Serving Substance Abuse Professionals Since 1993

Last Update: 10.10.08

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: Economic Aspects

107 citations. July 2007 to present

Prepared: June 2008

Alemi F; Sullivan T. An example of activity based costing of treatment programs. American Journal of Drug and Alcohol Abuse 33(1): 89-99, 2007. (21 refs.)

We introduce a new tool that can be used for estimating number, length of time, and nature of services patient receive in drug treatment programs. While the field has made significant progress in standardizing the collection of expenditure data, little progress has been made on creating a standard measure for estimating program activities and census. We report on a method of estimating program activities.

Anderson P; Baumberg B. Alcohol in Europe - Public Health Perspective: Report summary. Drugs: Education, Prevention and Policy 13(6): 483-488, 2006. (0 refs.)

"Alcohol in Europe" was an analysis of the health, social and economic impact of alcohol in Europe, undertaken by the European Commission. The main findings of the Report are reprinted here. The major sections include (1) Alcohol and the economy of Europe; (2) the use of alcohol in Europe; (3) the impact of alcohol on Europe; (4) the impact of alcohol policy options; (5) European and global alcohol policy; and (6) member state alcohol policy. Among the key findings are that alcohol is a central element in the economy accounting for EU9 billion for the European Union. The EU is the heaviest drinking region of the world, although per capita consumption has been declining. Binge drinking is common and the level equivalent to one in three persons binge-drinking at least once per month. It is estimated that 23 million European are alcohol dependent. In terms of the impact alcohol is responsible for 12% or male and 2% of female premature death per year. One in three road fatalities are alcohol related; 10% of youth female morality is alcohol related and 25% of male youth mortality. Not all the harm falls to the drinker; alcohol is associated with 60,000 underweight births, 16% of case of child abuse and 7 million children live in families adversely impacted by alcohol. The drinking -driving policies are seen as highly effective, including random breath testing, lowered BAC levels, license suspension and lower BAC for young drivers. Efforts judged to have a low impact include designated driver, training and public awareness. There is also strong evidence of polices that regulate the market, via alcohol taxes. However, one of the proble3ms is that member states have to abide by the trade law of the EU, thus restricting the ability to have advertising bans in some areas, or to raise taxes independently.

Antonanzas F; Rodriguez R. Tobacco policies in the European Union: A need for state and continental harmonisation? European Journal of Health Economics 8(4): 301-304, 2007. (8 refs.)

A reduction in tobacco consumption has been targeted as a major public health policy by the European Union (EU). Since 1987, there have been several directives and other legal texts concerning this issue. Despite this, the consumption of tobacco, mainly cigarettes, remains unchanged or continues its upward trend (depending on the country studied) and public health goals are not being met. Smoking is still the leading cause of avoidable death in Europe despite the measures taken to control tobacco consumption. Currently it is estimated that more than half a million people die every year in the EU as a direct or indirect consequence of smoking. The preferred reduction in tobacco consumption is from complete cessation. This requires coordination and collaboration at multiple levels. The WHO has recognized that the most efficient strategies to fight tobacco consumption are population-wide. The different types of policies and programs are reviewed. These include informative and educational policies, fiscal policies, ban policies, an subsidies and incentives (particularly to replace the tobacco-growing subsidies.)

Aos S; Mayfield J; Miller M; Yen W. Evidence-based treatment of alcohol, drug, and mental health disorders: Potential benefits, costs, and fiscal impacts for Washington State. Olympia, Washington: State of Washington, 2006. (62 refs.)

The Washington State Institute for Public Policy was directed by the 2005 Washington Legislature to estimate whether Òevidence-basedÓ treatment for people with alcohol, drug, and mental health disorders offers economic advantages. Do benefits outweigh costs? And, if so, what is the magnitude of the potential fiscal savings to government, as well as the total net benefits to all of Washington? Methods: To answer these questions, we systematically reviewed the Òwhat worksÓ literature regarding treatments for people with alcohol, drug, and mental health disorders. We then estimated the monetary value of the benefits, including factors such as improved performance in the job market, reduced health care and other costs, and reduced crime-related costs. Findings: (1) Evidence-based treatment works. We found that the average evidence-based treatment can achieve roughly a 15 to 22 percent reduction in the incidence or severity of these disorders-at least in the short term. ( 2) The economics look attractive. We found that evidenced-based treatment of these disorders can achieve about $3.77 in benefits per dollar of treatment cost. This is equivalent to a 56 percent rate of return on investment. From a narrower taxpayer's-only perspective, the ratio is roughly $2.05 in benefits per dollar of cost. (3) The potential is significant. We estimate that a reasonably aggressive implementation policy could generate $1.5 billion in net benefits for people in Washington ($416 million are net taxpayer benefits). The risk of losing money with an evidence-based treatment policy is small.

Public Domain

Armitage CJ; Harris PR; Hepton G; Napper L. Self-affirmation increases acceptance of health-risk information among UK adult smokers with low socioeconomic status. Psychology of Addictive Behaviors 22(1): 88-95, 2008. (28 refs.)

This study reports an experiment designed to test whether self-affirmation can overcome defensive processing of risk information in a sample of UK adult smokers with low socioeconomic status. Participants (N = 57) were randomized to either a self-affirmation or control condition before reading a government-sponsored antismoking leaflet and completing measures of message acceptance, intention, and self-efficacy. Participants' subsequent behavior (taking leaflets) was recorded surreptitiously. Results showed that the manipulation significantly increased message acceptance, intention and behavior, and that the effects of the manipulation on behavior were mediated through message acceptance and intention. The practical and theoretical implications of the findings are discussed in relation to the possible use of self-affirmation manipulations to enhance the effectiveness of smoking cessation interventions.

Arndt S. Open access and article processing charges. (editorial). Substance Abuse Treatment, Prevention, and Policy 1: article 19, 2006. (7 refs.)

Substance Abuse, Treatment, Prevention, and Policy uses a medium that provides the broadest possible worldwide readership. Anyone in the world can read articles without charge. Since the articles published here will hopefully help inform policy this is exactly the right target - free and unlimited access. Beginning July 2006, article-processing charges will be applied to papers published in this journal. [Note: The amount of the charge is not provided. The website indicates the charge is US $1,370]

Ben Abdallah A; Scheier LM; Inciardi JA; Copeland J; Cottler LB. A psycho-economic model of ecstasy consumption and related consequences: A multi-site study with community samples. (review). Substance Use & Misuse 42(11): 1651-1684, 2007. (101 refs.)

Becker and Murphy's (1988) theory of rational behavior suggests that economic factors play an influential role in the decision leading to drug consumption and possibly dependence. Psychological models, on the other hand, emphasize internal regulatory cues that motivate drug use and play a contributory role in dependence. Until now, the confluence of both economic and psychological models has not been tested empirically. The present study used latent-variable structural equation modeling (SEM) to examine the influence of both economic (social anomie, unit price, and time spent acquiring drugs) and psychological risk factors (motivation, depression, and sexual risk behaviors) on self-reported ecstasy use. Data were obtained from 612 recreational ecstasy users in the United States and Australia participating in a NIDA-funded epidemiological study examining trends in ecstasy use. The sample was mainly white (61%), male (58%), and young (mean age = 23 yrs [5.25]). All of the hypothesized latent constructs were statistically reliable and correlated in the expected direction. A saturated SEM indicated that monetary and opportunity cost, but not income, significantly predicted ecstasy use. Among the psychological measures, motivational cues were the strongest predictor of both use and dependence. Inclusion of gender, age, race, education, and site variables did not appreciably alter the final model parameters. The implications of incorporating the role of economic factors in shaping a more refined understanding of addiction are discussed. Suggestions for future research and study limitations are also noted.

Ben Lakhdar C. Quantitative and qualitative estimates of cross-border tobacco shopping and tobacco smuggling in France. Tobacco Control 17(1): 12-16, 2008. (15 refs.)

Objective: In France, cigarette sales have fallen sharply, especially in border areas, since the price increases of 2003 and 2004. It was proposed that these falls were not due to people quitting smoking but rather to increased cross-border sales of tobacco and/or smuggling. This paper aims to test this proposition. Methods: Three approaches have been used. First, cigarette sales data from French sources for the period 1999-2006 were collected, and a simulation of the changes seen within these sales was carried out in order to estimate what the sales situation would have looked like without the presence of foreign tobacco. Second, the statements regarding tobacco consumed reported by the French population with registered tobacco sales were compared. Finally, in order to identify the countries of origin of foreign tobacco entering France, we collected a random sample of cigarette packs from a waste collection centre. Results: According to the first method, cross-border shopping and smuggling of tobacco accounted for 8635 tonnes of tobacco in 2004, 9934 in 2005, and 9930 in 2006, ie, between 14% and 17% of total sales. The second method gave larger results: the difference between registered cigarette sales and cigarettes declared as being smoked was around 12 000 to 13 000 tonnes in 2005, equivalent to 20% of legal sales. The collection of cigarette packs at a waste collection centre showed that foreign cigarettes accounted for 18.6% of our sample in 2005 and 15.5% in 2006. France seems mainly to be a victim of cross-border purchasing of tobacco products, with the contraband market for tobacco remaining modest. Conclusion: in order to avoid cross-border purchases, an increased harmonisation of national policies on the taxation of tobacco products needs to be envisaged by the European Union.

Best CM; Sun K; de Pee S; Sari M; Bloem MW; Semba RD. Paternal smoking and increased risk of child malnutrition among families in rural Indonesia. Tobacco Control 17(1): 38-45, 2008. (24 refs.)

Objective: To determine whether paternal smoking is associated with an increased risk of child malnutrition among families in rural Indonesia. Methods: The relation between paternal smoking and child malnutrition was examined in a population-based sample of 438 336 households in the Indonesia Nutrition and Health Surveillance System, 2000-2003. Main outcome measures were child underweight (weight-for-age Z score <-2) and stunting (height-for-age Z score <-2) and severe underweight and severe stunting, defined by respective Z scores <-3, for children aged 0 59 months of age. Results: The prevalence of paternal smoking was 73.7%. The prevalence of underweight and stunting was 29.4% and 31.4%, and of severe underweight and severe stunting was 5.2%, and 9.1%, respectively. After adjusting for child gender, child age, maternal age, maternal education, weekly per capita household expenditure and province, paternal smoking was associated with an increased risk of underweight (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.05, p=0.001) and stunting (OR 1.11, 95% CI 1.09 to 1.13, p < 0.001) and severe underweight (OR 1.06, 95% CI 1.01 to 1.10) p=0.020) and severe stunting (OR 1.12, 95% CI 1.08 to 1.16, p < 0.001). Conclusions: Paternal smoking is associated with an increased risk of child malnutrition in families living in rural Indonesia.

Borras L; Mohr S; Boucherie M; Dupont-Willemin S; Ferrero F; Huguelet P et al. Patients with schizophrenia and their finances: How they spend their money. Social Psychiatry and Psychiatric Epidemiology 42(12): 977-983, 2007. (29 refs.)

