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CORK Bibliography: Economic Aspects

65 citations. January 2010 to present

Prepared: June 2011

Adda J; Cornaglia F. The effect of bans and taxes on passive smoking. American Economic Journal. Applied Economics 2(1): 1-32, 2010. (38 refs.)

We evaluate the effect of smoking bans and excise taxes on the exposure to tobacco smoke of nonsmokers, and we show their unintended consequences on children. Smoking bans perversely increase nonsmokers' exposure by displacing smokers to private places where they contaminate nonsmokers. We exploit data on bio-samples of cotinine, time use, and smoking cessation, as well as state and time variation in anti-smoking policies across US states. We find that higher taxes are an efficient way to decrease exposure to tobacco smoke.

Benson P. Tobacco talk: Reflections on corporate power and the legal framing of consumption. Medical Anthropology Quarterly 24(4): 500-521, 2010. (67 refs.)

This article examines how North Carolina tobacco farmers think about the moral ambiguities of tobacco business. Drawing on ethnographic research with tobacco farmers and archival research on the tobacco industry, I specify the core psychological defense mechanisms that tobacco companies have crafted for people associated with the industry. I also document local social, cultural, and economic factors in rural North Carolina that underpin ongoing rural dependence on tobacco despite the negativity that surrounds tobacco and structural adjustments. This article contributes to our knowledge about tobacco farmers and tobacco farming communities, which is important for tobacco-control strategies. I reflect on ethical and economic paradoxes related to the rise of corporate social responsibility in the tobacco industry, where an official legal framing of consumption, focused on informed adult consumer autonomy and health education, is promoted to undermine more robust public health prevention efforts.

Blecher E. Targeting the affordability of cigarettes: A new benchmark for taxation policy in low-income and-middle-income countries. Tobacco Control 19(4): 325-330, 2010. (16 refs.)

Objectives To investigate the appropriateness of tax incidence (the percentage of the retail price occupied by taxes) benchmarking in low-income and-middle-income countries (LMICs) with rapidly growing economies and to explore the viability of an alternative tax policy rule based on the affordability of cigarettes. Design The paper outlines criticisms of tax incidence benchmarking, particularly in the context of LMICs. It then considers an affordability-based benchmark using relative income price (RIP) as a measure of affordability. The RIP measures the percentage of annual per capita GDP required to purchase 100 packs of cigarettes. Using South Africa as a case study of an LMIC, future consumption is simulated using both tax incidence benchmarks and affordability benchmarks. Results: I show that a tax incidence benchmark is not an optimal policy tool in South Africa and that an affordability benchmark could be a more effective means of reducing tobacco consumption in the future. Conclusions: Although a tax incidence benchmark was successful in increasing prices and reducing tobacco consumption in South Africa in the past, this approach has drawbacks, particularly in the context of a rapidly growing LMIC economy. An affordability benchmark represents an appropriate alternative that would be more effective in reducing future cigarette consumption.

Bonevski B; Paul C; D'Este C; Sanson-Fisher R; West R; Girgis A. RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population. BMC Public Health 11: e-article 70, 2011. (51 refs.)

Background: Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population. Methods/Design: A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client-centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up. Discussion: This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited.

Callard C. Follow the money: How the billions of dollars that flow from smokers in poor nations to companies in rich nations greatly exceed funding for global tobacco control and what might be done about it. Tobacco Control 19(4): 285-290, 2010. (43 refs.)

The business of selling cigarettes is increasingly concentrated in the hands of five tobacco companies that collectively control almost 90% of the world's cigarette market, four of which are publicly traded corporations. The economic activities of these cigarette manufacturers can be monitored through their reports to shareholders and other public documents. Reports for 2008 show that the revenues of these five companies exceeded $300 billion, of which more than $160 billion was provided to governments as taxes, and that corporate earnings of the four publicly traded companies were over $25 billion, of which $14 billion was retained after corporate income taxes were paid. By contrast, funding for domestic and international tobacco control is not reliably reported. Estimated funding for global tobacco control in 2008, at $240 million, is significantly lower than resources provided to address other high-mortality global health challenges. Tobacco control has not yet benefited from the innovative finance mechanisms that are in place for HIV/AIDS, tuberculosis and malaria. The Framework Convention On Tobacco Control (FCTC) process could be used to redirect some of the earnings from transnational tobacco sales to fund FCTC implementation or other global health efforts.

Centers for Disease Control. Vital Signs: Current cigarette smoking among adults aged �18 years --- United States, 2009 Weekly. MMWR. Morbidity and Mortality Weekly Review 59(35): 1135-1140, 2010. (4 refs.)

Background: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States, causing approximately 443,000 premature deaths annually. Methods: The 2009 National Health Interview Survey and the 2009 Behavioral Risk Factor Surveillance System were used to estimate national and state adult smoking prevalence, respectively. Cigarette smokers were defined as adults aged �18 years who reported having smoked �100 cigarettes in their lifetime and now smoke every day or some days. Results: In 2009, 20.6% of U.S. adults aged �18 years were current cigarette smokers. Men (23.5%) were more likely than women (17.9%) to be current smokers. The prevalence of smoking was 31.1% among persons below the federal poverty level. For adults aged �25 years, the prevalence of smoking was 28.5% among persons with less than a high school diploma, compared with 5.6% among those with a graduate degree. Regional differences were observed, with the West having the lowest prevalence (16.4%) and higher prevalences being observed in the South (21.8%) and Midwest (23.1%). From 2005 to 2009, the proportion of U.S. adults who were current cigarette smokers did not change (20.9% in 2005 and 20.6% in 2009). Conclusions: Previous declines in smoking prevalence in the United States have stalled during the past 5 years; the burden of cigarette smoking continues to be high, especially in persons living below the federal poverty level and with low educational attainment. Sustained, adequately funded, comprehensive tobacco control programs could reduce adult smoking.

Public Domain

Cole J; Logan TK; Walker R. Social exclusion, personal control, self-regulation, and stress among substance abuse treatment clients. Drug and Alcohol Dependence 113(1): 13-20, 2011. (72 refs.)

The purpose of this study was to examine the relationship of social exclusion, personal control, and self-regulation to perceived stress among individuals who participated in publicly funded substance abuse treatment. Participants entered treatment between June 2006 and July 2007 and completed a 12-month follow-up survey by telephone (n = 787). The results of the OLS regression analysis indicate that individuals with greater social exclusion factors (e.g. greater economic hardship, lower subjective social standing, greater perceived discrimination), lower perceived control of one's life, and lower self-regulation had higher perceived stress. Furthermore, a significant interaction was found suggesting a stress-buffering effect of personal control between subjective social standing and perceived stress. Interestingly, income status was not significantly related to perceived stress, while economic hardship, which assesses participants' inability to meet basic expenses, was significantly associated with perceived stress. Future research should examine how to integrate the AA/NA teaching about powerlessness and its role in recovery with the importance of increased personal control and self-control in decreasing perceived stress. Implications for future research and substance abuse treatment are discussed.

Coleman T; Agboola S; Leonardi-Bee J; Taylor M; McEwen A; McNeill A. Relapse prevention in UK Stop Smoking Services: Current practice, systematic reviews of effectiveness and cost-effectiveness analysis. (review). Health Technology Assessment 14(49): 1-+, 2010. (176 refs.)

Background: Reducing smoking is a chief priority for governments and health systems like the UK National Health Service (NHS). The UK has implemented a comprehensive tobacco control strategy involving a combination of population tobacco control interventions combined with treatment for dependent smokers through a national network of NHS Stop Smoking Services (NHS SSS). Objectives: To assess the effectiveness and cost-effectiveness of relapse prevention in NHS SSS. To (1) update current estimates of effectiveness on interventions for preventing relapse to smoking; (2) examine studies that provide findings that are generalisable to NHS SSS, and which test interventions that might be acceptable to introduce within the NHS; and (3) determine the cost-effectiveness of those relapse preventions interventions (RPIs) that could potentially be delivered by the NHS SSS. Data sources: A systematic review of the literature and economic evaluation were carried out. In addition to searching the Cochrane Tobacco Addiction Group register of trials (2004 to July 2008), MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, the Science Citation Index and Social Science Citation Index were also searched. Review methods: The project was divided into four distinct phases with different methodologies: qualitative research with a convenience sample of NHS SSS managers; a systematic review investigation the efficacy of RPIs; a cost-effectiveness analysis; and a further systematic review to derive the relapse curves for smokers receiving evidence-based treatment of the type delivered by the NHS SSS. Results: Qualitative research with 16 NHS SSS managers indicated that there was no shared understanding of what relapse prevention meant or of the kinds of interventions that should be used for this. The systematic review included 36 studies that randomised and delivered interventions to abstainers. 'Self-help' behavioural interventions delivered to abstainers who had achieved abstinence unaided were effective for preventing relapse to smoking at long-term follow-up [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.15 to 2.01]. The following pharmacotherapies were also effective as RPIs after their successful use as cessation treatments: bupropion at long-term follow-up (pooled OR 1.49, 95% CI 1.10 to 2.01); nicotine replacement therapy (NRT) at medium- (pooled OR 1.56, 95% CI 1.16 to 2.11) and long-term follow-ups (pooled OR 1.33, 95% CI 1.08 to 1.63) and one trial of varenicline also indicated effectiveness. The health economic analysis found that RPIs are highly cost-effective. Compared with 'no intervention'; using bupropion resulted in an incremental quality-adjusted life-year (QALY) increase of 0.07, with a concurrent NHS cost saving of 68; for NRT, spending 12 pound resulted in a 0.04 incremental QALY increase; varenicline resulted in a similar QALY increase as NRT, but at almost seven times the cost. Extensive sensitivity analyses demonstrated that cost-effectiveness ratios were more sensitive to variations in effectiveness than cost and that for bupropion and NRT, cost-effectiveness generally remained. Varenicline also demonstrated cost-effectiveness at a 'willingness-to-pay' threshold of 20,000 per QALY, but exceeded this when inputted values for potential effectiveness were at the lower end of the range explored. For all drugs, there was substantial relapse to smoking after treatment courses had finished. Quit attempts involving NRT appeared to have the highest early relapse rates, when trial participants would be expected to still be on treatment, but for those involving bupropion and varenicline little relapse was apparent during this time. Limitations: The qualitative research sample was small. Conclusions: Based on the totality of evidence, RPIs are expected to be effective and cost-effective if incorporated into routine treatment within the NHS SSS. While staff within the NHS SSS were largely favourably inclined towards providing RPIs, guidance would be needed to encourage the adoption of the most effective RPIs, as would incentives that focused on the importance of sustaining quit attempts beyond the currently monitored 4-week targets.

