate the incremental cost-effectiveness of a formal smoking cessation program. The parameter estimates were taken from the available literature. The model included the cost and effectiveness of the smoking cessation program, cost and incidence of perioperative complications, postoperative mortality, and utility measured in quality adjusted life years (QALY). Dollars per QALY and life year were calculated and one-way sensitivity analyses were performed. Results: The cost/QALY and cost/life year were $16,415 and $45,629 at 1 year after surgery and $2609 and $2703 at 5 years, respectively. Most sensitivity analyses showed the 1 year postsurgery cost/QALY estimates were less than $50,000, and all were less than $12,000 at 5 years. Cost-effectiveness estimates were most sensitive to the frequency of perioperative complications and the estimated short-term utility estimates. Conclusion: A smoking cessation program initiated before Surgical lung resection is cost-effective at both I and 5 years postsurgery. Providers should encourage patients who are still smoking to engage in formal smoking cessation programs.

Storti CC; De Grauwe P. Globalization and the price decline of illicit drugs. International Journal of Drug Policy 20(1): 48-61, 2009. (25 refs.)

Background: This study aims at understanding the mechanisms underlying the dramatic decline of the retail prices of major drugs like cocaine and heroin during the past two decades. It also aims at analysing the implications of this decline for drug policies. Methods: We use a theoretical model to identify the possible causes of this price decline. This allows us to formulate the hypothesis that the major driving force behind the price decline is a reduction of the intermediation margin (the difference between the retail and producer prices). We also develop the hypothesis that globalization has been an important factor behind the decline of the intermediation margin. We then analyse the statistical information to test these hypotheses. Results: We find that the decline in the retail prices of drugs is related to the strong decline in the intermediation margin in the drug business, and that globalization is the main driving force behind this phenomenon. Globalization has done so by increasing the efficiency of the distribution of drugs, by reducing the risk premium involved in dealing with drugs, and by increasing the degree of competition ill the drug markets. Conclusion: We conclude that the cocaine and heroin price declines were due to a sharp fall in the intermediation margin, which was probably influenced by globalization. This phenomenon might have a strong impact on the effectiveness of drug policies, increasing the relative effectiveness of policies aiming at reducing the demand of drugs.

Tomlin JT. The impact of smoking bans on the hospitality industry: New evidence from stock market returns. B E Journal of Economic Analysis & Policy 9(1): e-article 13, 2009. (21 refs.)

The majority of over 150 studies conclude that smoking bans do not have adverse effects on the revenues, profits, or employment of hospitality industry firms. However, several important criticisms have recently been raised which call into question many of the prior results. I examine the market value impact of a proposed smoking ban using a sample and methodology not subject to the perceived shortcomings in prior studies - an event study on the Indian hospitality industry. Contrary to the results in most prior studies, I find negative abnormal stock returns to portfolios of the hospitality industry firms examined upon the announcement of a proposed smoking ban. These results support the conclusion that a smoking ban lowered the aggregate market value of these firms.

Vlahov D; Strathdee S. The bottom line on cash incentives with drug users. (editorial). Addiction 104(5): 796-797, 2009. (27 refs.)

Weimer DL; Vining AR; Thomas RK. Cost-benefit analysis involving addictive goods: Contingent valuation to estimate willingness-to-pay for smoking cessation. Health Economics 18(2): 181-202, 2009. (42 refs.)

The valuation of changes in consumption of addictive goods resulting from policy interventions presents a challenge for cost-benefit analysis. Consumer surplus losses from reduced consumption of addictive goods that are measured relative to market demand schedules overestimate the social cost of cessation interventions. This article seeks to show that consumer surplus losses measured using using a non-addicted demand schedule provide a better assessment of social cost. Specifically, (1) it develops an addiction model that permits an estimate of the smoker's compensating variation for the elimination of addiction; (2) it employs a contingent valuation survey of current smokers to estimate their willingness-to-pay (WTP) for a treatment that would eliminate addiction: (3) it uses the estimate of WTP from the survey to calculate the fraction of consumer surplus that should be viewed as consumer value and (4) it provides an estimate of this fraction. The exercise suggests that, as a tentative first and rough rule-of-thumb only about 75% of the loss of the conventionally measured consumer surplus should be counted as social cost for policies that reduce the consumption of cigarettes. Additional research to estimate this important rule-of-thumb is desirable to address the various caveats relevant to this study.