Although most patients with schizophrenia rely on state financial support, little is known about their expenses and how they use the money at their discretion. However, the ability to budget is a predictive factor in rehabilitation. An assessment of financial management skills could make it possible to develop more appropriate psycho-social assistance. Fifty-seven outpatients with schizophrenia treated in the public sector in Geneva, Switzerland took part in the study. Psychosocial, diagnostic, neurocognitive and symptomatological measures were collected. Data were gathered on patients' incomes and quality of life. A prospective analysis of their expenses during a 1-month period was also performed. Median income was 4,125 Swiss francs per month (i.e., 3,372 US dollars). After paying fixed expenses (which were handled with or without the assistance of a representative payee), a mean of 400 Swiss francs remained at their disposal to use as they wished. Seventy-two percent of this money was devoted to the use of psychoactive substances (e.g., cigarettes, alcohol, cannabis) or various drinks in coffee houses, and 28% on leisure activities (trips, sports and other recreational activities). Eighty-four percent of patients would have liked to have more money for leisure activities. The study was well-accepted and led to modification of the treatment plan in 84% of cases. Most of the discretionary money patients received was used for buying substances with addictive properties; this may hinder the practice of activities favouring recovery. Thus, it appears essential to guide patients in the management of their budgets.

Boyle RG; Enstad C; Asche SE; Thoele MJ; Sherwood NE. Evaluating strategies and costs to recruit smokeless tobacco users. Addictive Behaviors 32(12): 3088-3092, 2007. (8 refs.)

We recruited smokeless tobacco users throughout Minnesota to participate in a trial testing telephone counseling versus a written self-help manual for cessation. This paper describes the recruitment strategies applied on a state-wide basis. We established a recruitment tracking system to monitor weekly rates of screened callers and returned consents, allowing us to adjust future recruitment efforts. Screening was completed with 783 callers, with 406 subjects enrolled. Overall 44% of initial contacts and 52% of those screened enrolled in the study. The overall average cost per consented subject was $99. Sports talk radio, small print ads, and newspaper articles based on press releases were consistently effective channels for recruitment. The overall cost was expensive but reflected the geographic diversity of recruitment and the prevalence of oral snuff use.

Browning KK; Ferketich AK; Salsberry PJ; Wewers ME. Socioeconomic disparity in provider-delivered assistance to quit smoking. Nicotine & Tobacco Research 10(1): 55-61, 2008. (30 refs.)

The U.S. Public Health Service smoking cessation clinical practice guideline is the accepted gold standard for smoking cessation treatment. It offers evidence-based treatment recommendations for all clinicians to deliver to all patients at each visit. Despite the release of the guideline and the publication of Healthy People 2010, health care providers still may not appropriately counsel patients to quit smoking. Furthermore, disparities may exist among smokers who are assisted to quit smoking by their health care providers. The present study tested for an association between selected sociodemographic and tobacco-related factors and assistance to quit smoking. This 2001 National Health Interview Survey secondary analysis included a U.S. civilian, noninstitutionalized population. Participants were self-reported current smokers who visited a health care provider in the past 12 months and were at least 25 years old. The outcome measure was smokers' self-report of whether assistance to quit smoking was given by a health care provider. Of smokers who received advice (N=3,046), only 38% received assistance to quit smoking. Smokers were less likely to report assistance to quit smoking if they were younger or Black, or if they had a high or middle level of socioeconomic disadvantage. In the final logistic regression model, being married, attempting to quit in the past 12 months, and consuming more tobacco were associated with receiving assistance to quit smoking. Increased age also was associated with receiving assistance, as was greater socioeconomic advantage (higher education, higher income, health insurance). The mechanisms responsible for the disparities in delivery of tobacco dependence treatment must be investigated further.

Campbell G; Degenhardt L. Australian Capital Territory Drug Trends 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 269. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (26 refs.)

This report reports data on the use of illicit drugs in ACT, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, and antidepressants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 94 figures and tables.

Cantrell J; Hung D; Fahs MC; Shelley D. Purchasing patterns and smoking behaviors after a large tobacco tax increase: A study of Chinese Americans living in New York City. Public Health Reports 123(2): 135-146, 2008. (53 refs.)

Objectives. Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens the public health benefits of higher-priced cigarettes. Few studies examine responses to cigarette tax policies, particularly among high-risk minority populations. This study examined the prevalence and correlates of tax avoidance and changes in smoking behaviors among Chinese American smokers in New York City after a large tax increase. Methods. We conducted a cross-sectional study with data for 614 male smokers from in-person and telephone interviews using a comprehensive household-based survey of 2,537 adults aged 18-74 years. Interviews were conducted in multiple Chinese dialects. Results. A total of 54.7% of respondents reported engaging in at least one low- or no-tax strategy after the New York City and New York State tax increases. The more common strategies for tax avoidance were purchasing cigarettes from a private supplier/importer and purchasing duty free/overseas. Higher consumption, younger age, and number of years in the U.S. were consistently associated with engaging in tax avoidance. Younger and heavier continuing smokers were less likely to make a change in smoking behavior in response to the tax increase. Despite high levels of tax avoidance and varying prices, nearly half of continuing smokers made a positive change in smoking behavior after the tax increase. Conclusions. Expanded legislation and enforcement must be directed toward minimizing the availability of legal and illegal low- or no-tax cigarette outlets. Public education and cessation assistance customized for the Chinese American community is key to maximizing the effectiveness of tobacco tax policies in this population.

Cartwright WS. A critical review of accounting and economic methods for estimating the costs of addiction treatment. Journal of Substance Abuse Treatment 34(2): 224-233, 2008. (27 refs.)

Researchers have been at the forefront of applying new costing methods to drug abuse treatment programs and innovations. The motivation for such work has been to improve costing accuracy. Recent work has seen applications initiated in establishing charts of account and cost accounting for service delivery. As a result, researchers now have available five methods to apply to the costing of drug abuse treatment programs. In all areas of costing, there is room for more research on costing concepts and measurement applications. Additional work would be useful in establishing studies with activity-based costing for both research and managerial purposes. Studies of economies of scope are particularly relevant because of the integration of social services and criminal justice in drug abuse treatment. In the long run, managerial initiatives to improve the administration and quality of drug abuse treatment will benefit directly from research with new information on costing techniques.

Chung CW; Wang JD; Yu CF; Yang MC. Lifetime medical expenditure and life expectancy lost attributable to smoking through major smoking related diseases in Taiwan. Tobacco Control 16(6): 394-399, 2007. (18 refs.)

Objective: To estimate the lifetime financial burden on Taiwan's national health insurance (NHI) system, life expectancy and years of life expectancy lost (YLEL) attributable to smoking from major smoking related diseases. Methods: 10 major smoking related diseases (seven cancers, stroke, acute myocardial infarction and chronic obstructive pulmonary disease) were selected for this study. A survival analysis was conducted on linked cohorts from the National Death Registry database and the National Cancer Registry (NCR) and patients at the National Taiwan University Hospital (NTUH). Estimation of the smoking attributable fraction (SAF) for the study diseases was undertaken by combining the relative risks of smokers against non-smokers and the prevalence of smoking in Taiwan. The YLEL attributable to smoking was calculated for the study diseases by combining the survival analysis results, the SAF and the annual incidences of each disease. The lifetime medical expenditure for the study diseases was estimated by integrating the survival curve and the mean annual medical costs calculated from NHI reimbursement records. Results: There were 241 280 incidents of the 10 study diseases in 2001, of which about 53 648 cases (22.2%) were attributable to smoking, with a total YLEL of 191 313 at an average of about 3.6 YLEL per case. For each case, the average survival time was about 10.2 years. Under two different annual discount rates, the total lifetime financial burden on the NHI was estimated at between $ 291 million (pound 147 million; epsilon 216 million) (3% discount) and $ 336 million (1% discount) for all diseases attributable to smoking in 2001, accounting for about 24.6% of the total estimated lifetime medical expenditure for all incidents of the 10 study diseases. Conclusions: Smoking places tremendous financial and health burdens upon both society and individuals. A much more stringent tobacco control strategy is needed to curb the damage from smoking.

Cicero TJ; Inciardi JA; Surratt H. Trends in the use and abuse of branded and generic extended release oxycodone and fentanyl products in the United States. Drug and Alcohol Dependence 91(2/3): 115-120, 2007. (27 refs.)

Background: A great deal of previous work on the pharmacoeconomics of alcohol, tobacco and illicit drug abuse indicates that as cost decreases, abuse increases and vice versa. The application of these cost principles to the abuse of prescribed medications is largely unknown. In this paper we assessed whether the introduction of generic products in the U.S. increased the therapeutic use and illicit abuse of extended release oxycodone products and the fentanyl patch. Methods: As an index of therapeutic use, we purchased prescription data for each of the ZIP codes in which we had corresponding abuse data. To gather information about prescription drug abuse, we elicited cases with quarterly questionnaires completed by a key informant network. Results: The introduction of generic extended release (ER) oxycodone and fentanyl patch did not significantly change the total prescriptions written for these products, but markedly altered the composition of sales: branded sales dropped precipitously over a very short time and this was compensated for by a corresponding increase in sales of generics. Surprisingly, the introduction of generic products did not increase the abuse of ER oxycodone or fentanyl products; the branded version was the drug of choice for at least 2 years. Conclusions: Our data suggest that drug costs alone do not increase the overall likelihood that a prescription opioid analgesic will be used therapeutically or abused. However, while generics are rapidly endorsed by insurance companies as a prescribed entity, abuse of the branded versions of ER oxycodone and fentanyl remains predominant for some time.

Cole JC; Goudie AJ; Field M; Loverseed AC; Charlton S; Sumnall HR. The effects of perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases. Drug and Alcohol Dependence 94(1/3): 183-190, 2008. (32 refs.)

Previous research has indicated that non-dependent polydrug users are willing to pay more money to buy good quality drugs as their income increased. This study sought to examine whether altering the perceived quality of controlled drugs would affect drug purchases if the monetary price remained fixed. A random sample of 80 polydrug users were recruited. All participants were administered an anonymous questionnaire consisting of the Drug Abuse Screening Test for Adolescents (DAST-A), the Severity of Dependence Scale for cannabis (SDS), the,Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression Scale (HADS), and questions about their drug use. Participants then completed a simulation of controlled drug purchases where the price of alcohol, amphetamine, cannabis, cocaine, and ecstasy remained the same but their perceived quality changed (i.e. unit price increased as the perceived quality decreased). The demand for alcohol was quality inelastic and alcohol quality had no effects on the purchase of any other controlled drug. Demand for cannabis was quality elastic and alcohol substituted for cannabis as its unit price increased. Demand for cocaine was quality elastic and alcohol, cannabis, and ecstasy substituted for cocaine as its unit price increased. Demand for ecstasy was quality elastic and alcohol and cocaine both substituted for ecstasy as its unit price increased. These results suggest that perceived quality influences the demand for controlled drugs and that monitoring the perceived quality of controlled drugs may provide a warning of potential public health problems in the near future.

Colman GJ; Remler DK. Vertical equity consequences of very high cigarette tax increases: If the poor are the ones smoking, how could cigarette tax increases be progressive? Journal of Policy Analysis and Management 27(2): 376-400, 2008. (43 refs.)

Cigarette smoking is concentrated among low-income groups. Consequently, cigarette taxes are considered regressive. However, if poorer individuals are much more price sensitive than richer individuals, then tax increases would reduce smoking much more among the poor and their cigarette tax expenditures as a share of income would rise by much less than for the rich. Warner (2000) said this phenomenon would make cigarette tax increases progressive. We test this empirically. Among low-, middle-, and high-income groups, we estimate total price elasticities of -0.37, -0.35, and -0.20, respectively. We find that cigarette tax increases are not close to progressive, using both tax expenditure-based and traditional welfare measures. This finding is robust to cross-border purchasing, generic cigarettes, and substantial external effects. However, we find that taxes can be progressive under some behavioral economic models (Gruber & Koszegi, 2004) but that these may only apply to a small share of smokers.