Copello A; Templeton L; Powell J. The impact of addiction on the family: Estimates of prevalence and costs. Drugs: Education, Prevention and Policy 17(special issue): 63-74, 2010. (39 refs.)

The negative impact of alcohol or drug misuse on the family has been well documented. However, the predominantly individualistic approach to treatment and policy has led to lack of accurate calculations of the numbers of affected family members and the associated costs to families and society of their suffering, the stress they experience and the care they provide to the substance misuser. For the practice and policy agendas to continue to evolve, such estimates are vital. This article summarizes what is currently known about the numbers of affected family members and the associated costs to families and society. The main findings from the first piece of research undertaken in the UK to model the numbers of adult family members of illegal drug misusers and associated costs are then presented. Finally, this article discusses the strengths and limitations of such models and the implications for both service development and policy.

Cotter T; Perez D; Dunlop S; Hung WT; Dessaix A; Bishop JF. The case for recycling and adapting anti-tobacco mass media campaigns. Tobacco Control 19(6): 514-517, 2010. (12 refs.)

Effective mass media campaigns are hard to come by. A delicate blend of art and science is required to ensure content is technically accurate as well as being creatively engaging for the target audience. However, the most expensive component of a media campaign is not its development but its placement at levels that allow smokers to see, engage and respond to its content. This paper uses two examples to illustrate the process of adapting existing effective material to maximise the expenditure of precious resources on the placement of material.

Cowell AJ; Brown JM; Wedehase BJ; Masuda YJ. Costs of using motivational interviewing for problem drinking in the U.S. Air Force. Military Medicine 175(12): 1007-1013, 2010. (40 refs.)

Despite the popularity of motivational interviewing (MI) to address heavy drinking, limited evidence exists on the costs of using MI to address heavy drinking. This study examines the costs of using MI to address heavy drinking at four U.S. Air Force (USAF) bases. Clients were referred to and assessed at a base program to address their drinking as a result of an incident; those who were not alcohol dependent were invited to participate in the study. Participants: consented and were randomly assigned to one of three intervention arms: individual MI (IMI), group MI (GMI), and Substance Abuse Awareness Seminar (SAAS). Three cost perspectives were taken: USAF, client, and the two combined. Data were collected from bases and public sources. The start-up cost per base ranged from $1,340 to $2,400 per provider staff member. Average implementation costs across bases were highest for the SAAS intervention ($148 per client).

de Silva V; Samarasinghe D; Hanwella R. Association between concurrent alcohol and tobacco use and poverty. Drug and Alcohol Review 30(1): 69-73, 2011. (21 refs.)

Introduction and Aims: The harm from alcohol and tobacco use in low- and middle-income countries includes substantial economic cost to the individual. Our aim was to describe the expenditure on concurrent alcohol and tobacco use in relation to family income in two districts in Sri Lanka. Design and Methods: A community-based cross-sectional study was carried out in two districts in Sri Lanka. We sampled 2684 men over 18 years of age using multistage cluster sampling. Cost of alcohol and cigarettes was calculated using the retail price for each brand and multiplying by the amount consumed. Results: Among current alcohol users 63.1% were also smokers. Among current smokers 61.9% were also using alcohol. Prevalence of concurrent alcohol and tobacco use in urban areas was 20.1% and in rural areas 14%. The two lowest income categories (<$US76 per month) spent more than 40% of their income on concurrent use while the next category ($US76-143 per month) spent 34.8% of their income on concurrent use. Discussion and Conclusions: The poor spent less than those with higher income on alcohol and tobacco, but the expenditure constituted a much larger slice of their income thus compromising their ability to meet basic needs. In low-income countries, damaging economic consequences start at lower levels of alcohol and tobacco consumption and affect a significant proportion of the population. Defining risk levels and guidelines on safe limits based purely on individual health harm has, at best, little meaning in such settings.

Debrot K; Tynan M; Francis J; MacNeil A. State cigarette excise taxes --- United States, 2009. MMWR. Morbidity and Mortality Weekly Review 59(13): 385-388, 2010. (10 refs.)

Cigarette excise tax increases reduce tobacco use and initiation. A 10% increase in the price of cigarettes can reduce consumption by nearly 4% among adults and can have an even greater effect among youths and other price-sensitive groups. When combined with other evidence-based components of comprehensive tobacco control programs, cigarette excise tax increases can be even more effective in reducing tobacco-related death and disease (2). Excise tax increases also can serve as a revenue source to fund and expand state tobacco control programs, further reducing tobacco use and disease. For example, if every state were to increase its cigarette excise tax by $1.00, even accounting for the resulting decrease in consumption, an estimated $9.1 billion in additional revenue would be generated each year in the United States. Additionally, approximately 1 million premature smoking-caused deaths would be prevented, and 2.3 million children would not initiate smoking. Data is provided for each state.

Public Domain

Delas J; Adan E; Diaz O; Aguas M; Pons M; Fuertes R. Smoked cocaine in socially-depressed areas. Harm Reduction Journal 7: e-article 27, 2010. (21 refs.)

Background: The main objectives of this study are to describe the smoked cocaine user's profile in socially-depressed areas and their needs from a harm-reduction perspective, to investigate their use of smoking crack and compare the acute effects between injecting and smoking consumption. Methods: The study took place in SAPS, Barcelona, Spain. Two focus group sessions were undertaken with a total of 8 drug users. Secondly, the 8 participants answered a structured questionnaire and in the course of the sessions, as a snowball activity, were trained to survey 6 other crack smokers. Results: We obtained 56 questionnaires. The majority of participants were from non-European Community countries (62.69%), 70.2% of participants referred to sharing the smoking equipment. The most frequent symptoms reported during smoked cocaine were mydriasis (83.33%)), perspiration (72.92%) and compulsive object search (70.83%). During the group sessions, participants said that smoked cocaine is much more addictive than injected cocaine and causes more anxiety. Participants also reported the difficulty of changing from injected use to smoked use, due to the larger amount of cocaine needed to reach the same effects as when having injected. Conclusions: We can conclude that the research, focused on achieving greater knowledge of the smoked cocaine user's profile, their usage of smoking crack, consumption patterns and acute effects, should be incorporated into substance misuse interventions.

Doku D; Koivusilta L; Raisamo S; Rimpela A. Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents. BMC Public Health 10: e-article 758, 2010. (26 refs.)

Background: In Western countries, tobacco use is most prevalent among adolescents in lower socioeconomic groups. The association between socioeconomic status (SES) and tobacco use among adolescents in developing countries is unexplored. Using multiple SES measures, we investigated this association among adolescents in Ghana. Method: A school-based survey of a representative sample of 13-18-year-old Ghanaians (N = 1,165, response rate = 89.7%) was conducted in three regions, in 2008. Logistic regression analysis was used to evaluate the relationship of smoking, tawa (smokeless tobacco) use with familial SES (parental occupation and education, material affluence scale, family structure), an adolescent's individual social position (school performance, plans after graduation) and inter-generational social mobility (predicted by the differences of familial and individual positions). Results: Socioeconomic differences existed in tobacco use whether measured by familial SES or individual social position with higher prevalence in lower socioeconomic groups. Low father's education and living in a non-nuclear family were associated with both forms of tobacco use while low material affluence was associated with tawa use only; individual social position measured by plans after graduation was the strongest predictor of both smoking and tawa use. Inter-generational downward social mobility and particularly staying in low SES was related to both forms of tobacco use. Conclusions: Similar to Western countries, lower SES is related to an adolescent's tobacco use also in developing countries. Cumulative socioeconomic disadvantage over generations increases the probability of tobacco use.

Gifford AE; Farkas KJ; Jackson LW; Molteno CD; Jacobson JL; Jacobson SW et al. Assessment of benefits of a universal screen for maternal alcohol use during pregnancy. Birth Defects Research. Part A: Clinical and Molecular Teratology 88(10, special issue): 838-846, 2010. (40 refs.)

INTRODUCTION: The objective of this report is to estimate the benefits of universal meconium screening for maternal drinking during pregnancy. Fetal alcohol spectrum disorder (FASD), including its most severe manifestation fetal alcohol syndrome (FAS), is preventable and remains a public health tragedy. The incidences of FAS and FASD have been conservatively estimated to be 0.97 and 10 per 1000 births, respectively. Meconium testing has been demonstrated to be a promising at-birth method for detection of drinking during pregnancy. METHODS: The current costs of FAS and FASD, alcohol treatment programs, and meconium screening were estimated by literature review. Monetary values were converted roughly to equal dollars in 2006. RESULTS: Costs of adding meconium analysis to the current newborn screening program and of treatment for the identified mothers were estimated and compared to potential averted costs that may result from identification and intervention for mothers and affected infants. Three potential maternal treatment strategies are analyzed. Depending on the treatment type, the savings may range from $6 to $97 for every $1 spent on screening and treatment. DISCUSSION: It needs to be emphasized, however, that such screening is premature and that to be effective this screening can be implemented only if there is a societal willingness to institute prevention and intervention programs to improve both women's and children's health. Future research should be directed at improving detection and developing in-depth prevention and remedial intervention programs. A thorough consideration of the ethical issues involved in such a screening program is also needed.