Xin Y; Qian J; Xu L; Tang S; Gao J; Critchley JA. The impact of smoking and quitting on household expenditure patterns and medical care costs in China. Tobacco Control 18(2): 150-155, 2009. (30 refs.)

Background: Smoking remains very common in Chinese men, and the economic burden caused by cigarette consumption on smokers and their families may be substantial. Using a large nationally representative household survey, the third National Health Services Survey (NHSS, 2003), we estimated the economic impact of smoking on households. Methods: Smoking status of all household members (over 15 years) was collected by interview for the NHSS, and households classified into one of seven categories based on their smoking status. Information on household income and expenditure, and use of health services was also obtained. We assessed both the "direct'' costs (reducing funds available for spending on other commodities such as food, education, medical care, etc, using a fractional logit model), and "indirect costs'' (increasing medical expenditures, using a log-linear model). Results: Every five packets of cigarettes consumed per capita per month reduces household spending on other commodities, most notably on education (by about 17 yuan per capita per annum) and medical care (11 yuan). The effects are greatest among low-income rural households. Households with quitters spend substantially more on medical care than never-smoking households (64 yuan for households with two or more quitters). Conclusions: If a household member smokes, there is less money available for commodities such as education and medical care. Medical care expenditure is substantially higher among households with quitters, as ill-health is the main reason for quitting smoking in China. Smoking impoverishes a substantial number of poorer rural households.

Zagar AK; Zagar RJ; Bartikowski B; Busch KG. Cost comparisons of raising a child from birth to 17 years among samples of abused, delinquent, violent, and homicidal youth using victimization and justice system estimates. Psychological Reports 104(1, Special Issue): 309-338, 2009. (68 refs.)

Data from youth studied by Zagar and colleagues were randomly sampled to create groups of controls and abused, delinquent, violent, and homicidal youth (n=30 in each). Estimated costs of raising a nondelinquent youth from birth to 17 yr. were compared with the average costs incurred by other youth in each group. Estimates of living expenses, direct and indirect costs of victimization, and criminal justice system expenditures were Summed. Groups differed significantly on total expenses, victimization costs, and criminal justice expenditures. Mean total costs for a homicidal youth were estimated at $3,935,433, while those for a control youth were $150,754. Abused, delinquent, and violent youth had average total expenses roughly double the total mean costs of controls. Prevention of dropout, alcoholism, addiction, career delinquency, or homicide justifies interception and empirical treatment on a cost-benefit basis, but also based on the severe personal costs to the victims and to the youth themselves.

Zaridze D; Maximovitch D; Lazarev A; Igitov V; Boroda A et al. Alcohol poisoning is a main determinant of recent mortality trends in Russia: Evidence from a detailed analysis of mortality statistics and autopsies. International Journal of Epidemiology 38(1): 143-153, 2009. (22 refs.)

Background: The changes in Russian mortality rates during the last two decades are unprecedented in a modern industrialized country. Although these fluctuations have attracted much interest, trends for major groups of causes of death have been analysed while trends in specific causes of death might shed light on the underlying determinants. Methods: We analysed trends in total and cause-specific mortality in Russia for 1991-2006. The records of 24 836 forensic autopsies carried out during the period 1990-2004 in the city of Barnaul were analysed with respect to blood alcohol level. Results: Diseases of the circulatory system (in the age group 35-69 years) and external causes (in the age group 15-34 years) were the main contributors to the fluctuations in Russian mortality rates observed in 1991-2006. The largest relative changes were for conditions directly related to alcohol intake. Among cardiovascular diseases, fluctuations were due to 'other forms' of acute and chronic ischaemia, and to atherosclerotic heart disease, while rates of myocardial infarction were low and relatively constant. In the autopsy series a very high proportion of decedents whose death was attributed to 'other' or 'not classified' cardiovascular diseases had lethal or potentially lethal concentrations of ethanol in blood. Conclusions: The increases in mortality in 1991-94 and in 1998-2003 coincided with economic and societal crisis, while decreases in 1994-98 and 2003-06 correlate with improvement in the economic situation. Excessive alcohol intake is a major cause of premature male Russian mortality, although many alcohol-related deaths are wrongly attributed to diseases of the circulatory system.