Cummins SE; Bailey L; Campbell S; Koon-Kirby C; Zhu SH. Tobacco cessation quitlines in North America: A descriptive study. Tobacco Control 16(Supplement 1): 19-25, 2007. (31 refs.)

Background: Quitlines have become an integral part of tobacco control efforts in the United States and Canada. The demonstrated efficacy and the convenience of telephone based counselling have led to the fast adoption of quitlines, to the point of near universal access in North America. However, information on how these quitlines operate in actual practice is not often readily available. Objectives: This study describes quitline practice in North America and examines commonalities and differences across quitlines. It will serve as a source of reference for practitioners and researchers, with the aim of furthering service quality and promoting continued innovation. Design: A self administered questionnaire survey of large, publicly funded quitlines in the United States and Canada. A total of 52 US quitlines and 10 Canadian quitlines participated. Descriptive statistics are provided regarding quitline operational structures, clinical services, quality assurance procedures, funding sources and utilisation rates. Results: Clinical services for the 62 state/provincial quitlines are supplied by a total of 26 service providers. Nine providers operate multiple quitlines, creating greater consistency in operation than would otherwise be expected. Most quitlines offer services over extended hours (mean 96 hours/week) and have multiple language capabilities. Most (98%) use proactive multisession counselling - a key feature of protocols tested in previous experimental trials. Almost all quitlines have extensive training programmes (> 60 hours) for counselling staff, and over 70% conduct regular evaluation of outcomes. About half of quitlines use the internet to provide cessation information. A little over a third of US quitlines distribute free cessation medications to eligible callers. The average utilisation rate of the US state quitlines in the 2004 - 5 fiscal year was about 1.0% across states, with a strong correlation between the funding level of the quitlines and the smokers' utilisation of them (r = 0.74, p < 0.001). Conclusions: Quitlines in North America display core commonalities: they have adopted the principles of multisession proactive counselling and they conduct regular outcome evaluation. Yet variations, tested and untested, exist. Standardised reporting procedures would be of benefit to the field. Shared discussion of the rationale behind variations can inform future decision making for all North American quitlines.

Cunradi CB; Lipton R; Banerjee A. Occupational correlates of smoking among urban transit operators: a prospective study. Substance Abuse Treatment, Prevention, and Policy 2: article 36, 2007. (34 refs.)

Background: Workers in blue-collar and service occupations smoke at higher rates than workers in white-collar and professional occupations. Occupational stress may explain some of the occupational class differences in smoking and quitting behavior. The purpose of this study is to investigate the contribution of occupational factors to smoking behavior over a ten year period among a multiethnic cohort of urban transit operators, while accounting for demographic factors and alcohol. Methods: The sample consists of 654 San Francisco Municipal Railway (MUNI) transit operators who participated in two occupational health studies and biennial medical examinations during 1983-85 and 1993-95. Workers who has initiated, increased, or maintained their smoking over the ten year period were compared to workers who remained non-smokers. Occupational factors included self-rated frequency of job problems (e.g., difficulties with equipment, passengers, traffic), job burnout (i.e., the emotional exhaustion subscale of the Maslach Burnout Inventory), time needed to unwind after work, and years employed as a transit operator. A series of logistic regression models were developed to estimate the contribution of occupational factors to smoking behavior over time. Results: Approximately 35% of the workers increased, initiated, or maintained their smoking over the ten-year period. Frequency of job problems was significantly associated with likelihood of smoking increase, initiation, or maintenance (OR=1.30; 95% CI 1.09, 1.55). Black operators were significantly more likely to have smoked over the ten-year period compared to operators in other racial/ethnic groups. Conclusions: Understanding the role of work-related stress vis-a-vis smoking behavior is of critical importance for crafting workplace smoking prevention and cessation interventions that are applicable to blue-collar work settings, and for developing policies that mitigate occupational stress.

Dave D. Illicit drug use among arrestees, prices and policy. Journal of Urban Economics 63(2): 694-714, 2008. (29 refs.)

Prior studies, by relying on nationally representative surveys, have overlooked the important fact that use of addictive substances is not uniformly distributed; subgroups of hardcore users account for most of the drug consumption. This study employs the Arrestee Drug Abuse Monitoring system to analyze the demand for cocaine and heroin by urban arrestees, employing objective indicators of use based on urinalysis. The data are repeated city cross sections, and panel data methodology is employed to account for endogeneity. Cocaine and heroin prices have a negative effect on the probability of use even among this group of heavy users. Results indicate that subjective, self-reported measures of participation are likely to be under-reported, which may impart bias to estimates of the price elasticity. The own-price cocaine participation elasticity is about -0.15, and the own-price heroin participation elasticity is about -0.10 for arrestees. This contemporaneous elasticity understates the full effect, and the long-run price elasticity is about twice the magnitude. The magnitude of the price response is substantially smaller relative to the estimates in the prior literature, and calculations suggest that further enforcement and interdiction-driven increases in drug prices may not be cost-effective.

de Graaff B; Bruno R. Tasmanian Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 273. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (70 refs.)

This report reports data on the use of illicit drugs in Tasmania, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 135 figures and tables.

Delaney L; Harmon C; Wall P. Behavioral economics and drinking behavior: Preliminary results from an Irish college study. Economic Inquiry 46(1): 29-36, 2008. (21 refs.)

This article examines the results of single-equation regression models of the determinants of alcohol consumption patterns among college students modeling a rich variety of covariates including gender, family and peer drinking, tenure, personality, risk perception, time preferences, and age of drinking onset. The results demonstrate very weak income effects and very strong effects of personality, peer drinking (in particular closest friend), time preferences, and other substance use. The task of future research is to verify these results and assess causality using more detailed methods.

Earleywine M, ed. Pot Politics: Marijuana and the Costs of Prohibition. Oxford UK: Oxford University Press, 2007

An underlying thesis of this edited work is that the harms associated with the prohibition of marijuana are disproportionately greater than the problems attributable to its pharmacological effects. In an introductory chapter, entitled "Thinking clearly about marijuana, the editor identifies a dozen common logical errors, some universal to social science (e.g. confusing correlation with causality) and others marijuana-specific -- confusing the effects of prohibition with effects of use and confusing the presence of detectable metabolites with intoxication. The work includes chapter directed to the economic costs associated with its illicit status, the costs and benefits of current control policy, ethical considerations, as well as religious, psychological, and policy perspectives on issues of prohibition versus legalization.

European Monitoring Centre for Drugs and Drug Addiction. The State of the Drugs Problem in Europe. Annual Report 2006. Luxembourg: European Monitoring Centre for Drugs and Drug Addiction, 2006. (50 refs.)

This is the 11th Annual Report on the drug use within the European Union. The background to the annual report are two new action plans recently enacted in the EU. One is measures to strengthen measures against drug trafficking. Another is the adoption of a drug strategy to be implemented between 2005-2012, with an emphasis on prevention, treatment, and harm reduction to reduce demand. Also, in contrast to the U.S. greater distinction is made between drug trade and drug use, with greater penalties for the former and a reduced emphasis on custodial emphasis for the latter. The report provides an overview of drug problems throughout the 25 EU member countries, Norway, Bulgaria, Romania and Turkey. The report begins with a highlight on new developments and trends. For example, drugs are probably cheaper now than ever before in Europe, based on a five-year trend analysis of the street prices of drugs such as cannabis, cocaine, heroin, amphetamines and ecstasy. Between 1999 and 2004, the rate of decline has been greatest for ecstasy (45% decline) and least for herbal cannabis (13% decline). The report has eight chapters. The first chapter outlines polices and laws. Chapter 2 provides an overview of the response to drug problems. Chapters 3 through 6 address specific drugs - cannabis, amphetamines (plus ecstasy and other psychotropics), cocaine, opiates. For each of these there is information on patterns of use, source of drugs, treatment demand, patterns of use and comparisons between countries, and production and trafficking, price and purity. Chapter 7 considers drug-related infectious disease and related mortality. The concluding chapter addresses issues related to monitoring drug use and creation of indicators, and challenges related to adequately describing polydrug use. Three aspects are selected for special attention - recreational drug use, European drug policies and gender differences in drug use. In respect to heroin, there is an increasing use of drug substitution therapy as well as a "graying" of heroin users and those involved in substitution therapy. There are 14 figures.

2007, Project Cork

Farrelly MC; Hussin A; Bauer UE. Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers' quitline. Tobacco Control 16(Supplement 1): 121-123, 2007. (13 refs.)

Objectives: This study assessed the relative effectiveness and cost effectiveness of television, radio and print advertisements to generate calls to the New York smokers' quitline. Methods: Regression analysis was used to link total county level monthly quitline calls to television, radio and print advertising expenditures. Based on regression results, standardised measures of the relative effectiveness and cost effectiveness of expenditures were computed. Results: There was a positive and statistically significant relation between call volume and expenditures for television (p < 0.01) and radio (p <0.001) advertisements and a marginally significant effect for expenditures on newspaper advertisements (p < 0.065). The largest effect was for television advertising. However, because of differences in advertising costs, for every $ 1000 increase in television, radio and newspaper expenditures, call volume increased by 0.1%, 5.7% and 2.8%, respectively. Conclusions: Television, radio and print media all effectively increased calls to the New York smokers' quitline. Although increases in expenditures for television were the most effective, their relatively high costs suggest they are not currently the most cost effective means to promote a quitline. This implies that a more efficient mix of media would place greater emphasis on radio than television. However, because the current study does not adequately assess the extent to which radio expenditures would sustain their effectiveness with substantial expenditure increases, it is not feasible to determine a more optimal mix of expenditures.

Farrelly MC; Loomis BR; Mann NH. Do increases in cigarette prices lead to increases in sales of cigarettes with high tar and nicotine yields? Nicotine & Tobacco Research 9(10): 1015-1020, 2007. (20 refs.)

We used scanner data on cigarette prices and sales collected from supermarkets across the United States from 1994 to 2004 to test the hypothesis that cigarette prices are positively correlated with sales of cigarettes with higher tar and nicotine content. During this period the average inflation-adjusted price for menthol cigarettes increased 55.8%. Price elasticities from multivariate regression models suggest that this price increase led to an increase of 1.73% in sales-weighted average tar yields and a 1.28% increase in sales-weighted average nicotine yields for menthol cigarettes. The 50.5% price increase of nonmenthol varieties over the same period yielded an estimated increase of 1% in tar per cigarette but no statistically significant increase in nicotine yields. An ordered probit model of the impact of cigarette prices on cigarette strength (ultra-light, light, full flavor, unfiltered) offers an explanation: As cigarette prices increase, the probability that stronger cigarette types will be sold increases. This effect is larger for menthol than for nonmenthol cigarettes. Our results are consistent with earlier population-based cross-sectional and longitudinal studies showing that higher cigarette prices and taxes are associated with increasing consumption of higher-yield cigarettes by smokers.

Fazey C. International policy on illicit drug trafficking: The formal and informal mechanisms. Journal of Drug Issues 37(4): 755-779, 2007. (45 refs.)