Gilmore AB; Branston JR; Sweanor D. The case for OFSMOKE how tobacco price regulation is needed to promote the health of markets, government revenue and the public. Tobacco Control 19(5): 423-430, 2010. (39 refs.)

Mainstream economic theory outlines four main causes of market failure and it is already well established that two of these (information failure and externalities) exist in a tobacco market. A third cause of market failure market power is also a serious problem in many tobacco markets. Market power combined with unintended and often overlooked consequences of tobacco tax policies notably that gradual increases in specific taxes may allow the industry to disguise significant price increases has at least in high income countries given cigarette manufacturers considerable pricing power and profits. This paper examines ways this market failure could be addressed and proposes as a solution a system of price cap regulation wherein a cap is placed on the pre tax cigarette manufacturers price but not on the retail price that consumers face. Well established in the utilities industry price cap regulation would set a maximum price that cigarette companies can charge for their product based on an assessment of the genuine costs each firm faces in its operations and an assumption about the efficiency savings it would be expected to make. Such a system would achieve three main benefits. First, it would address the problem of market failure and excess profits while simultaneously allowing current tobacco control policies including tax and price increases to expand thus tax increases would remain a central tenet of tobacco control policies and retail prices could continue to increase. Second, it would increase government revenue by transferring the excess profits from the industry to the government purse. Third, it would bring numerous public health benefits In addition to addressing market power while simultaneously allowing tobacco control policies to expand it could offer a means of preventing down trading to cheaper products and controlling unwanted industry practices such as cigarette smuggling price fixing and marketing to the young The paper outlines in some detail how such a system might be developed in the UK while briefly exploring how it could be applied elsewhere including in markets with state monopolies.

Grant JE; Schreiber L; Odlaug BL; Kim SW. Pathologic gambling and bankruptcy. Comprehensive Psychiatry 51(2): 115-120, 2010. (40 refs.)

Background: Although prior studies have examined rates of bankruptcy in pathologic gambling (PG), there are only limited data regarding the clinical correlates of those with PG who declare bankruptcy because of gambling. Method: Five hundred seventeen consecutive subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PG (54.7% females; mean age 47.6 years) were grouped into 2 categories: those who had (n = 93; 18.0%) and had not (n = 424; 82.0%) declared bankruptcy secondary to gambling. Groups were compared on clinical characteristics, gambling severity (using the Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling, Gambling Symptom Assessment Scale; Clinical Global Impression-severity scale, and time and money spent gambling), and psychiatric comorbidity. Results: Gamblers who had declared bankruptcy were more likely to be single (P = .004); have an earlier age of problem gambling onset (P = .032); and have more financial (P < .001), work-related (P = .006), marital (P < .001), and legal (P < .001) problems secondary to their gambling. They also reported higher rates of depressive disorders (P < .001), substance use disorders (P = .005) and were more likely to be daily users of nicotine (P = .022). Money spent gambling did not differ significantly between groups. Conclusion: These preliminary results suggest that bankruptcy in PG may be associated with specific clinical differences. Treatment strategies may want to assess bankruptcy status to develop more effective treatments that take account of these clinical differences.

Grant TM; Jack DC; Fitzpatrick AL; Ernst CC. Carrying the burdens of poverty, parenting, and addiction: Depression symptoms and self-silencing among ethnically diverse women. Community Mental Health Journal 47(1): 90-98, 2011. (55 refs.)

Depression among women commonly co-occurs with substance abuse. We explore the association between women's depressive symptoms and self-silencing accounting for the effects of known childhood and adult risk indicators. Participants are 233 ethnically diverse, low-income women who abused alcohol/drugs prenatally. Depressive symptomatology was assessed using the Addiction Severity Index. Multivariate logistic regression models examined the association between self-silencing and the dependent depression variable. The full model indicated a 3% increased risk for depressive distress for each point increase in self-silencing score (OR = 1.03; P = .001). Differences in depressive symptomatology by ethnic groups were accounted for by their differences in self-silencing.

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

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

Griffin BA; Ramchand R; Edelen MO; McCaffrey DF; Morral AR. Associations between abstinence in adolescence and economic and educational outcomes seven years later among high-risk youth. Drug and Alcohol Dependence 113(2-3): 118-124, 2011. (71 refs.)

Aim: In this study, we investigated the relationship between abstinence and long-term educational and economic outcomes among a sample of high-risk youth. Methods: Multivariable regression models were used to estimate associations between abstinence and outcomes among a sample of 13-17 year-olds referred to group homes in Los Angeles in 1999-2000 and followed for 87 months afterwards. Abstinence was measured during the first year of the study. We considered differential effects based on the duration of abstinence (12 vs. 6 months) and type of abstinence (all substances vs. use of alcohol and/or marijuana) on three 87-month outcomes: having received a high-school diploma or equivalent by age 20, institutionalization in the past 90 days, and total legitimate income for the past 90 days. Results: Abstinence from all substances for 12 months was associated with positive long-term educational and economic outcomes relative to using any drug during the same time interval. Abstaining from all substances for 12 months was also associated with an increased likelihood of being a legitimate wage earner and decreased likelihood of being institutionalized relative to using only alcohol and/or marijuana during that time interval. No effect on long-term outcomes was seen among youth who abstained for only 6 months relative to those who used drugs during this interval, or for youth who used only alcohol and/or marijuana over 12 months vs. those who used other drugs during this interval. Conclusions: The results presented here justify continued and expanded efforts to promote long periods of abstinence from all drugs for high-risk youth.

Haley SJ; Dugosh KL; Lynch KG. Performance contracting to engage detoxification-only patients into continued rehabilitation. Journal of Substance Abuse Treatment 40(2): 123-131, 2011. (48 refs.)

In 2006, only 18.7% of Delaware's detoxification patients were admitted to continuing recovery-oriented treatment within 30 days after discharge. In response, Delaware established financial contingencies to (1) maintain 90% detoxification occupancy, (2) make receipt of 10% of the facility's monthly reimbursement contingent on 25% of patients entering treatment, and (3) provide a $500 bonus for every patient with three or more prior detoxification visits who was retained in treatment. Under the performance contract, the detoxification provider (1) maintained the 90% occupancy requirement, (2) achieved the 25% treatment entry target for 7 of 12 months, and (3) observed only 8% (27/337) of detoxification completions that met the targeted length of stay. Continuation to and retention in treatment was even more constrained for patients with three or more prior detoxifications. Contrary to the policy intent, the number of patients with three or more detoxifications in fiscal year (FY) 2008 is nearly triple that of FY 2006. The modest gain in the transition rate was achieved without changes in patient access; the FY 2008 patient population reported significantly higher rates of homelessness and a younger age of first use than before the performance contract in FY 2006. Performance contracting may offer promise for improving transition to treatment rates. However, the unique needs of detoxification patients, the treatment capacity of each level of care to meet patient needs, and the structure of the performance contract must be carefully considered. Performance contracting efforts may be strengthened when service contracts across the system are tightly synchronized.

Hansen RN; Oster G; Edelsberg J; Woody GE; Sullivan SD. Economic costs of nonmedical use of prescription opioids. Clinical Journal of Pain 27(3): 194-202, 2011. (36 refs.)

Objectives: Although the economic costs of substance misuse have been extensively examined in the published literature, information on the costs of nonmedical use of prescription opioids is much more limited, despite being a significant and rapidly growing problem in the United States. Methods: We estimated the current economic burden of nonmedical use of prescription opioids in the United States in terms of direct substance abuse treatment, medical complications, productivity loss, and criminal justice. We distributed our broad cost estimates among the various drugs of misuse, including prescription opioids, down to the individual drug level. Results: In 2006, the estimated total cost in the United States of nonmedical use of prescription opioids was $53.4 billion, of which $42 billion (79%) was attributable to lost productivity, $8.2 billion (15%) to criminal justice costs, $2.2 billion (4%) to drug abuse treatment, and $944 million to medical complications (2%). Five drugs-OxyContin, oxycodone, hydrocodone, propoxyphene, and methadone-accounted for two-thirds of the total economic burden. Discussion: The economic cost of nonmedical use of prescription opioids in the United States totals more than $50 billion annually; lost productivity and crime account for the vast majority (94%) of these costs.

Ilgen MA; Price AM; Burnett-Zeigler I; Perron B; Islam K; Bohnert ASB et al. Longitudinal predictors of addictions treatment utilization in treatment-naive adults with alcohol use disorders. Drug and Alcohol Dependence 113(2-3): 215-221, 2011. (43 refs.)

Background: Despite the substantial prevalence of alcohol use disorders (AUDs), prior research indicates that most people with AUDs never utilize either formal or informal treatment services. Several prior studies have examined the characteristics of individuals with AUDs who receive treatment; however, limited longitudinal data are available on the predictors of receiving AUD services in treatment-naive individuals with AUDs. Methods: This study utilized data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to identify adults in Wave 1 who met criteria for an AUD within the last 12 months and reported no prior lifetime alcohol treatment (N = 2760). These individuals were surveyed again at Wave 2, approximately 3-4 years later (N = 2170). This study examined the Wave 1 demographic and psychiatric conditions that were associated with receipt of AUD treatment services between Waves 1 and 2. Results: In multivariable analyses, use of AUD treatment services between Waves 1 and 2 was significantly more likely among those who were male, non-Caucasian, younger, had lower income, and who had health insurance. Additionally, those who met criteria for a baseline drug use disorder, anxiety disorder or a personality disorder were more likely to receive AUD treatment. Conclusions: Treatment was more often utilized in those who had more severe baseline psychopathology and in those with fewer economic resources. These findings highlight the need to broaden the types of care available to individuals with AUDs to increase the appeal of AUD services.

Jones SC; Barrie L. RTDs in Australia: Expensive designer drinks or cheap rocket fuel? Drug and Alcohol Review 30(1): 4-11, 2011. (34 refs.)

Introduction and Aims. The ready-to-drink (RTD) market is growing rapidly, and this product category has been shown to be particularly appealing to young drinkers. The purpose of this study was to identify and describe the range and availability of RTDs available in New South Wales (NSW) (including metropolitan, regional and rural areas), with a particular focus on the variations in alcohol content and pricing. Design and Methods. A total of 52 alcohol outlet audits were conducted across nine locations, including metropolitan, regional and rural New South Wales. Trained auditors recorded the RTDs for sale in each outlet, including product characteristics and prices for each product, and overall fridge/store space allocated to RTDs. Results. Across the 52 bottle shops audited, 150 individual RTD alcohol products were identified, ranging from 4.8% to 7.5% alcohol by volume and from 1.0 to 2.7 standard drinks (SD) per unit. When purchased in multipacks (typically four or six units), the cost per SD ranged from $1.95 to $3.70, decreasing to as low as $1.22 per SD when on special. Discussion and Conclusions. The proliferation of high-strength RTDs and the substantial discounting of multipack purchases means that RTDs can no longer be seen as expensive low-strength sweet-flavoured drinks targeted at female drinkers, but as a broader product category that includes high-strength male-targeted brands. There is a need for further research to examine young people's preferences for these different product types; and consideration of policies, alongside price-based interventions, that address broader marketing strategies.

Karriker-Jaffe KJ. Areas of disadvantage: A systematic review of effects of area-level socioeconomic status on substance use outcomes. (review). Drug and Alcohol Review 30(1): 84-95, 2011. (55 refs.)

Issues. This review examines whether area-level disadvantage is associated with increased substance use and whether study results are impacted by the size of the area examined, definition of socioeconomic status (SES), age or ethnicity of participants, outcome variables or analytic techniques. Approach. Five electronic databases and the reference sections of identified papers were searched to locate studies of the effects of area-level SES on substance use published through the end of 2007 in English-language, peer-reviewed journals or books. The 41 studies that met inclusion criteria included 238 effects, with a subsample of 34 studies (180 effects) used for the main analyses. Study findings were stratified by methodological characteristics and synthesised using generalised estimating equations to account for clustering of effects within studies. Key Findings. There was strong evidence that substance use outcomes cluster by geographic area, but there was limited and conflicting support for the hypothesis that area-level disadvantage is associated with increased substance use. Support for the disadvantage hypothesis appeared to vary by sample age and ethnicity, size of area examined, type of SES measure, specific outcome considered and analysis techniques. Implications. Future studies should use rigorous methods to yield more definitive conclusions about the effects of area-level SES on alcohol and drug outcomes, including composite measures of SES and both bivariate and multivariate analyses. Conclusion. Further research is needed to identify confounds of the relationship between area-level SES and substance use and to explain why the effects of area-level SES vary by outcome and residents' age.

Katainen A. Social class differences in the accounts of smoking: Striving for distinction? Sociology of Health & Illness 32(7): 1087-1101, 2010. (37 refs.)

The dominant trend in smoking prevalence in most Western countries is its increasing association with lower socioeconomic positions, making it a major factor behind inequalities in health. This paper focuses on the reasoning behind smoking, as well as on its social significance among middle-class and working-class smokers. The data consist of 55 semi-structured interviews with daily smokers, ex-smokers and occasional smokers from different occupational backgrounds. The analysis revealed considerable differences in the ways of accounting for smoking, relating to the respondents' occupational backgrounds. Contrary to expectations, non-manual workers tended to consider their smoking functional, pleasurable and controlled, whereas the opposite was the case with the manual workers. Despite the high prevalence of smoking in that group, they were least willing to justify or rationalise their behaviour, whereas the agenda of middle-class smokers could be interpreted as the reconciliation of middle-class habitus with a risky, working-class habit.

Kim A; Kamyab K; Zhu JS; Volpp K. Why are financial incentives not effective at influencing some smokers to quit? Results of a process evaluation of a worksite trial assessing the efficacy of financial incentives for smoking cessation. Journal of Occupational and Environmental Medicine 53(1): 62-67, 2011. (22 refs.)

Objective: Process evaluation of a worksite intervention in which employees were offered $750 to complete a cessation program and to quit smoking. Methods: Awareness and attitudes about financial incentives were assessed following a randomized controlled trial of 878 smokers at a US-based company. Results: Cessation program attendance was higher in incentive group versus control (20.2% vs 7.1%, P < 0.01). Most quitters (69.8%) in the incentive group who were already motivated to quit and reported that they would have quit for less money, said incentives were "not at all" or only "somewhat" important. Most nonquitters in the incentive group reported that even $1500 would not have motivated them to quit. Conclusions: Financial incentives are ineffective at motivating some smokers to quit. Internal motivation and readiness to quit need to be sufficiently high for relatively modest incentives to be effective.

King BA; Hyland AJ; Borland R; McNeill A; Cummings KM. Socioeconomic variation in the prevalence, introduction, retention, and removal of smoke-free policies among smokers: Findings from the International Tobacco Control (ITC) Four Country Survey. International Journal of Environmental Research and Public Health 8(2): 411-434, 2011. (39 refs.)

Introduction: Exposure to secondhand smoke causes premature death and disease in non-smokers and indoor smoke-free policies have become increasingly prevalent worldwide. Although socioeconomic disparities have been documented in tobacco use and cessation, the association between socioeconomic status (SES) and smoke-free policies is less well studied. Methods: Data were obtained from the 2006 and 2007 Waves of the International Tobacco Control Four Country Survey (ITC-4), a prospective study of nationally representative samples of smokers in Canada, the United States, the United Kingdom, and Australia. Telephone interviews were administered to 8,245 current and former adult smokers from October 2006 to February 2007. Between September 2007 and February 2008, 5,866 respondents were re-interviewed. Self-reported education and annual household income were used to create SES tertiles. Outcomes included the presence, introduction, and removal of smoke-free policies in homes, worksites, bars, and restaurants. Results: Smokers with high SES had increased odds of both having [OR: 1.54, 95% CI: 1.27-2.87] and introducing [OR: 1.49, 95% CI: 1.04-2.13] a total ban on smoking in the home compared to low SES smokers. Continuing smokers with high SES also had decreased odds of removing a total ban [OR: 0.44, 95% CI: 0.26-0.73]. No consistent association was observed between SES and the presence or introduction of bans in worksites, bars, or restaurants. Conclusions: The presence, introduction, and retention of smoke-free homes increases with increasing SES, but no consistent socioeconomic variation exists in the presence or introduction of total smoking bans in worksites, bars, or restaurants. Opportunities exist to reduce SES disparities in smoke-free homes, while the lack of socioeconomic differences in public workplace, bar, and restaurant smoke-free policies suggest these measures are now equitably distributed in these four countries.

Konghom S; Verachai V; Srisurapanont M; Suwanmajo S; Ranuwattananon A; Kimsongneun N et al. Treatment for inhalant dependence and abuse. (review). Cochrane Database of Systematic Reviews 12: e-article CD007537, 2010. (13 refs.)

Background: Inhalants are being abused by large numbers of people throughout the world, particularly socio-economically disadvantaged children and adolescents. The neuropsychological effects of acute and chronic inhalant abuse include motor impairment, alterations in spontaneous motor activity, anticonvulsant effects, anxiolytic effects, sensory effects, and effects and learning, memory and operant behaviour (e. g., response rates and discriminative stimulus effects). Objectives: To search and determine risks, benefits and costs of a variety treatments for inhalant dependence or abuse. Search strategy: We searched MEDLINE (1966 - February 2010), EMBASE (Januray 2010) and Cochrane Central Register of Controlled Trials (CENTRAL) (February 2010). We also searched for ongoing clinical trials and unpublished studies via Internet searches. Selection criteria: Randomised-controlled trials and controlled clinical trails (CCTs) comparing any intervention in people with inhalant dependence or abuse. Data collection and analysis: Two reviewers independently selected studies for inclusion, assessed trial quality and extracted data. Main results: No studies fulfilling the inclusion criteria have been retrieved. Authors' conclusions: Implications for practice: due to the lack of studies meeting the inclusion criteria, no conclusion can be drawn for clinical practice. Implications for research: as a common substance abuse with serious health consequences, treatment of inhalant dependence and abuse should be a priority area of substance abuse research.

Labonne J; Chase RS. So you want to quit smoking: Have you tried a mobile phone? Applied Economics Letters 18(2): 103-106, 2011. (7 refs.)

Using spatially coded data on mobile phone coverage and panel data from 2100 households in 135 communities of the Philippines, we estimate the impact of mobile phone ownership on tobacco consumption. Purchasing a mobile phone leads to a 17.1% decrease in tobacco consumption per adult over the age of 15.

Licht AS; Hyland AJ; O'Connor RJ; Chaloupka FJ; Borland R; Fong GT et al. Socio-economic variation in price minimizing behaviors: Findings from the International Tobacco Control (ITC) Four Country Survey. International Journal of Environmental Research and Public Health 8(1): 234-252, 2011. (38 refs.)