In the last 10 years the world's leading economic powers have driven important changes in international policy on illicit drug trafficking. They have set up and financed semi-formal or informal transnational groups to proactively implement policy on the ground. This is a reaction to the bureaucratic, formal mechanisms of the United Nations and its agencies, where policy is diluted by the need for consensus among 53 member states, plus various regional groupings of other countries. The new groups take a more integrated approach to the problem by going beyond trafficking into countering money laundering and controlling the sale of precursor chemicals, which criminal gangs use to synthesize drugs earlier in the supply chain to reduce the bulk of trafficked materials. The established link between organized transnational crime, drugs, and the financing of terrorism has added impetus to these efforts, but there is still a need for better cooperation on projects and to harmonize the collection of seizure statistics between key international bodies.

Featherston J; Lenton S. Western Australia Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 268. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (22 refs.)

This annual survey reports data on the use of illicit drugs in Western Australia. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs. For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 77 figures and tables.

Fellows JL; Bush T; McAfee T; Dickerson J. Cost effectiveness of the Oregon quitline ''free patch initiative''. Tobacco Control 16(Supplement 1): 147-152, 2007. (28 refs.)

Objective: We estimated the cost effectiveness of the Oregon tobacco quitline's ''free patch initiative'' compared to the pre-initiative programme. Methods: Using quitline utilisation and cost data from the state, intervention providers and patients, we estimated annual programme use and costs for media promotions and intervention services. We also estimated annual quitline registration calls and the number of quitters and life years saved for the pre-initiative and free patch initiative programmes. Service utilisation and 30-day abstinence at six months were obtained from 959 quitline callers. We compared the cost effectiveness of the free patch initiative (media and intervention costs) to the pre-initiative service offered to insured and uninsured callers. We conducted sensitivity analyses on key programme costs and outcomes by estimating a best case and worst case scenario for each intervention strategy. Results: Compared to the pre-intervention programme, the free patch initiative doubled registered calls, increased quitting fourfold and reduced total costs per quit by $2688. We estimated annual paid media costs were $215 per registered tobacco user for the pre-initiative programme and less than $4 per caller during the free patch initiative. Compared to the pre-initiative programme, incremental quitline promotion and intervention costs for the free patch initiative were $86 (range $22 -$353) per life year saved. Conclusions: Compared to the pre-initiative programme, the free patch initiative was a highly cost effective strategy for increasing quitting in the population.

Fleck RK; Hanssen FA. Why understanding smoking bans is important for estimating their effects: California's restaurant smoking bans and restaurant sales. Economic Inquiry 46(1): 60-76, 2008. (25 refs.)

A large literature has sought to determine whether smoking bans help or hinder restaurants. Much of the literature improperly specifies its econometric equations and thus mistakenly infers causality. Examining the relationship between restaurant smoking bans and restaurant revenues in 267 California communities, we reach two main conclusions. First, California's municipal restaurant smoking bans are endogenous in a critical way-restaurant sales growth (or something correlated with restaurant sales growth) appears to cause restaurant bans, not vice versa. Consequently, failure to control properly for trends can produce spurious "evidence" of causation. Second, ban heterogeneity (e.g., state versus local) can be exploited to sort out-or rule out-causal effects. In other words, pooling data and treating smoking bans implemented at different levels as homogenous (as many studies do) ignores an important source of information and is likely to lead to erroneous conclusions. Our analysis holds lessons for the many studies that have examined the arguably more important question of how smoking bans affect smoking rates.

Frone MR. Are work stressors related to employee substance use? The importance of temporal context in assessments of alcohol and illicit drug use. Journal of Applied Psychology 93(1): 199-206, 2008. (48 refs.)

In this study, the author explored the relations of 2 work stressors (work overload and job insecurity) to employee alcohol use and illicit drug use. The primary goal was to explore the importance of temporal context (before work, during the workday, and after work) in the assessment of substance use compared with context-free (overall) assessments. Data were collected from a national sample of U.S. workers (N = 2,790) who took part in a broad cross-sectional survey on workplace health and safety. Consistent with past research, the results fail to support a relation between work stressors and overall measures of alcohol and illicit drug use. However, the results support the relation of work stressors to alcohol and illicit drug use before work, during the workday, and after work. These results provide support for both the stress-induced substance use and stress response dampening propositions of the tension-reduction hypothesis. When exploring the work environment as a potential cause of employee substance use, these results underscore the importance of measures that assess alcohol and illicit drug use in terms of their temporal relation to the workday.

Goldstein RZ; Tomasi D; Alia-Klein N; Cottone LA; Zhang L; Telang F et al. Subjective sensitivity to monetary gradients is associated with frontolimbic activation to reward in cocaine abusers. Drug and Alcohol Dependence 87(2/3): 233-240, 2007. (47 refs.)

Drug addiction is characterized by marked disruptions in the ability to process reward. Here we evaluated in cocaine addicted and healthy control participants the subjective sensitivity to reward gradients and its association with neural responses to sustained reward. A self-report questionnaire was used to assess the former. A functional magnetic resonance imaging task that utilized monetary reward as feedback in a blocked design was used to assess the latter. Results revealed that whereas control subjects valued high money more than low money, over half of the cocaine addicted subjects valued all monetary amounts equally. This compromised subjective sensitivity to gradients in reward value was significantly correlated with higher activations to money in the lateral orbitofrontal cortex/inferior frontal gyrus (BA 47) and amygdala, and lower activations in the middle frontal gyrus (BA 6), which together explained 85% of the variability on this rating scale in the cocaine abusers only. These results provide for the first time evidence of restricted subjective sensitivity to gradients of reward in cocaine addiction and of the involvement of frontolimbic brain regions (including the orbitofrontal cortex) in this deficit.

Guo JJ; Keck PE; Li H; Patel NC. Treatment costs related to bipolar disorder and comorbid conditions among medicaid patients with bipolar disorder. Psychiatric Services 58(8): 1073-1078, 2007. (41 refs.)

Objective: This study assessed costs among patients with bipolar disorder for treatment related to bipolar disorder and to comorbid conditions. Risk factors associated with costs were also assessed. Methods: Data (January 1998 to December 2002) were from a seven-state Medicaid managed care claims database for 13,471 patients who had received a diagnosis of bipolar disorder, most of whom received medications. Each medical claims cost was adjusted by the medical component of the Consumer Price Index as the dollar value in 2002. In a Poisson regression analysis, treatment costs per enrollment month were regressed on patient's age, gender, medications, and clinical comorbidities. Results: Bipolar disorder treatment accounted for 30% of costs and comorbid disorders for 70%. Key cost components were inpatient care (35%), outpatient care (16%), prescriptions (13%), and physician encounters (11%). Patients with bipolar disorder received a variety of medications: lithium, 13%; anticonvulsants, 35%; second-generation antipsychotics, 24%; first-generation antipsychotics, 22%; and antidepressants, 42%. Compared with the costs for patients receiving antidepressants alone or no medication, the high costs for bipolar disorder treatment and overall treatment were associated with use of second-generation antipsychotics (rate ratio [RR] = 1.71, 95% confidence interval [CI] = 1.58-1.86 and RR = 1.26, CI = 1.18-1.34, respectively) and use of anticonvulsants (RR = 1.37, CI = 1.26-1.48 and RR = 1.06, CI = 1.00-1.12). Higher costs were significantly associated with key comorbidities, such as drug abuse (RR = 1.58, CI = 1.47-1.70), cerebral-vascular disease (RR = 1.72, CI = 1.51-1.94), ischemic heart disease (RR = 1.47, CI = 1.30-1.66), and hypertension (RR = 1.44, CI = 1.33-1.56). Conclusions: Cost-containment efforts may need to manage or prevent key comorbidities among patients with bipolar disorder and to evaluate the association between antipsychotic use and treatment outcomes and hospital services.

Haggerty KP; Fleming CB; Catalano RF; Petrie RS; Rubin RJ; Grassley MH. Ten years later: Locating and interviewing children of drug abusers. Evaluation and Program Planning 31(1): 1-9, 2008. (27 refs.)

Longitudinal studies require high follow-up rates in order to maintain statistical power, reduce bias, and enhance the generalizability of results. This study reports on locating and survey completion for a 10-year follow-up of the Focus on Families project, an investigation of 130 families headed by parents who were enrolled in methadone treatment for opiate addiction. Despite having no contact with participants in the study for at least 10 years, the project successfully located nearly 99% of parent participants and 98% of their children. Twenty-four percent of the parents and one child had died before the follow-up. Of the surviving sample, 91% of parents and 86% of the children completed the follow-up interview. Multiple techniques were used to locate study participants, including internet searches, researching court and public records, collaborating with government and service agencies, and contacting family and social networks. For more than half of the sample, costly efforts were required to locate individual participants.

Halvaksz JA. Cannabis and fantasies of development: Revaluing relations through land in rural Papua New Guinea. Australian Journal of Anthropology 18(1): 56-71, 2007. (59 refs.)

Over the past decade, marijuana has become a significant element within Papua New Guinea's communities, revealing an important connection to the broader political economy. For young men, fluctuating commodity prices, the intermittent exploitation of mineral wealth and a reluctant tourist economy only gives them a taste for development. Marijuana seems to offer its permanence. Somewhere between the harsh reality of local economic and ecological futures young men near the town of Wau (Morobe Province) imagine themselves as successful entrepreneurs in the emerging drug trade. In particular, I consider how young men imagine the planting of this illicit crop as mediating tensions between acting individually and acting communally. While most have yet to take action on these fantasies, they provide insight into the development aspirations of rural Papua New Guineans. In this paper, I examine these development fantasies as they speak to a broader political economy and transformations of local landscapes throughout rural Pacific communities.

Havenaar JM; Geerlings MI; Vivian L; Collinson M; Robertson B. Common mental health problems in historically disadvantaged urban and rural communities in South Africa: prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology 43(3): 209-215, 2008. (21 refs.)

This paper reports on an epidemiological study of common mental health and substance abuse problems in a historically disadvantaged urban and rural community in South Africa. In the rural Limpopo Province of South Africa, and in a peri-urban township near Cape Town, self-report instruments were used in two random population samples and among respondents at primary care and traditional healer settings, to assess common mental health problems, substance abuse problems and associated problems in social functioning. A high prevalence of mental health and substance abuse problems was observed in both communities, with highest rates in the peri-urban township. Even higher prevalences were found among respondents at primary health care or traditional healers. The study shows that mental health and substance abuse problems constitute a considerable burden of disease among disadvantaged communities in South Africa. The study further underscores the integral role of traditional healers in the mental health care system.

Heckman JJ; Flyer F; Loughlin C. An assessment of causal inference in smoking initiation research and a framework for future research. Economic Inquiry 46(1): 37-44, 2008. (37 refs.)

Reliably identifying the causal factors underlying youth smoking initiation is an important part of developing effective smoking prevention programs and shaping other types of smoking-related policies. The establishment of reliable scientific evidence in support of a causal link between cigarette advertising and youth smoking initiation depends on both rich longitudinal data as well as careful empirical applications. We examine basic principles of empirical scientific investigation of potential causal relationships, discuss findings of recent research on causal factors of youth smoking, and evaluate evidence from the public health literature regarding the effects of cigarette advertising on youth smoking.

Hemphill SA; Munro G; Oh S. Adolescents' expenditure on alcohol: A pilot study. Australian Journal of Social Issues 42(4): 623-636, 2007. (31 refs.)