This paper examines how socio-economic status (SES) modifies how smokers adjust to changes in the price of tobacco products through utilization of multiple price minimizing techniques. Data come from the International Tobacco Control Policy Evaluation (ITC) Four Country Survey, nationally representative samples of adult smokers and includes respondents from Canada, the United States, the United Kingdom and Australia. Cross-sectional analyses were completed among 8,243 respondents (7,038 current smokers) from the survey wave conducted between October 2006 and February 2007. Analyses examined predictors of purchasing from low/untaxed sources, using discount cigarettes or roll-your-own (RYO) tobacco, purchasing cigarettes in cartons, and engaging in high levels of price and tax avoidance at last purchase. All analyses tested for interactions with SES and were weighted to account for changing and under-represented demographics. Relatively high levels of price and tax avoidance behaviors were present; 8% reported buying from low or untaxed source; 36% used discount or generic brands, 13.5% used RYO tobacco, 29% reported purchasing cartons, and 63% reported using at least one of these high price avoidance behaviors. Respondents categorized as having low SES were approximately 26% less likely to report using low or untaxed sources and 43% less likely to purchase tobacco by the carton. However, respondents with low SES were 85% more likely to report using discount brands/RYO compared to participants with higher SES. Overall, lower SES smokers were 25% more likely to engage in at least one or more tax avoidance behaviors compared to their higher SES counterparts. Price and tax avoidance behaviors are relatively common among smokers of all SES strata, but strategies differed with higher SES groups more likely to report traveling to a low-tax location to avoid paying higher prices, purchase duty free tobacco, and purchase by cartons instead of packs all of which were less commonly reported by low SES smokers. Because of the strategies lower SES respondents are more likely to use, reducing price differentials between discount and premium brands may have a greater impact on them, potentially increasing the likelihood of quitting.

Lo CF. FCTC guidelines on tobacco industry foreign investment would strengthen controls on tobacco supply and close loopholes in the tobacco treaty. Tobacco Control 19(4): 306-310, 2010. (18 refs.)

The Framework Convention on Tobacco Control (FCTC) contains no provisions covering tobacco industry investments. This creates the potential for tobacco companies to benefit from investment liberalisation by using foreign investments to avoid tobacco tariffs, increase tobacco consumption and otherwise impair the implementation of FCTC-style measures. Reducing and ultimately eliminating foreign investment activities by tobacco companies can be justified on health grounds, even though it runs counter to current investment liberalisation trends. Through the FCTC process, nonbinding guidelines can be elaborated to assist parties in recognising and responding to foreign investment strategies of tobacco companies, to support efforts to exclude the tobacco sector from investment liberalisation and otherwise would improve all countries' awareness of the threat from foreign investment strategies of tobacco companies and provide them with approaches to handle the problems.

Lubetkin EI; Lu WH; Krebs P; Yeung H; Ostroff JS. Exploring primary care providers' interest in using patient navigators to assist in the delivery of tobacco cessation treatment to low income, ethnic/racial minority patients. Journal of Community Health 35(6): 618-624, 2010. (52 refs.)

We examined attitudes and practices regarding tobacco cessation interventions of primary care physicians serving low income, minority patients living in urban areas with a high smoking prevalence. We also explored barriers and facilitators to physicians providing smoking cessation counseling to determine the need for and interest in deploying a tobacco-focused patient navigator at community-based primary care practice sites. A self-administered survey was mailed to providers serving Medicaid populations in New York City's Upper Manhattan and areas of the Bronx. Provider counseling practices were measured by assessing routine delivery (a parts per thousand yen80% of the time) of a brief tobacco cessation intervention (i.e., "5 A's"). Provider attitudes were assessed by a decisional balance scale comprising 10 positive (Pros) and 10 negative (Cons) perceptions of tobacco cessation counseling. Of 254 eligible providers, 105 responded (41%). Providers estimated 22% of their patients currently use tobacco and nearly half speak Spanish. A majority of providers routinely asked about tobacco use (92%) and advised users to quit (82%), whereas fewer assisted in developing a quit plan (32%) or arranged follow-up (21%). Compared to providers reporting < 80% adherence to the "5 A's", providers reporting a parts per thousand of 80% adherence tended to have similar mean Pros and Cons scores for Ask, Advise, and Assess but higher Pros and lower Cons for Assist and Arrange. Sixty four percent of providers were interested in providing tobacco-related patient navigation services at their practices. Although most providers believe they can help patients quit smoking, they also recognize the potential benefit of having a patient navigator connect their patients with evidence-based cessation services in their community.

Magnus A; Cadilhac D; Sheppard L; Cumming T; Pearce D; Carter R. Economic benefits of achieving realistic smoking cessation targets in Australia. American Journal of Public Health 101(2): 321-327, 2011. (30 refs.)

Objectives. We estimated the economic impact of reductions in the prevalence of tobacco smoking on health, production, and leisure in the 2008 Australian population. Methods. We selected a prevalence target of 15%. Cohort lifetime health benefits were modeled as fewer incident cases of tobacco-related diseases, deaths, and disability-adjusted life-years. We estimated production gains by comparing surveyed participation and absenteeism rates of adult smokers and ex-smokers valued according to the human capital and friction cost approaches. We estimated household production and leisure gains from time use surveys and valued these gains with the appropriate proxy. Results. In the 2008 Australian population, an absolute reduction in smoking prevalence of 8% would result in 158000 fewer incident cases of disease, 5000 fewer deaths, 2.2 million fewer lost working days, and 3000 fewer early retirements and would reduce health sector costs by AUD 491 million. The gain in workforce production was AUD 415 million (friction cost) or AUD 863 million (human capital), along with gains of 373000 days of household production and 23000 days of leisure time. Conclusions. Lowering smoking prevalence rates can lead to substantial economic savings and health benefits.

Marinho V; Laks J; Coutinho ESF; Blay SL. Tobacco use among the elderly: A systematic review and meta-analysis. (review). Cadernos De Saude Publica 26(12): 2213-2233, 2010. (67 refs.)

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

Martire KA; Mattick RP; Doran CM; Hall WD. Cigarette tax and public health: What are the implications of financially stressed smokers for the effects of price increases on smoking prevalence? Addiction 106(3): 622-630, 2011. (37 refs.)

Aims: This paper models the predicted impact of tobacco price increases proposed in the United States and Australia during 2009 on smoking prevalence in 2010 while taking account of the effects of financial stress among smokers on cessation rates. Methods: Two models of smoking prevalence were developed for each country. In model 1, prevalence rates were determined by price elasticity estimates. In model 2 price elasticity was moderated by financial stress. Each model was used to estimate smoking prevalence in 2010 in Australia and the United States. Results: Proposed price increases resulted in a 1.89% and 7.84% decrease in smoking participation among low socio-economic status (SES) groups in the United States and Australia, respectively. Model 1 overestimated the number of individuals expected to quit in both the United States (0.13% of smokers) and Australia (0.36% of smokers) by failing to take account of the differential effects of the tax on financially stressed smokers. The proportion of low-income smokers under financial stress increased in both countries in 2010 (by 1.06% in the United States and 3.75% in Australia). Conclusions: The inclusion of financial stress when modelling the impact of price on smoking prevalence suggests that the population health returns of increased cigarette price will diminish over time. As it is likely that the proportion of low-income smokers under financial stress will also increase in 2010, future population-based approaches to reducing smoking will need to address this factor.

Mason WA; Hitch JE; Kosterman R; McCarty CA; Herrenkohl TI; Hawkins JD. Growth in adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders, and risky sex: A comparison of youth from low- versus middle-income backgrounds. Journal of Child Psychology and Psychiatry 51(12): 1377-1385, 2010. (44 refs.)

Background: This study examined adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders (AUDs), and risky sex. Analyses further examined the influences of late childhood involvement in these problem behavior outcomes, with mediation through teen delinquency and alcohol use, and examined differences in the pathways for youth from low- compared to middle-income backgrounds. Method: Multiple-group latent growth curve modeling was conducted using data collected from a sample of 808 youth followed from age 10 to age 24. Self-report assessments included delinquent involvement, alcohol use, and sexual activity in late childhood; delinquency and alcohol use in adolescence; and crime, AUDs, and risky sex in early adulthood. Results: Late childhood delinquent involvement was associated with young adult crime, AUDs, and risky sex indirectly through adolescent delinquency, and had a persistent direct effect on crime. Adolescent delinquency also mediated the relation between early sex onset and crime. Early alcohol use predicted a higher level of, and a faster rate of increase in, adolescent drinking, which predicted, in turn, young adult AUDs and risky sex. Significant group differences indicated stronger associations between adolescent delinquency and each young adult outcome for youth from low- compared to those from middle-income backgrounds. Conclusions: Early intervention may help prevent the development of crime, AUDs, and risky sex behaviors, especially among disadvantaged youth.

Matthew-Simmons F; Shanahan M; Ritter A. Reported value of cannabis seizures in Australian newspapers: Are they accurate? Drug and Alcohol Review 30(1): 21-25, 2011. (18 refs.)

Introduction and Aims. The news media is often touted as an important, yet inaccurate source of information about drug issues for the general public. This paper investigates the accuracy of reporting in the Australian media regarding the value of cannabis seizures made by the police. Design and Methods. A sample of Australian newspaper articles, which featured both a direct estimate of the value of a cannabis seizure and the number of plants seized, were examined. The reported values from these articles were then compared with a range of estimates made using data on cannabis plant yield and price, taken from research literature. Results. Fifteen articles were examined, referring to fourteen different seizures. The reported value of cannabis seizures in this sample of articles was highly inflated when compared with the authors' estimated value. The reported newspaper values of seizures were between 1.8 and 11.9 times higher than our middle estimate. Discussion and Conclusions. The most likely reason for the wide difference between the reported and estimated value of these seizures is the possible variability in cannabis plant yield. Whatever the reason for the discrepancy between the reported values and our estimates, greater transparency surrounding the valuations of cannabis seizures would help to better determine the true impacts of law enforcement interventions on this illicit drug supply chain.

McCarty D; Perrin NA; Green CA; Polen MR; Leo MC; Lynch F. Methadone maintenance and the cost and utilization of health care among individuals dependent on opioids in a commercial health plan. Drug and Alcohol Dependence 111(3): 235-240, 2010. (18 refs.)

Background: Few health plans provide maintenance medication for opioid dependence. This study assessed the cost of treating opioid-dependent members in a commercial health plan and the impacts of methadone maintenance on costs of care. Methods: Individuals with diagnoses of opioid dependence (two or more diagnoses per year) and at least 9 months of health plan eligibility each year were extracted from electronic health records for the years 2000 through 2004 (1,518 individuals and 2,523 observations across the study period-some individuals were in multiple years) Analyses examined the patterns and costs of health care for three groups of patients (1) one or more methadone visits during the year (n = 1 298; 51%) (2) no methadone visits and 0 or 1 visits in the Addiction Medicine Department (n = 370 15%) (3) no methadone visits and 2 or more visits in addiction medicine (n = 855, 34%) Results: Primary care (86%) emergency department (48%) and inpatient (24%) visits were common. Mean total annual costs to the health plan were $11,200 (2004 dollars) per member per year. The health plan's costs for members receiving methadone maintenance were 50% lower ($7,163) when compared to those with two or more outpatient addiction treatment visits but no methadone ($14,157) and 62% lower than those with one or zero outpatient addiction treatment visits and no methadone treatment ($18, 694) Conclusions: Use of opioid maintenance services was associated with lower total costs of care for opioid-dependent members in a commercial health plan.

Melchior M; Choquet M; Le Strat Y; Hassler C; Gorwood P. Parental alcohol dependence, socioeconomic disadvantage and alcohol and cannabis dependence among young adults in the community. European Psychiatry 26(1): 13-17, 2011. (48 refs.)

We tested the hypothesis that socioeconomic disadvantage exacerbates the intergenerational transmission of substance dependence. Among 3056 community-based young adults (18-22 years, 2007), the prevalence of alcohol dependence (WHO AUDIT, 5.8%) and cannabis dependence (DSM IV criteria, 7.3%) was doubled in the presence of combined parental alcohol dependence and socioeconomic disadvantage.

Morris DS. Tobacco manufacturing data demonstrate industry product switching in response to tax increases. (editorial). Tobacco Control 19(5): 421-422, 2010. (2 refs.)

Myers BJ; Louw J; Pasche SC. Inequitable access to substance abuse treatment services in Cape Town, South Africa. Substance Abuse Treatment, Prevention and Policy 5: e-article 28, 2010. (30 refs.)

Background: Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. Methods: This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. Results: Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization. Conclusions: Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services.

O'Brien J; Geikie A; Jardine A; Oakes W; Salmon A. Integrating smoking care in community service organisations to reach disadvantaged people: Findings from the Smoking Matters project. Health Promotion Journal of Australia 21(3): 176-182, 2010. (40 refs.)

Issue addressed: Smoking rates among very disadvantaged populations groups are much higher than for the general Australian population. Smoking makes a significant contribution to the reduced health and material well-being experienced by these groups. Community service organisations have been suggested as a promising setting to provide smoking cessation support for disadvantaged people, but few initiatives have explored the feasibility of this strategy. Methods: The project involved work with five non-government community service organisations as demonstration sites for the integration of smoking care. Sites were offered staff training, smoking-care resources and policy support to address tobacco in the service environment and in their work with clients. Pre-and post-training surveys were undertaken with training participants and a follow-up survey was conducted after three months. Survey questions assessed staff members' confidence, knowledge and skills to address smoking, as well as changes in staff practice. Results: The response rate for the surveys before and after the training sessions was almost 100%, with 63 of the 64 participants providing post-training surveys. The response rate of the three-month follow-up survey was approximately 50% with 34 respondents. Findings: indicate that staff did develop confidence, skills and knowledge to address tobacco issues. Some organisations made changes to policy, such as introducing designated smoking areas and providing financial support for clients and staff to quit smoking. Practice change was evident among some staff, particularly in addressing smoking as part of routine case management and use of the 5A's brief intervention framework. Conclusions: The project findings lend support to the view that community service organisations could play a role in providing smoking care to disadvantaged people.

Park EJ; Kim H; Kawachi I; Kirn IH; Choi SI. Area deprivation, individual socioeconomic position and smoking among women in South Korea. Tobacco Control 19(5): 383-390, 2010. (63 refs.)

Background The objective of this study was to examine how area deprivation and individual socioeconomic position affect smoking among women using national survey data Methods Smoking and individual sociodemographic characteristics were gathered from the Third Korea National Health and Nutrition Examination Survey 2005 The Carstairs index was derived for each area using the 2005 census data The data were analysed using multilevel logistic regression models Results After adjusting for age and marital status low education and manual jobs were significantly associated with a higher likelihood of smoking In addition the effect of manual jobs on smoking was modified by area deprivation When individual occupation and area deprivation were examined together results indicated that women with manual occupation had much greater odds of smoking when they lived in the least deprived areas (OR 403 CI 200 to 8 14) than did women with manual job who lived in the middle or most deprived areas (OR 219 Cl 115 to 4 16) compared to the reference group (housewives in the middle or most deprived areas) Conclusion The results of the present study show that among Korean women manual work is associated with smoking and the association is strongest among those living in the least deprived areas This interaction between manual work and area deprivation resulted in a higher smoking prevalence among women in affluent urban areas

Pisinger C; Aadahl M; Toft U; Jorgensen T. Motives to quit smoking and reasons to relapse differ by socioeconomic status. Preventive Medicine 52(1): 48-52, 2011. (22 refs.)

Objective. To investigate motives, strategies and experiences to quit smoking and reasons to relapse as a function of socioeconomic status. Methods. A population-based study, Inter99, Denmark. Two thousand six hundred twenty-one daily smokers with a previous quit attempt completed questionnaires at baseline. Cross-sectional baseline-data (1999-2001) were analysed in adjusted regression analyses. Results. Consistent findings across the three indicators of socioeconomic status (employment, school education, higher education/vocational training): smokers with low socioeconomic status were significantly more likely than smokers with high socioeconomic status to report that they wanted to quit because smoking was too expensive (OR: 1.85 (1.4-2.4), for school education) or because they had health related problems (OR: 1.75 (1.4-2.2)). When looking at previous quit attempts, smokers with low socioeconomic status were significantly more likely to report that it had been a bad experience (OR: 1.41 (1.1-1.8)) and that they had relapsed because they were more nervous/restless/depressed (OR: 1.43 (1.1-1.8)). Conclusions. This study shows that smokers with low socioeconomic status have other motives to quit and other reasons to relapse than smokers with high socioeconomic status. Future tobacco prevention efforts aimed at smokers with low socioeconomic status should maybe focus on current advantages of quitting smoking, using high cost of smoking and health advantages of quitting as motivating factors and by including components of mental health as relapse prevention.

Ribisl KM; Patrick R; Eidson S; Tynan M; Francis J. State cigarette minimum price laws --- United States, 2009. MMWR. Morbidity and Mortality Weekly Review 59(13): 389-392, 2010. (9 refs.)

Cigarette price increases reduce the demand for cigarettes and thereby reduce smoking prevalence, cigarette consumption, and youth initiation of smoking. Excise tax increases are the most effective government intervention to increase the price of cigarettes, but cigarette manufacturers use trade discounts, coupons, and other promotions to counteract the effects of these tax increases and appeal to price-sensitive smokers. State cigarette minimum price laws, initiated by states in the 1940s and 1950s to protect tobacco retailers from predatory business practices, typically require a minimum percentage markup to be added to the wholesale and/or retail price. If a statute prohibits trade discounts from the minimum price calculation, these laws have the potential to counteract discounting by cigarette manufacturers. To assess the status of cigarette minimum price laws in the United States, CDC surveyed state statutes and identified those states with minimum price laws in effect as of December 31, 2009. This report summarizes the results of that survey, which determined that 25 states had minimum price laws for cigarettes (median wholesale markup: 4.00%; median retail markup: 8.00%), and seven of those states also expressly prohibited the use of trade discounts in the minimum retail price calculation. Minimum price laws can help prevent trade discounting from eroding the positive effects of state excise tax increases and higher cigarette prices on public health.

Public Domain

Ritter A; Chalmers J. The relationship between economic conditions and substance use and harm. Drug and Alcohol Review 30(1): 1-3, 2011. (29 refs.)

Ross H; Blecher E; Yan L; Hyland A. Do cigarette prices motivate smokers to quit? New evidence from the ITC survey. Addiction 106(3): 609-619, 2011. (23 refs.)

Aims: To examine the importance of cigarette prices in influencing smoking cessation and the motivation to quit. Design: We use longitudinal data from three waves of the International Tobacco Control Policy Evaluation Survey (ITC). The study contrasts smoking cessation and motivation to quit among US and Canadian smokers and evaluates how this relationship is modified by cigarette prices, nicotine dependence and health knowledge. Different price measures are used to understand how the ability to purchase cheaper cigarettes may reduce the influence of prices. Our first model examines whether cigarette prices affect motivation to quit smoking using Generalized Estimating Equations to predict cessation stage and a least squares model to predict the change in cessation stage. The second model evaluates quitting behavior over time. The probability of quitting is estimated with Generalized Estimating Equations and a transition model to account for the 'left-truncation' of the data. Settings: US and Canada. Participants: 4352 smokers at Wave 1, 2000 smokers completing all three waves. Measurements: Motivation to quit, cigarette prices, nicotine dependence and health knowledge. Findings: Smokers living in areas with higher cigarette prices are significantly more motivated to quit. There is limited evidence to suggest that price increases over time may also increase quit motivation. Higher cigarette prices increase the likelihood of actual quitting, with the caveat that results are statistically significant in one out of two models. Access to cheaper cigarette sources does not impede cessation although smokers would respond more aggressively (in terms of cessation) to price increases if cheaper cigarette sources were not available. Conclusions: This research provides a unique opportunity to study smoking cessation among adult smokers and their response to cigarette prices in a market where they are able to avoid tax increases by purchasing cigarettes from cheaper sources. Higher cigarette prices appear to be associated with greater motivation to stop smoking, an effect which does not appear to be mitigated by cheaper cigarette sources. The paper supports the use of higher prices as a means of encouraging smoking cessation and motivation to quit.