Minimal research has examined the extent to which underage youth access and purchase alcohol. This pilot study investigated adolescents' expenditure on alcohol, and the circumstances in which underage youth access alcohol. A street intercept survey was used to interview 187 young people aged 13 to 17 years in shopping centres in metropolitan and rural Victoria, Australia. Seventy percent of the sample self-reported that they drink alcohol. Young people were more likely to report that they were drinkers as their income increased. More than one-third of the sample and over half of drinkers purchased alcohol with their own money, spending on average $22 when they last purchased alcohol. Drinkers obtained their alcohol from a variety of other sources including friends over 18 years old and their parents. This study shows that underage youth have access to and pay for alcohol even if they do not purchase it personally. Further research in this area with a larger sample is clearly warranted to inform both prevention strategies and effective practice.

Hendrickson RG; Cloutier R; McConnell KJ. Methamphetamine-related emergency department utilization and cost. Academic Emergency Medicine 15(1): 23-31, 2008. (44 refs.)

Objective: To quantify the frequency, cost, and characteristics associated with emergency department (ED) visits that are related to methamphetamine use. Methods: This was a prospective observational study. The authors performed a training program for ED clinicians on the acute and chronic effects of methamphetamine and the signs of methamphetamine abuse. A standardized two question survey was administered to clinicians concerning the relationship between the ED visit and the patient's methamphetamine use. The survey was embedded in the patient tracking system and was required for all ED patients before disposition. Survey results were merged with administrative data on demographics, diagnosis, disposition, and charges. Univariate analyses were used to determine patient characteristics associated with methamphetamine-related ED visits. Results: The authors examined 15,038 ED visits over a 20-week period from February 2006 to June 2006. There were a total of 353 methamphetamine-related visits, for an average of 17.65 visits per week (2.4% of all visits). Hospital charges for methamphetamine-related ED visits averaged $133,181 per week, for an estimated total of $6.9 M in annual charges. Methamphetamine-related ED patients were more likely to be male (odds ratio [OR] 1.6, 95% confidence interval [CI] = 1.30 to 2.01), white (OR 1.8, 95% CI = 1.38 to 2.29), and uninsured (OR 3.2, 95% CI = 2.21 to 4.69). The top four medical conditions associated with methamphetamine-related visits were mental health (18.7%), trauma (18.4%), skin infections (11.1%), and dental diagnoses (9.6%). Conclusions: Methamphetamine abuse accounts for a modest but substantial proportion of ED utilization and hospital cost. Methamphetamine-related ED visits are most commonly related to mental illness, trauma, skin, and dental-related problems.

Herttua K; Makela P; Martikainen P. Differential trends in alcohol-related mortality: A register-based follow-up study in Finland in 1987-2003. Alcohol and Alcoholism 42(5): 456-464, 2007. (46 refs.)

Aims: To assess to what extent alcohol-related mortality has changed by age, sex and education in Finland in 1987-2003, a period which saw two periods of economic growth, separated by a severe depression (1991-1995). Methods: A register-based follow-up study of all over 15-year-old Finnish men and women. Age, sex and education of the participants were measured at the time of the 1985, 1990, 1995 and 2000 censuses. Follow-up for mortality was for 1987--2003. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. Results: Among men and women aged 45 years and over, the trends in alcohol-related mortality were associated with economic cycles. Among those aged less than 45 years, alcohol-related mortality decreased from the early 1990s, but intoxication-related accidents and violence still contributed largely to premature mortality. The unfavourable trend for older men resulted from an increase in mortality due to directly alcohol-attributable diseases, alcohol-related diseases of the circulatory system and accidents and violence, and for older women from an increase due to intoxication-related accidents and violence, and alcohol-attributable diseases. Alcohol-related mortality was higher in lower educational groups, and among women the educational gap widened towards the end of the study period. Conclusion: This study shows that trends in both economic conditions and per capita consumption of alcohol are not associated with trends in alcohol-related mortality in all population subgroups. In health policy more attention should be paid to divergent trends in gender, age and education specific alcohol-related mortality.

Hill SC; Liang L. Smoking in the home and children's health. Tobacco Control 17(1): 32-37, 2008. (18 refs.)

Objectives: We estimate for young children the annual excess health service use, healthcare expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home in the United States. Methods: Health service use, healthcare expenditures and disability bed days data come from the 1999 and 2001 Medical Expenditure Panel Survey (MEPS). Reported smoking in the home comes from the linked National Health Interview Survey, from which the MEPS sample is drawn. Multivariate statistical analysis controls for potential confounding factors. The sample is 2759 children aged 0-4. Results: Smoking in the home is associated with an increase in the probability of emergency department visits for respiratory conditions by five percentage points and the probability of inpatient use for these conditions by three percentage points. There is no relation between indoor smoking by adults and either ambulatory visits or prescription drug expenditures. Overall, indoor smoking is associated with $117 in additional healthcare expenditures for respiratory conditions for each exposed child aged 0-4. Indoor smoking is also associated with an eight percentage point increase in the probability of having a bed day because of respiratory illness for children aged 1-4. Conclusions: Despite the significant progress made in tobacco control, many children are still exposed to secondhand smoke in their home. Reducing exposure to smoking in the home would probably reduce healthcare expenditures for respiratory conditions and improve children's health.

Hoeflmayr D; Hanewinkel R. Do school-based tobacco prevention programmes pay off? The cost-effectiveness of the 'smoke-free class competition'. Public Health 122(1): 34-41, 2008. (35 refs.)

Objective: The objective of this study was to determine the cost-effectiveness of a school-based tobacco prevention programme. Study design: Using data from a previous effectiveness study of the 'Smoke-free Class Competition' (SFC), an economic analysis was conducted to determine the cost-effectiveness of the SFC. Cost data were collected from financial statements of the operating agency, surveys of regional co-ordinators and participating classes (direct and productivity costs). The benefit was the product of the number of students prevented from becoming established smokers, based on a stochastic progression model extending the programme's outcome evaluation, and the (direct and indirect) value per prevented smoker. Intervention: To take part in the SFC, classes make the decision to be a non-smoking class for 6 months (from autumn to spring). The pupils themselves and their teachers monitor the smoking status of the pupils and report on it regularly. Classes that refrain from smoking can win a number of attractive prizes. In the school year 2001/2002 150,566 German students participated in the SFC, representing approximately 4% of the total target population of 11-14-year-old German students. The effectiveness evaluation is based on 2,142 students who participated in the programme in the school year 1998/1999. Results: In the school year 2001/2002, it is estimated that the SFC prevented 3,076 students from becoming established smokers, with net benefits of 5.59 Mio. Euro (direct net benefits) and 15.00 Mio. Euro, (total net benefits). The direct benefit/cost ratio was 8.2 and the total benefit/cost ratio was 3.6. Conclusions: Data suggest that the SFC is a cost-effective school-based intervention.

Hollis JF; McAfee TA; Fellows JL; Zbikowski SM; Stark M; Riedlinger K. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control 16(Supplement 1): 153-159, 2007. (53 refs.)

Objectives: State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches. Methods: This 3 x 2 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months. Results: Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was $2467 for brief NRT, $1912 for moderate no NRT, $2109 for moderate NRT, $2641 for intensive no NRT, and $2112 for intensive NRT. Conclusion: Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.

Horgan CM; Reif S; Hodgkin D; Garnick DW; Merrick EL. Availability of addiction medications in private health plans. Journal of Substance Abuse Treatment 34(2): 147-156, 2008. (31 refs.)

Health plans have implemented cost sharing and administrative controls to constrain escalating prescription expenditures. These policies may impact physicians' prescribing and patients' use of these medications. Important clinical advances in the pharmacological treatment of addiction highlight the need to examine how pharmacy benefits consider medications for substance dependence. The extent of restrictions influencing the availability of these medications to consumers is unknown. We use nationally representative survey data to examine the extent and stringency of private health plans' management of naltrexone and disulfiram for alcohol dependence, and buprenorphine for opiate dependence. Thirty-one percent of insurance products excluded buprenorphine from formularies, whereas 55% placed it on the highest cost-sharing tier. Generic naltrexone is the only substance dependence medication that is both rarely excluded from formularies and usually placed on a lower cost-sharing tier. These findings demonstrate that pharmacy benefits have an impact on access to medications for substance abuse.

Inness M; Barling J; Rogers K; Turner N. De-marketing tobacco through price changes and consumer attempts to quit smoking. Journal of Business Ethics 77(4): 405-416, 2008. (40 refs.)

Using panel data from three Canadian provinces, this article examines the relationship between the de-marketing of tobacco products through provincial-level price increases and consumers' attempts to quit smoking as measured by the uptake of tobacco replacement therapies. We ground our hypotheses in the rational addiction model and the theory of planned behavior. Our analyses suggest a positive, one-month lagged effect of a price increase of tobacco products on the uptake of tobacco replacement therapies. This effect dissipates 3 months later, suggesting that there is a critical period for aggressive de-marketing of tobacco products. We discuss the implications of these results for theory and future research into de-marketing harmful consumer products.

Jahiel RI; Babor TF. Industrial epidemics, public health advocacy and the alcohol industry: lessons from other fields. (editorial). Addiction 102(9): 1335-1339, 2007. (55 refs.)

Jimenez-Ruiz JA; de Miera BS; Reynales-Shigematsu LM; Waters HR; Hernandez-Avila M. The impact of taxation on tobacco consumption in Mexico. Tobacco Control 17(2): 105-110, 2008. (26 refs.)

Background: The price of cigarettes to consumers in Mexico, and Latin America in general, remains low in comparison with other regions of the world. In Mexico, taxes represented 59% of the total price of cigarettes in 2006, compared to 75% or more in many high-income countries. The feasibility of raising taxes on cigarettes in Mexico-to both discourage consumption and increase revenues - is an important policy question. Methods: Using household survey data, we undertake a pooled cross-sectional analysis of the demand for cigarettes in Mexico. We use a two-part model to estimate the price elasticity of cigarettes. This model controls for the selection effect that arises from the fact that the impact of price on the decision to smoke or not is estimated using all households in the dataset. Results: The results indicate that price is a significant factor in household decisions concerning smoking and the number of cigarettes smoked. Holding other factors constant, our simulations show that a 10% increase in the cigarette tax in Mexico - calculated as a percentage of the price - yields a 12.4% increase in the price to the consumer, a 6.4% decrease in consumption of cigarettes and a 15.7% increase in the revenue yielded by the tax. Conclusion: In Mexico, there are strong arguments for increasing cigarette taxes. Revenue raised could be used to further prevent tobacco consumption and to finance current funding shortages for the treatment of diseases related to smoking.

John RM. Crowding out effect of tobacco expenditure and its implications on household resource allocation in India. Social Science & Medicine 66(6): 1356-1367, 2008. (28 refs.)

This paper examines whether spending on tobacco crowds out expenditure on basic needs and whether it has implications on nutrition intake and household resource allocation in India. The paper uses a household sample survey from India for the year 1999-2000. A system of quadratic conditional Engel curves was estimated for a set of 10 broad groups of commodities. The results suggest that tobacco consuming households had lower consumption of certain commodities such as milk, education, clean fuels and entertainment which may have more direct bearing on women and children in the household than on men suggesting possible 'gender effects' and biases in the allocation of goods and services within the household. Tobacco spending was also found to have negative effects on per capita nutrition intake. The nature of crowding out was found to be similar in low- and high-income households.

Jordan N; Grissom G; Alonzo G; Dietzen L; Sangsland S. Economic benefit of chemical dependency treatment to employers. Journal of Substance Abuse Treatment 34(3): 311-319, 2008. (24 refs.)

Using assessment data from the Substance Abuse Treatment Support System, we estimated the economic benefit of chemical dependency treatment to employers. A cohort of individuals (N = 498) treated at Kaiser Permanente's Addiction Medicine programs in Southern California completed assessments before and at least 30 days after treatment began. Compared to intake, subsequent assessments indicated substantial reduction in the number of patients who missed work, were late for work, were less productive than usual at work, and/or had conflict with coworkers or management. The net economic value of these improvements to their employers depended upon the utilization rate of the benefit and the salary level of the employees receiving treatment. For a utilization rate of 0.9% and a mean annual salary of US$45,000, the net benefit of treatment was US$1,538 for >= 61 days of treatment. Based solely upon these employment-related measures, without factoring in the medical cost offset or indirect benefits of treatment that may help employees to maintain higher levels of productivity, employers break even on an investment of US$30 per member per year for a chemical dependency treatment benefit if the mean annual salary of the employees participating in treatment is US$36,565.

Kahende JW; Woollery T; Chung-won L. Assessing medical expenditures on 4 smoking-related Diseases. American Journal of Health Behavior 31(6): 602-611, 2007

Objectives: To examine the current-period cost of treating 4 major smoking-related diseases: lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, and cerebrovascular disease. Methods: Analyses are based on the MarketScan database, a medical claims database from large employers. Results: We found that total expenditures to treat ischemic heart disease were highest, followed by those to treat chronic obstructive pulmonary disease (COPD). When median expenditures per claim and disease severity were considered, lung cancer was the most expensive condition to treat and ischemic heart disease the least expensive. Median treatment expenditures increased as the severity of disease increased. Conclusion: Treating smoking-related diseases is costly in the current-period and over a lifetime.

Kan MY. Investigating cigarette affordability in 60 cities using the cigarette price-daily income ratio. Tobacco Control 16(6): 429-432, 2007. (21 refs.)

Objective: To investigate cigarette affordability in 60 cities. Methods: Affordability of cigarettes is defined as the ratio of the price of one pack of cigarettes to daily income (cigarette price-daily income ratio: CPDIR). Daily income data were calculated using the mean of the seven occupations with the lowest daily wage, as listed in the 2006 Union Bank of Switzerland survey; cigarette prices in 2006 were sourced from the Economist Intelligence Unit. Results: Cigarette affordability in most of the surveyed cities remains high. There is a tendency for cities with high income economies to have a high level of cigarette affordability. Most of the cities in Western Europe and South and North America have high cigarette affordability, whereas 66.7% of their counterparts in Eastern Europe have medium cigarette affordability. In Asia, all cities with high cigarette affordability belong to the group of upper middle to high income economies, except for the Philippines. In Africa, Johannesburg and Nairobi have high and medium levels of cigarette affordability, respectively. Conclusion: Cigarette affordability for most of the sampled cities, especially those in high income economies, is high. There is room for increasing cigarette prices via tax increases. There is a risk that the increase in cigarette prices in newly emerging economies lags behind the high speed of economic growth being experiencing. Tax increases should be given high priority.

Kaskutas LA; Zavala SK; Parthasarathy S; Witbrodt J. Costs of day hospital and community residential chemical dependency treatment. Journal of Mental Health Policy & Economics 11(1): 27-32, 2008. (22 refs.)

Background: Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs. Aims: This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum. Method: This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects. Results: Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was $575 per week at day hospital, versus $370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men). Discussion: These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients. Conclusion: Outcomes and costs at residential versus day hospital programs were similar for women and for Whites. For non-Whites, and marginally for men, a preference for residential care would appear to come at a higher cost. Implications for Health Care Provision and Use: Lengths of stay in residential treatment were significantly longer than in day hospital, but costs per week were lower. Women and Whites appear to be equally well-served in residential and day hospital programs, with no significant cost differential. Provision of residential treatment for non-Whites may be more costly than day hospital, because their residential stays are likely to be 3 times longer than they would be if treated in day hospital. For men, residential care will be marginally more costly. Implications for Health Policy Formulation: Residential treatment appears to represent a cost-effective alternative to day hospital for female and White clients with severe alcohol and drug problems who are not at environmental risk. Implications for Further Research: The much shorter stays in day hospital than at residential among non-Whites highlight the need for research to better understand how to best meet the needs and preferences of non-White clients when considering both costs and outcomes.

Keller PA; Koss KJ; Baker TB; Bailey LA; Fiore MC. Do state characteristics matter? State level factors related to tobacco cessation quitlines. Tobacco Control 16(Supplement 1): 175-180, 2007. (29 refs.)

Background: Quitline services are an effective population-wide tobacco cessation strategy adopted widely in the United States as part of state comprehensive tobacco control efforts. Despite widespread evidence supporting quitlines' effectiveness, many states lack sufficient financial resources to adequately fund and promote this service. Efforts to augment state tobacco control efforts might be fostered by greater knowledge of state level factors associated with the funding and implementation of those efforts. Methods: We analysed data from the 2004 North American Quitline Consortium survey and from publicly available sources to identify state level factors related to quitline implementation and funding. Factors included in the analyses were state demographic characteristics, tobacco use variables, state tobacco control spending, and economic and political climate variables. Univariate and multivariate regression analyses were conducted. Results: The best fitting multivariate model that significantly predicted the presence or absence of a state quitline included only cigarette excise tax rate (p = 0.020). In terms of funding levels, states with high rates of cigarette consumption (p = 0.047) and with higher per capita expenditures for tobacco control programmes (p = 0.0.004) were most likely to spend more on per capita operations budget for quitlines. Conclusion: State level factors appear to play a part in whether states had established quitlines by mid-2004 and the amount of per capita quitline funding.

Kinner SSA; Lloyd B. Queensland Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 272. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (14 refs.)

This report reports data on the use of illicit drugs in Queensland, derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 127 figures and tables.

Knealing TW; Roebuck MC; Wong CJ; Silverman K. Economic cost of the therapeutic workplace intervention added to methadone maintenance. Journal of Substance Abuse Treatment 34(3): 326-332, 2008. (24 refs.)

Therapeutic workplace is a novel intervention that uses access to paid training and employment to reinforce drug abstinence within the context of standard methadone maintenance. We used the Drug Abuse Treatment Cost Analysis Program as a standard method of estimating the economic costs of this intervention. In a 1-year period, the therapeutic workplace served 122 methadone maintenance clients who had a median length of stay of 22 weeks. The workplace maintained a mean daily census of 48 clients. The combined cost of methadone maintenance and the therapeutic workplace was estimated at US$362 per week. This cost is less than that of other treatments that might be used to promote abstinence in individuals who continue to use drugs during methadone treatment. Given prior evidence of effectiveness, these cost data may be useful to policy makers, social service agencies, and researchers interested in using or further developing the therapeutic workplace intervention.

Kozlowski LT. Effect of smokeless tobacco product marketing and use on population harm from tobacco use -- Policy perspective for tobacco-risk reduction. American Journal of Preventive Medicine 33(6, Supplement S): S379-S386, 2007. (74 refs.)

This article presents policy perspectives on the marketing of smokeless tobacco products to reduce population harm from tobacco use. Despite consensus that smokeless tobacco products as sold in the United States are less dangerous than cigarettes, there is no consensus on how to proceed. Diverse factions have different policy concerns. While the tobacco industry is exempted from U.S. Food and Drug Administration (FDA) oversight, the pharmaceutical industry whose nicotine replacement therapy (NRT) medicines compete with smokeless tobacco as noncombustible nicotine-delivery systems are regulated by the FDA. Some public health experts support smokeless tobacco use to reduce population harm from tobacco; other public health experts oppose promoting smokeless tobacco for harm reduction. Adult consumers can freely purchase currently-marketed smokeless tobacco products and even more-deadly cigarettes. Concerns with and advantages of smokeless tobacco products are discussed. In that noncombustible medicinal nicotine-delivery systems have been proven to be effective smoking-cessation aids, smokeless tobacco, as another source of psychoactive doses of nicotine, could be used similarly, in a dose-response fashion as a smoking-cessation aid (consistent with FDA principles for evaluating generic versions of drugs). Price measures should be used on tobacco products to make costs to consumers proportional to product health risks (which would make smokeless tobacco much cheaper than cigarettes), and smokeless tobacco should be encouraged as an option for smoking cessation in adult smokers, particularly for those who have failed to stop smoking using NRT or other methods.

Krause EI. Take my property please! Who should bear the burden of cleaning up toxic methamphetamine lab waste? Catholic University Law Review 56(1): 187-226, 2006. (222 refs.)

The house had been used as a laboratory to "cook" methamphetamine, resulting in hazardous chemical residue that leeched into the porous surfaces of their home, costing the Needhams thousands of dollars for the professional inspection and cleanup. ... Similarly, in United States v. Asarco Inc., the Idaho federal district court adopted the takings analysis from Northeastern Pharmaceutical in rejecting a mining corporation's claims that imposition of CERCLA liability for hazardous waste cleanup constituted a regulatory taking of its property. ... CERCLA (and Washington's MTCA, for example) provides a complete defense to liability for cleaning up hazardous waste when a property owner was unaware of the contamination prior to ownership of the property and did not contribute to the contamination. ... (b) the contamination from the manufacture of methamphetamine was caused entirely by a third party and use of the property as a methamphetamine laboratory was reasonably unforeseeable to the owner. ... Providing property owners with a defense to liability for the cleanup costs not only decreases the chances of a property owner succeeding in a takings challenge of the methamphetamine decontamination statutes, but it also protects the "[i]nnocent members of the public" in a larger sense by protecting the innocent property owners of the contaminated property in question. ... When Kent and Cindy Needham purchased their second home to save additional money to purchase their dream home, they had no idea that their purchase would quickly lead them near bankruptcy. n1 Shortly after the Needhams moved into their second home, they began experiencing physical ailments including blisters and exacerbated symptoms of Mrs. Needham's dormant multiple sclerosis. n2 Unfortunately, their physical reactions were symptoms of a larger problem that detrimentally affected the Needham's finances. n3 The house had been used as a laboratory to "cook" methamphetamine, resulting in hazardous chemical residue that leeched into the porous surfaces of their home, costing the Needhams thousands of dollars for the professional inspection and cleanup. n4 As much as it may seem that this unfortunate story is an isolated incident, the Needhams' home-buying experience is not unique. Newspapers and magazines across the country report similar incidents of homeowners unknowingly moving into former methamphetamine laboratories, who discover the history of their home's use upon experiencing detrimental health effects and spend thousands of dollars to clean up the home or [*188] attempt to resell it to recover their costs. n5 State legislatures n6 are taking note of the growing problems associated with contamination of residential properties n7 used as methamphetamine labs and are working toward combating these problems by enacting statutes that establish standards for cleaning up the hazardous chemical waste that is left behind.

Leinsalu M; Tekkel M; Kunst AE. Social determinants of ever initiating smoking differ from those of quitting: a cross-sectional study in Estonia. European Jounal of Public Health 17(6): 572-578, 2007. (43 refs.)