Sabia S; Gueguen A; Berr C; Berkman L; Ankri J; Goldberg M et al. High alcohol consumption in middle-aged adults is associated with poorer cognitive performance only in the low socio-economic group. Results from the GAZEL cohort study. Addiction 106(1): 93-101, 2011. (41 refs.)

Aims: To examine the association of alcohol consumption over 10 years with cognitive performance in different socio-economic groups. Design: Prospective cohort study, the French GAZEL study. Setting: France. Participants: Employees of France's national electricity and gas company. Measurements: Alcohol intake was assessed annually, beginning in 1992, using questions on frequency and quantity of alcoholic beverages consumed in a week; used to define mean consumption and trajectory of alcohol intake over 10 years. Cognitive performance among participants aged >= 55 years (n = 4073) was assessed in 2002-04 using the Digit Symbol Substitution Test (DSST), a measure of psychomotor speed, attention and reasoning. Occupational position at age 35 and education were used as the markers of socio-economic position. Findings: All analyses were stratified by socio-economic position. In the low occupational group, participants consuming a mean of more than 21 drinks per week had 2.1 points lower (95% CI: -3.9, -0.3) DSST score compared to those consuming four to 14 drinks per week. In participants with primary school education, the corresponding difference was 3.6 points (95% CI: -7.1, -0.0). No association between alcohol consumption and cognitive performance was observed in the intermediate and high socio-economic groups, defined using either occupation or education. Analysis of trajectories of alcohol consumption showed that in the low socio-economic groups large increase or decrease in alcohol consumption was associated with lower cognitive scores compared to stable consumption. Conclusions: Our results suggest that high alcohol consumption is associated with poorer cognitive performance only in the low socio-economic group, due possibly to greater cognitive reserve in the higher socio-economic groups.

Saenz-de-Miera B; Thrasher JF; Chaloupka FJ; Waters HR; Hernandez-Avila M; Fong GT. Self-reported price of cigarettes, consumption and compensatory behaviours in a cohort of Mexican smokers before and after a cigarette tax increase. Tobacco Control 19(6): 481-487, 2010. (28 refs.)

Objective To assess the impact of a 2007 cigarette tax increase from 110% to 140% of the price to the retailer on cigarette price and consumption among Mexican smokers, including efforts to offset price increases. Methods Data were analysed from the 2006 and 2007 administrations of the International Tobacco Control (ITC) Policy Evaluation Survey in Mexico, which is a population-based cohort of adult smokers. Self-reported price of last cigarette purchase, place of last purchase, preferred brand, daily consumption and quit behaviour were assessed at baseline and follow-up. Results Self-reported cigarette prices increased by 12.7% after the tax increase, with prices for international brands increasing more than for national brands (13.5% vs 8.7%, respectively). Although the tax increases were not fully passed onto consumers particularly on national brands, no evidence was found for smokers changing behaviour to offset price increases. Consistent declines in consumption across groups defined by sociodemographic and smoking-related psychosocial variables suggest a relatively uniform impact of the tax increase across subpopulations. However, decreased consumption appeared limited to people who smoked relatively more cigarettes a day (>5 cigarettes/day). Average daily consumption among lighter smokers did not significantly decline. A total of 13% (n=98) of the sample reported being quit for a month or more at follow-up. In multivariate models, lighter smokers were more likely than heavier smokers to be quit. Conclusions Results suggest that the 2007 tax increase was passed on to consumers, whose consumption generally declined. Since no other tobacco control policies or programmes were implemented during the period analysed, the tax

Samet JM. Estimating the burden of smoking: Premature mortality, morbidity, and costs. Salud Publica de Mexico 52(Supplement 2): S98-S107, 2010. (45 refs.)

Estimation of the burden of disease attributable to smoking has now become standard in documenting the impact of the tobacco epidemic and in motivating tobacco control.This paper addresses the methods used to estimate the attributable burden of mortality and the related estimation of morbidity and economic costs. Estimates of attributable mortality and morbidity for the Americas range widely, reflecting the maturity of the tobacco epidemic.The estimates are highest for the United States, and lower for Mexico and other countries of the Americas.

Sharkey K; Gillam L. Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. Journal of Medical Ethics 36(11): 661-665, 2010. (54 refs.)

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive 'high tech' medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals.

Shidhaye R; Patel V. Association of socio-economic, gender and health factors with common mental disorders in women: a population-based study of 5703 married rural women in India. International Journal of Epidemiology 39(6): 1510-1521, 2010. (59 refs.)

Background: There are few population-based studies from low- and middle-income countries that have described the association of socioeconomic, gender and health factors with common mental disorders (CMDs) in rural women. Methods: Population-based study of currently married rural women in the age group of 15-39 years. The baseline data are from the National Family Health Survey-II conducted in 1998. A follow-up study was conducted 4 years later in 2002-03. The outcome of CMD was assessed using the 12-item General Health Questionnaire (GHQ-12). Due to the hierarchical nature and complex survey design, data were analysed using mixed-effect logistic regression with random intercept model. Results A total of 5703 women (representing 83.5% of eligible women) completed follow-up. The outcome of CMD was observed in 609 women (10.7%, 95% confidence interval 9.8-11.6). The following factors were independently associated with the outcome of CMD in the final multivariable model: higher age, low education, low standard of living, recent intimate partner violence (IPV), husband's unsatisfactory reaction to dowry, husband's alcohol use and women's own tobacco use. Conclusions: Socio-economic and gender disadvantage factors are independently associated with CMDs in this population of women. Strategies that address structural determinants, for example to promote women's education and reduce their exposure to IPV, may reduce the burden of CMDs in women.

Shuaib F; Foushee HR; Ehiri J; Bagchi S; Baumann A; Kohler C. Smoking, sociodemographic determinants, and stress in the Alabama Black belt. Journal of Rural Health 27(1): 50-59, 2011. (54 refs.)

Purpose: In the Alabama Black Belt, poverty is high, and the educational level is low. Studies have found increased tobacco use among individuals exposed to high levels of stress. Few studies have been conducted in this region to measure smoking status, its sociodemographic determinants, and how smoking status relates to stressful environmental conditions. Methods: A cross-sectional questionnaire survey of 1,387 individuals. Findings: Approximately 25% of the respondents currently smoked cigarettes. Females were less likely to smoke compared to males (OR, 0.29; 95% CI, 0.23-0.38). Blacks were less likely to smoke cigarettes compared to whites (OR, 0.64; 95% CI, 0.43-0.95). Compared to individuals who were employed, participants who were unemployed or retired had increased odds of smoking (OR, 1.68; 95% CI, 1.15-2.20). The odds of being a current smoker were increased in the presence of moderate level stress (OR, 2.06; 95% CI, 1.38-3.07) or when there was a high level of stress (OR, 2.21; 95% CI, 1.47-3.31). Smoking was associated with increased odds of having a moderate level (OR, 2.06; 95% CI, 1.38-3.08) and a high level of stress (OR, 2.21; 95% CI, 1.47-3.32). Females who reported moderate to high levels of stress had increased odds of being smokers compared to males. Interaction between gender and stress showed deviation from additivity. Conclusion: Our findings suggest a high rate of cigarette use in the area. Increased stress levels appear to predispose females more than males to cigarette smoking. The implications of this association may guide interventions targeted at reducing smoking and its complications.

Spurling G; Hayman N. Self-rated health status in an urban indigenous primary care setting: Implications for clinicians and public health policy. Australian and New Zealand Journal of Public Health 34(6): 598-601, 2010. (8 refs.)

Background: Self-rated health status provides insights into the health beliefs of a population. This will be important for framing public health messages in the context of the need to 'close the gap' for Australian Indigenous people. Our primary objectives were to describe the self-rated health status of Indigenous people attending the Inala Indigenous Health service, identify associations with positive and negative self-rated health status and identify targets for public health awareness raising activity. Methods: Using a convenience sample, we approached all Indigenous patients attending the Inala Indigenous Health Service for an Indigenous adult health check between June 2007 and July 2008. From Indigenous adult health check data we analysed self-rated health status and chronic disease risk factors. Results: Out of a possible 509, 413 patients were recruited (response rate 81%). The number of participants who rated their health as fair or poor was 47%. The association of greatest magnitude and statistical significance with Indigenous patients' self rated health status (negative versus positive) was waist circumference followed by smoking, depression and age. Chronic disease risk factors not associated with self-rated health status included systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise. Conclusions: High rates of negative self-rated health status were found. Public health awareness-raising for Indigenous audiences should consider targeting chronic disease risk factors such as systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise.

Srivastava P. Does bingeing affect earnings? Economic Record 86(275): 578-595, 2010. (47 refs.)

Both anecdotal and empirical lines of evidence have pointed out that frequent binge drinking has far more serious consequences than occasional bingeing. As a result, a lower penalty for heavy drinking will be estimated by combining the heavy bingers with individuals who binge on rare occasions and are not necessarily less productive. This article explores the drinking-earnings relationship based on a finer distinction between frequent and occasional bingeing, and an extension to female subjects. It finds that frequent bingers experience reduced earnings whereas non-bingers and occasional bingers earn a positive premium over abstainers.

Svensson M; Hagquist C. Adolescents alcohol-use and economic conditions: A multilevel analysis of data from a period with big economic changes. European Journal of Health Economics 11(6): 533-541, 2010. (27 refs.)