Background: To study the association of socioeconomic and demographic indicators with ever initiating regular smoking and quitting smoking among ever regular smokers in Estonia in order to identify target groups for equity-oriented tobacco control policies. Methods: Data for 4277 individuals in the 25-64 age group come from three cross-sectional studies conducted in 2000, 2002 and 2004. Age-standardized prevalence rates and odds ratios with 95 confidence intervals were calculated. Results: High rates of ever initiation were observed for lower educated men and women after controlling for other socioeconomic indicators. This association was not observed for women above age 50. Independent, although weaker associations were found among men who were unemployed or with a low occupational status. Low cessation rates were observed among men who were unemployed, who had a lower occupational position or who had a low income. These associations remained after controlling for other socioeconomic variables. The effect of income became stronger in the older age groups among men. Rates of ever initiation and cessation also varied strongly in relationship to some demographic variables. The highest initiation rates were found among divorced women and among women living in the capital city. The lowest cessation rates were found among divorced women, and among Russian men. Conclusions: While educational level was the strongest predictor of ever initiating regular smoking, smoking cessation was related more directly to aspects of social disadvantage originating in adult life. To be effective, tobacco control interventions should not only target lower educated, but also those in material disadvantage.

Levy DT; Benjakul S; Ross H; Ritthiphakdee B. The role of tobacco control policies in reducing smoking and deaths in a middle income nation: Results from the Thailand SimSmoke simulation model. Tobacco Control 17(1): 53-59, 2008. (60 refs.)

Objectives: With the male smoking prevalence near 60% in 1991, Thailand was one of the first Asian nations to implement strict tobacco control policies. However, the success of their efforts has not been well documented. Methods: The role of tobacco control policies are examined using the "SimSmoke'' tobacco control model. We first validated the model against survey data on smoking prevalence. We then distinguished the effect of policies implemented between 1991 and 2006 from long-term trends in smoking rates. We also estimated smoking attributable deaths and lives saved as a result of the policies. Results: The model validates well against survey data. The model shows that by the year 2006, policies implemented between 1991 and 2006 had already decreased smoking prevalence by 25% compared to what it would have been in the absence of the policies. Tax increases on cigarettes and advertising bans had the largest impact, followed by media anti-smoking campaigns, clean air laws and health warnings. The model estimates that the policies saved 31 867 lives by 2006 and will have saved 319 456 lives by 2026. Conclusions: The results document the success of Thailand in reducing smoking prevalence and reducing the number of lives lost to smoking, thereby showing the potential of tobacco control policies specifically in a middle-income country. Additional improvements can be realised through higher taxes, stronger clean air policies, comprehensive cessation treatment policies, and targeted media campaigns.

Levy DT; Mumford EA; Gerlowski DA. Examining trends in quantity smoked. Nicotine & Tobacco Research 9(12): 1287-1296, 2007. (54 refs.)

Although the quantity smoked is known to affect smokers' health risks and likelihood of cessation, little is known about trends in quantity smoked and the role of policies in affecting those trends. We examined trends in quantity smoked using a new measure derived from U. S. Department of Agriculture per-capita cigarette consumption (PCC) and smoking prevalence data. We compared this measure to a survey measure of mean cigarettes smoked per day from the National Health Interview Survey (NHIS). Using our measure, we examined trends in quantity smoked at the national level from 1974 to 2004 and for two states, California and Massachusetts. We used regression analysis to distinguish price and other policy-related trends from long-term trends. The derived measure of quantity tracked well with the NHIS measure. Through 1990, changes in quantity were well explained by price changes, with no residual trend in quantity smoked. Since 1990, price showed similar effects, but a downward trend was observed. In California and Massachusetts the initiation of a comprehensive tobacco program as well as price and tax changes were found to explain trends in quantity smoked. Continued progress in reducing the quantity smoked is likely to require the consistent implementation of current policies and the introduction of new policies. Although sustained reductions in quantity smoked may take a long time to affect smokers' health outcomes, sustained reductions appear to be related to cessation. The measure developed in the present study provides a useful tool for tracking trends in quantity smoked.

Lovenheim MF. How far to the border?: The extent and impact of cross-border casual cigarette smuggling. National Tax Journal 61(1): 7-33, 2008. (29 refs.)

This paper uses data on cigarette consumption in the Current Population Survey Tobacco Supplements to estimate cigarette demand models that incorporate the decision of whether to smuggle cigarettes across a lower-price border. I find demand elasticities with respect to the home state price are indistinguishable from zero on average and vary significantly with the distance individuals live to a lower-price border. However, when smuggling incentives are eradicated, the price elasticity is negative but still inelastic. I also estimate between 13 and 25 percent of consumers purchase cigarettes in border localities. The central implication of this study is cross-border smuggling confounds many of the potential health and revenue gains from cigarette taxation.

Lutsenko H; Doran CM; Hall WD. Australian smokers' use of bupropion and nicotine replacement therapies and their relation to reimbursement, Australia 2001-05. Drug and Alcohol Review 27(2): 160-164, 2008. (23 refs.)

Objective. To compare the usage of bupropion hydrochloride and nicotine replacement in Australia between 2001 and 2005. Design and Setting. We analysed aggregate data on the utilisation of: (1) bupropion under the Pharmaceutical Benefit Scheme (PBS) between 2001 and 2005; (2) bupropion and nicotine replacement therapy (NRT) on the Repatriation Pharmaceutical Benefit Scheme (RPBS) between 1995 and 2005; and (3) NRT aggregate sales data from GlaxoSmithKline for 2001-05. The National Drug Strategy Household Survey (NDSHS) 2004 was used to estimate the proportion of smokers who received a bupropion prescription in each year. Main Outcome Measures. Numbers of annual prescriptions for bupropion on the PBS and buproprion and NRT on the RPBS; annual sales figures on NRT patches (2001-05); and the estimated proportion of Australian smokers who used bupropion in 2003. Results. The number of bupropion prescriptions on the PBS peaked at 351 772 in 2001 (costing the PBS $83 million). This declined by 72% to 97 173 in 2005 (a cost of $12 million). The estimated percentage of smokers in Australia who used bupropion in a year fell from 11% in 2001 to 3.6% in 2005. The annual number of bupropion prescriptions on theRP BS fell from 3786 in 2001 to 1173 in 2005, while there was no change in the number of NRT prescriptions (3793 in 2001 and 3886 in 2005). Sales data from the leading market supplier of NRT also indicated that NRT use continued to grow in Australia while bupropion use declined. Conclusions. Bupropion usage has fallen by 72% since a peak in the year of first listing on the PBS, while the utilisation of NRTs appears to have increased, despite the price differential in favour of bupropion. Implications. Given the greater interest among smokers in NRT than bupropion (and evidence of the effectiveness and cost-effectiveness of NRT), the Australian government should reconsider its decision not to list NRT on the PBS.

Makela P; Bloomfield K; Gustafsson NK; Huhtanen P; Room R. Changes in volume of drinking after changes in alcohol taxes and travellers' allowances: Results from a panel study. Addiction 103(2): 181-191, 2008. (36 refs.)

Aims: The aim of this paper is to study short-term changes in alcohol consumption by subgroups of the population in Denmark, Finland and southern Sweden following large-scale decreases in alcohol taxation in Denmark and Finland and large increases in travellers' allowances in Finland and Sweden. Design General population random samples surveyed before and after the changes, using northern Sweden as a control site. Setting: Denmark, Finland, southern Sweden and northern Sweden. Participants Respondents aged 16-69 years. Measurements Volume of drinking is the main measure reported. Changes are examined by gender, age, income and year 2003 consumption level. Results Consumption decreased or remained the same among women and men in all three study sites. Relative changes were similar across subgroups of age, gender and income in all countries. In absolute terms, there was a consistent differential change by age in Denmark, Finland and Southern Sweden, with the higher level of the young and lower level of the old converging. Women's and men's consumption converged in Finland and southern Sweden. The changes did not differ systematically by income. Changes were not larger among heavier drinkers. Conclusions: The results did not confirm expectations: an increase in consumption larger than that in the control site could not be shown in any of the countries or subgroups of the population. If there has been an effect - as shown in aggregate data in Finland - it seems to have been stronger among the old than the young and, in Finland and southern Sweden, among women rather than men.

Malliarakis KD; Lucey P. Social determinates of health: Focus on substance use and abuse. Nursing Economics 25(6): 368-+, 2007. (15 refs.)

Addiction is a progressive, chronic, and relapsing disorder of the brain that cannot be cured but can be treated. It is imperative to recognize the social overlay when planning to meet the health care needs of clients with addiction care needs. The implications for society are significant as addiction is a multifarious disease that costs the individual as well as the taxpayers. Administrators have the opportunity to provide education for all health personnel on early intervention and screening. Denial is a hallmark of the disease of addiction. Health care personnel must not be in denial about addiction because they can take action to prevent and treat addictions.

Marlow ML. Determinants of state tobacco-control expenditures. Applied Economics 40(7): 831-839, 2008. (25 refs.)

While Centers for Disease Control and Prevention believe that most state governments under-fund tobacco-control programs, little is known about why large variation in spending exists between state governments. This study explores reasons for spending variation through an econometric model of per capita spending on tobacco-control programs that explores the effects of smoking prevalence while holding constant tobacco settlement funds, state budget deficits, and other factors that might also be expected to influence spending variation. Empirical evidence indicates no support for the hypothesis that states with high smoking prevalence spend more on tobacco-control than other states. This finding may be quite surprising to those working in areas of public health and clearly leads to many important policy questions regarding why the data indicate that funding does not appear to bear any relation to perceived public health problems as would be predicted if policymakers were following a 'rational needs' approach to funding.

Mathur C; Stigler MH; Perry CL; Arora M; Reddy KS. Differences in prevalence of tobacco use among Indian urban youth: The role of socioeconomic status. Nicotine & Tobacco Research 10(1): 109-116, 2008. (26 refs.)

This study examined whether the distribution of tobacco use and related psychosocial risk factors among youth in urban India vary by socioeconomic status (SES). Data were derived from a cross-sectional survey of students enrolled in the 6th and 8th grades in 32 schools in Delhi and Chennai (N=11,642). The survey was conducted in 2004, before the implementation of a program designed to prevent and reduce tobacco use (MYTRI). Mixed-effect regression models were used (a) to determine the prevalence of tobacco use among private (higher SES) and government (lower SES) school students, (b) to investigate whether certain psychosocial factors were associated with increased tobacco use, and (c) to determine how these factors varied by school type. Ever-use of multiple forms of tobacco (e.g., gutkha, bidis, and cigarettes) was more prevalent among government school students than private school students. After adjusting for city, gender, grade, and age, we found the prevalence rate for ever-use of any tobacco product to be 18.9% for government school students, compared with 12.2% for private school students (p <.01). Students in government schools scored lower than private school students on most psychosocial risk factors for tobacco use studied here, indicating higher risk. Government school students scored the lowest for refusal skills, self-efficacy, and reasons not to use tobacco. Social susceptibility to chewing tobacco and social susceptibility to smoking were strong correlates of current tobacco use among government school students. Exposure to tobacco advertising was also a strong correlate of current tobacco use for government school students but not private school students. In two large cities of India, students attending government schools are using many forms of tobacco at higher rates than private school students. The psychosocial risk profile of government school students suggests they are more vulnerable to initiation and use and to outside influences that encourage use.

Moon C. Northern Territory Drug Trends, 2006. Findings from the Illicit Drug Reporting System (IDRS). NDARC Technical Report No. 271. Sydney: National Drug and Alcohol Research Centre (Australia), 2007. (50 refs.)

This report reports data on the use of illicit drugs in New South Wales (NSW), derived from an annual survey. Data is provided for each of the major drug classes -- heroin, methamphetamine, cocaine, cannabis, opioids, and other drugs (alcohol, tobacco, ecstasy, benzodiazepines, pharmaceutical stimulants, antidepressants, hallucinogens and inhalants). For each of these there is discussion of price, availability, potency, use patterns, related harms and trends in use. The report concludes with discussion of the associated harms including: blood-borne viral infections, sharing of injecting equipment, locations of injections, injection-related health problems, driving, expenditures on illicit drugs, mental health problems, substance-related aggression and criminal and police activity. The report has 123 figures and tables.

Morgenstern J; Blanchard KA; Kahler C; Barbosa KM; McCrady BS; McVeigh KH. Testing mechanisms of action for intensive case management. Addiction 103(3): 469-477, 2008. (34 refs.)

Aim: This study identified factors that predict, mediate or moderate the effects of intensive case management (ICM) on longer-term drug abstinence outcomes in women on welfare. Design In a parent study women were assigned randomly to usual care (UC) or intensive case manangement (ICM). Treatment was provided for 12 weeks and follow-up continued for 15 months after study intake. A set of hypothesized mediators was assessed at month 3 and a rigorous four-step mediational model was tested using outcomes in months 4-15. Participants Participants were 302 drug-dependent women applying and eligible for federal welfare and not currently in drug abuse treatment. Inventions ICM provided intensive treatment engagement including voucher incentives for treatment attendance and case management services; UC provided primarily referral to community treatment programs. Measurement: Substance use outcomes were assessed using the time-line follow-back interview and confirmed using biological and collateral measures. Findings Participants in ICM had more case manager contacts, better treatment engagement and more self-help attendance than did those in UC. Each of these variables predicted, and was shown to be a mediator of outcome, but case management contact was an especially robust mediator. Further, ICM effects were strongest for those who attended treatment least. Contrary to prediction, greater psychopathology and environmental stressors did not predict worse outcomes. Conclusions: Findings suggest that case management is an active intervention that may both facilitate and substitute for formal drug abuse treatment.

Mustonen H; Makela P; Huhtanen P. People are buying and importing more alcohol than ever before. Where is it all going? Drugs: Education, Prevention and Policy 14(6): 513-527, 2007. (15 refs.)

Aims: Removal of import quotas for alcoholic beverages from other EU countries and cuts on alcohol taxes by one third on average resulted in approximately a 10% increase in per capita alcohol consumption in 2004, and a further 3% in 2005. Our aim was to study which population groups accounted for this increase, and what happened to self-reported alcohol-related harm. Methods: A panel survey with a general population random sample was carried out. The current data are the first and third waves of the panel. A questionnaire was sent in autumn 2003 to 4000 Finns aged 15 to 69. In 2005, the questinnaire was mailed to 1209 persons who responded both in 2003 and in 2004 and who agreed to participate in the follow-up. Findings: The respondents themselves reported no increase in either their own consumption or in alcohol-related harm from 2003 to 2005, and there were few changes by subgroup of the population either. Conclusions: The survey data did not capture the increase in consumption that has been observed in per capita consumption. The permanent consequences of the changes in the alcohol situation in 2004 remain to be seen in future statistics and studies.

Obot IS; Saxena S, eds. Substance Use Among Young People in Urban Environments. Geneva: World Health Organization, Department of Mental Health and Substance Abuse, 2005. (Chapter refs.)

This book constitutes an exploration of drug use and misuse, which insists that these occurrences have to be understood within an ecological frame -- that is, the setting in which it occurs. The adolescent in the Mexican shanty town, who is employed by a drug distribution syndicate to fly a kite to warn his employers that the police are entering the neighbourhood, has taken up this job because there are few other jobs available and that kind of employment may well be a personal gateway to drug misuse. Drug dealing and drug use are often, at least in part, products of circumstance rather than of psychopathology, or genetics, or 'brain disease'. The theme is explored in each of the 11 chapters of the book. it grew out of a WHO program on urbanization and its impact on adolescent drug use. Contributing authors come from Brazil, Canada, the Czech Republic, India, Indonesia, Israel, Japan, Mexico, South Africa, Thailand and the United States. The publication derives from a WHO project on urbanization and youth which was initiated in 2000. Across the diversity of individual statements is the common, linked exploration of what the environmental impact of rapid urbanization is likely to do to the lives of young people and to their drug use-that is the particular issue which can be seen as illustrating the general fact that drug use is usually the product of rather more than the meeting between disarticulated agent and abstracted host.

Office of Applied Studies, Substance Abuse and Mental Health Administration. National Survey of Substance Abuse Treatment Services (N-SSATS): 2006 Data on Substance Abuse Treatment Facilities, DASIS Series S-39. Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (0 refs.)

SAMHSA's Office of Applied Studies (OAS) conducts the National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. In 2006, on the date of the census, there were 13,771 facilities serving 1,130,881 individuals. Over half (59%) were facilities provided by private nonprofit organizations, 28% were private for-profit organizations, 7% run by local governments, 3% by State governments, 2% by the Federal government, and 1% by tribal governments. Of the reporting facilities 62% of the facilities reported substance abuse treatment services was their primary focus of activity, 27% of the facilities reported that their primary focus was a mix of mental health and substance abuse treatment services. On the date of the census 90% of residential beds were filled. 63% of all facilities provided a sliding scale for fees, 53% of all facilities offered substance abuse treatment at no charge to eligible clients who could not pay, and 4% provided substance abuse treatment at no charge to all clients. Federal, State, or local government funds were received by 59% of all facilities. Most facilities (83%) offered specially designed programs: 37% offered programs or groups for persons with co-occurring mental health and substance abuse disorders, 32% for adult women, 32% for adolescents, 31% for driving under the influence of alcohol or drugs (DUI/DWI), 28% for criminal justice clients, 25% for adult men, 14% for pregnant/postpartum women, 10% for persons with HIV or AIDS, 7% for seniors or older adults, and 6% for gays or lesbians. Substance abuse treatment services in sign language for the hearing impaired were offered in 29% of all facilities and in languages other than English in 45%.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services (N-SSATS): 2006. Data on Substance Abuse Treatment Facilities. DASIS Series S-39. Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (0 refs.)

SAMHSA's Office of Applied Studies (OAS) conducts the National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. This survey is designed to collect data on the location, characteristics, and use of alcoholism and drug abuse treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions. The reference date for the 2006 one-day census was March 31, 2006. Among the highlights of the findings are the following: (1) In 2006, there were 13,771 facilities providing information. (2) From 2002 to 2006 there was a slight decline (less than 1%) in the number of persons in treatment. (3) In 2006, 59% of the facilities were run by private nonprofit organizations; 28% were private for-profit organizations; 7% by local governments, 3% by State governments, 2% by the Federal government, and 1% by tribal governments. (4) Between 2002 and 2006 the proportion of substance abuse treatment clients in private for-profit facilities increased from 26% to 29%; the proportion of clients in local State, and Federal government facilities fell from 17% to 15%. (5) On the date of the census 91% of non-hospital residential beds and 90% of all hospital inpatient beds designated for substance abuse treatment were in use. (6) A sliding fee scale was used by 63% of all facilities. (7) Most facilities (83%) offered specially designed programs --37% offered programs or groups for persons with co-occurring psychiatric problems, 32% for women, 32% for adolescents, 31% for driving under the influence of alcohol or drugs (DUI/DWI), 28% for criminal justice clients, 25% for adult men, 14% for pregnant/postpartum women, 10% for persons with HIV or AIDS, 7% for seniors or older adults, and 6% for gays or lesbians.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Youth Activities, Substance Use, and Family Income. (April 9, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (5 refs.)

Based on SAMHSA's 2005 National Survey on Drug Use and Health, 92.4% of youths aged 12 to 17 participated in one or more school-based, community-based, church or faith-based, or other such activities during the past year: 27.1% participated in one to three activities, 31.4% participated in four to six activities, and 33.9% participated in seven or more activities in the past year. Youth in families of lower income were more likely not to participate in any school-based, community-based, church or faith-based or related activities; however, regardless of family income those youth who did participate had lower rates of cigarette, alcohol, or illicit drug use than those who did not participate in such activities. The greater the number of activities, the lower the rates of past year use of cigarettes, alcohol, or illicit drugs among youth. For example, the rates of illicit drug use were 18.3% for youth who participated in no such activities, 11.9% for those with 1-3 activities, 9.4% for 4-6 activities, and 6.8% for 7 or more youth activities in the past year.

Public Domain

Olmstead TA; Sindelar JL; Petry NM. Clinic variation in the cost-effectiveness of contingency management. American Journal on Addictions 16(6): 457-460, 2007. (23 refs.)

This study determined whether, and by how much, the cost-effectiveness of contingency management (CM) varied across the eight clinics in the National Institute on Drug Abuse Clinical Trials Network MIEDAR trial. Incremental costs, incremental outcomes, and incremental cost-effectiveness ratios (ICERs) of CM compared to usual care were calculated, compared and contrasted for each of the clinics. Results showed that the incremental cost of using CM compared to usual care varied by a factor of 1.9 across the clinics, ranging from an additional $306 to an additional $582 per patient. The effect of CM on the longest duration of continuous stimulant abstinence (LDA) varied by a factor of 8.0 across the clinics, ranging from an additional 0.5 to an additional 4.0 weeks. The ICERs for the LDA varied by a factor of 4.6 across the clinics, ranging from $145 to $666. These results show that the cost-effectiveness of CM varied widely among the clinics in the MIEDAR trial. Future research should focus on identifying the sources of this variation, perhaps by identifying clinic-level best practices and/or identifying those subgroups of patients that respond the most cost-effectively, with the ultimate goal of improving the cost-effectiveness of CM overall.

Pacula RL; Ringel J; Dobkin C; Truong K. The incremental inpatient costs associated with marijuana comorbidity. Drug and Alcohol Dependence 92(1/3): 248-257, 2008. (21 refs.)

In this paper we examine the incremental cost of marijuana comorbidity for alcohol, mood and thought diagnoses in hospital settings. We use data from the 1993-2000 National Hospital Discharge Survey to examine the effect on length of stay and the 1995-2000 Florida Hospital Discharge Data to examine charges. General linear modeling (GLM) and propensity score methods are employed to deal with concerns stemming from the distribution of the dependent variables and statistically significant differences in the baseline characteristics of marijuana users versus non-users. Marijuana comorbidity is associated with longer length of stays and higher charges for patients suffering from a primary diagnosis of an alcohol problem. We also find higher average charges for patients suffering from mood disorders, though the finding is not robust across all model specifications. We do not find any significant effects for thought disorders. Findings from this study suggest that a marijuana comorbidity increases the cost of treating patients with alcohol problems and mood disorder diagnoses, implying that there may be real health consequences associated with marijuana abuse and dependence and more work considering this possibility is warranted.

Pampel F. National income, inequality and global patterns of cigarette use. Social Forces 86(2): 445-466, 2007. (50 refs.)

Declining tobacco use in high-income nations and rising tobacco use in low- and middle-income nations raises questions about the sources of worldwide patterns of smoking. Theories posit a curvilinear influence of national income based on the balance of affordability and health-cost effects. In addition, however, economic inequality, gender inequality and government policies may moderate the rise and fall in smoking prevalence with national income, This study tests these arguments using aggregate data for 145 nations and measures of smoking prevalence circa 2000. The results show nonlinear effects of national income for males that take the form of an inverted U, but show linear effects for females. They also show non-additive effects of economic inequality for males that moderate both the rise and decline of smoking with national income and non-additive effects of gender equality for