This paper examines how the unemployment rate is related to adolescent alcohol use and experience of binge drinking during a time period characterized by big societal changes. The paper uses repeated cross-sectional adolescent survey data from a Swedish region, collected in 1988, 1991, 1995, 1998, 2002 and 2005, and merges this with data on local unemployment rates for the same time periods. Individual level frequency of alcohol use as well as experience of binge drinking is connected to local level unemployment rate to estimate the relationship using multilevel modeling. The model includes municipality effects controlling for time-invariant differences between municipalities as well as year fixed effects controlling for municipality-invariant changes over time in alcohol use. The results show that the unemployment rate is negatively associated with adolescents' alcohol use and the experience of binge drinking. When the unemployment rate increases, more adolescents do not drink at all. Regular drinking (twice per month or more) is, on the other hand, unrelated to the unemployment rate. Examining gender-differences in the relationship, it is shown that the results are driven by behavior in girls, whereas drinking among boys does not show any significant relationship with changes in the unemployment rate.

Tauras JA; Levy D; Chaloupka FJ; Villanti A; Niaura RS; Vallone D et al. Menthol and non-menthol smoking: The impact of prices and smoke-free air laws. Addiction 105(Supplement 1): 115-123, 2010. (23 refs.)

Aims: To examine the relationship between menthol and non-menthol prices and smoke-free air laws and the choice between menthol and non-menthol cigarettes among current smokers. Design, setting and participants: Data were extracted from the nationally representative (USA) 2003 and 2006/07 Tobacco Use Supplements to the Current Population Survey. A total of 57,383 adult smokers (aged 18+) were examined. Measurements: A regression model was used to estimate the probability of being a menthol smoker conditional on being a current smoker who had a distinct preference for either non-menthol or menthol cigarettes. Cigarette prices, smoke-free air laws and socioeconomic and demographic characteristics were examined as covariates. Findings The prices of menthol and non-menthol cigarettes were associated with the choice between menthol and non-menthol cigarettes. However, smokers did not find menthol and non-menthol cigarettes to be close substitutes for one another. Non-menthol cigarettes were found to be less of a substitute for menthol cigarettes than vice versa. Young adults and African Americans were less responsive to prices with respect to switching between menthol and non-menthol cigarettes than were older adults and non-African Americans, respectively. Conclusions: The US Food and Drug Administration (FDA) is grappling with the issue of whether or not to ban menthol cigarettes. The findings from this study suggest that smokers do not find menthol and non-menthol cigarettes to be close substitutes. The strong preference for mentholated cigarettes may serve as a lever to reduce smoking prevalence when combined with increased access to effective cessation treatments.

Thomson G; Wilson N; Blakely T; Edwards R. Ending appreciable tobacco use in a nation using a sinking lid on supply. Tobacco Control 19(5): 431-435, 2010. (76 refs.)

We discuss some of the practical and ethical questions that may arise for a jurisdiction where a sinking lid endgame strategy for tobacco supply is implemented. Such a strategy would involve regular required reductions in the amount of tobacco released to the market for sale sufficient to achieve the desired level of commercial sales by a target date. Tobacco manufacturers would periodically bid to the government for a residual quota. Prices would increase as supply reduced. The price level would be influenced by demand which in turn would reflect the impact of other interventions to reduce demand and the changing normality of smoking. Higher priced tobacco could result in increased smuggling, theft, illegal sales and short to medium term aggravation of some social inequalities. We suggest that the strategy be introduced in conjunction with a range of complementary interventions that would help reduce demand and thus help ensure that the possible adverse effects are minimised. These complementary interventions include providing comprehensive best practice smoking cessation support, better information to smokers and the public strengthened regulation of tobacco retailing and supply further controlling the pack and product design measures to restrict supplies that bypass the increases in product price strengthened enforcement and combating industry attacks. General prerequisites for a sinking lid strategy include public support for the goal of a tobacco free society and strong political leadership. The likely context for initial success in jurisdictions includes geographical isolation and/or strong border controls absence of significant tobacco production and/or manufacturing and low government corruption.

Walker DM; Jackson JD. The effect of legalized gambling on state government revenue. Contemporary Economic Policy 29(1): 101-114, 2011. (35 refs.)

Legalized gambling is an attractive option to state governments facing tightening fiscal constraints. Yet, the empirical evidence on the effect of gambling on state revenues is limited. Most studies examine a single industry in a single state, and for a relatively short period of time. This study provides a more general analysis of gambling industries and their effects on state revenues. We use data on gambling volume and state government revenues net of federal government transfers for all 50 states from 1985 to 2000. We find that lotteries and horse racing tend to increase state revenues, while casinos and greyhound racing tend to decrease state revenues.

Windsor LC; Benoit E; Dunlap E. Dimensions of oppression in the lives of impoverished black women who use drugs. Journal of Black Studies 41(1): 21-39, 2010. (32 refs.)

Oppression against Black women continues to be a significant problem in the United States. The purpose of this study is to use grounded theory to identify multiple dimensions of oppression experienced by impoverished Black women who use drugs by examining several settings in which participants experience oppression. Three case studies of drug using, impoverished Black women were randomly selected from two large scale consecutive ethnographic studies conducted in New York City from 1998 to 2005. Analysis revealed five dimensions of oppression occurring within eight distinct settings. While dimensions constitute different manifestations of oppression, settings represented areas within participants' lives or institutions with which participants interact. Dimensions of oppression included classism, sexism, familism, racism, and drugism. Settings included the school system, correction system, welfare system, housing and neighborhood, relationship with men, family, experiences with drug use, and employment. Findings have important implications for social justice, welfare, drug, and justice system policy.

Yancey AK; Grant D; Kurosky S; Kravitz-Wirtz N; Mistry R. Role modeling, risk, and resilience in California adolescents. Journal of Adolescent Health 48(1): 36-43, 2011. (35 refs.)

Purpose: To examine the relationship between role model presence, type of role model, and various health-risk and health-protective behaviors among California adolescents. Methods: We used cross-sectional data on 4,010 multiethnic adolescents aged 12-17 years from the 2003 California Health Interview Survey, a population-based random-digit dial telephone survey of more than 40,000 California households. The survey, conducted every other year since 2001, collects extensive demographic, health, and health-related information. Results: Fifty-nine percent of adolescents identified a role model. Affluent teens were more likely to have a role model than lower income teens. Role models were generally of the same ethnicity and gender as the teens; ethnic congruence was higher among African Americans and whites than Latinos and Asians; gender congruence was higher among males. Type of role model was significantly associated with health-related behaviors. Identification of a teacher was strongly associated with positive health behaviors. Correlations with health-promoting behaviors were generally smaller in magnitude but consistently positive among family member and athlete role models. Peer or entertainer role models were associated with health-risk behaviors. Conclusion: Not only role model presence but also the type of role model is an important predictor of adolescent health-related behaviors. Our findings have implications for designing youth targeted interventions and policies involving role models.

Yang GH; Li QA; Wang CX; Hsia J; Yang Y; Xiao L et al. Findings from 2010 Global Adult Tobacco Survey: Implementation of MPOWER policy in China. Biomedical and Environmental Sciences 23(6): 422-429, 2010. (10 refs.)

Objective: To assess the implementation of five key tobacco control policies in China: protection from second-hand smoke (SHS); offering help to quit; health warnings regarding tobacco use; the enforcement of bans on tobacco advertising, promotion, and sponsorship; and increasing tobacco taxes and prices. Methods: Using 2010 Global Adults Tobacco Survey in China (GATS-China), 10 indicators are used to assess the implementation of five key tobacco control policies of MPOWER in China. Results Overall, 63.3% and 72.7% of adultsnoticed people smoking indoor workplaces and public places, respectively. Approximately 60% of smokers were not asked about their smoking habits and approximately 67% were not advised to quit on their visit to a health worker. Sixty percent of adults noticed health warning messages on cigarette packaging and in the media in the last 30 days, 63.6% stated that they would not consider quitting. Twenty percent of respondents noticed tobacco advertising, promotion, and/or sponsorship activities in the 30 days prior to the survey. Among them, 76.3% noticed the direct advertising and 50% noticed from TV programs. Although purchasing price of one pack of cigarettes ranged from 1 to 200 RMB, 50% of current smokers (about 150 million) spent 5 RMB or less on one pack of cigarette. The expenditure on 100 packets of cigarettes represents 2% of 2009 GDP per capita. Conclusion: The average score for the implementation of the 5 policies of MPOWER in China is 37.3 points, indicating tobacco control policies in China is poor and there is a large gaps from the FCTC requirements.

Young D; Wilson N; Borland R; Edwards R; Weerasekera D. Prevalence, correlates of, and reasons for using roll-your-own tobacco in a high RYO use country: Findings from the ITC New Zealand Survey. Nicotine & Tobacco Research 12(11): 1089-1098, 2010. (37 refs.)

To describe the prevalence, correlates of, and reasons for use of roll-your-own (RYO) tobacco in a high RYO use and ethnically diverse country: New Zealand (NZ). The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) is sampled from the New Zealand Health Survey, with boosted sampling of Maori, Pacific peoples, and Asian New Zealanders. We surveyed 1,376 current adult smokers using standard ITC project procedures in 2007-2008. Prevalence of regularly smoking RYOs was 53% (with 38% of all smokers being exclusive RYO smokers). RYO use was higher among disadvantaged smokers, heavier smokers, those with a relatively low intention of quitting, and those with more friends who smoke. RYO use increased more in the youngest age groups as disadvantage increased. "Lower price" dominated the reasons smokers' cited for smoking RYOs (at 83%). About one fifth cited "less health concerns" as a reason. RYO smoking is particularly associated with individual deprivation and high levels of dependence. Its capacity to blunt price signals provided by tobacco taxes is accompanied by misperceptions that it is less hazardous to health and it is particularly prevalent among vulnerable disadvantaged populations (including M (a) over bar ori, young people, and those with mental health problems). Governments should reconsider removing any tax advantages given to RYO tobacco, ensure RYO smokers are properly informed of health risks, and supported to quit as strongly as other smokers. However, governments should also examine a broader range of options including a higher differential tax on RYO tobacco, removing flavors, and controlling all tobacco marketing.