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CORK Bibliography: Government Policies, Drugs



100 citations. January 2011 to present

Prepared: March 2012



Agorastos A; Zurhold H; Verthein U; Petridou A; Haasen C. Addiction services in Cyprus: Results of an EU Twinning Project. Drugs: Education, Prevention and Policy 18(5): 340-352, 2011. (38 refs.)

Introduction: This evaluation is part of a Twinning Project between Cyprus and Germany, aimed at evaluating the governmental drug services in Cyprus and promoting the improvement and introduction of new drug treatment services, in order to assist the new Member State in the implementation and harmonization with the European Community's legislation. Methods: A field investigation studied parameters as population in need, treatment demand and coverage, as well as high-risk patterns and their trend over the past years. Results: The main findings were a high level of problematic drug use, mainly high-risk intravenous heroin and cocaine use, and an increase treatment demand for women, adolescents and migrants. Expert interviews named gaps in treatment options, including a previous lack of maintenance treatment, insufficient harm reduction measures and inadequate treatment concepts to meet specific needs of problematic drug users. Discussion: Recommendations for improvement can be integrated into present services. Cypriot authorities have started implementing the suggestions, so that an overall improvement of services can be expected in the future.

Copyright 2011, Taylor & Francis


Alexander B. The Globalization of Addiction: A Study in Poverty of the Spirit. New York: Oxford University Press, 2011

To take the broadest possible view, it might be said that scientific modern medicine has failed when it comes to addiction. There are no reliable methods to cure it, prevent it, or take the pain out of it. There is no durable consensus on what addiction is, what causes it, or what should be done about it. Meanwhile, rates of addiction continue to increase around the world. This book argues that the cause of this failure to control addiction is that the conventional wisdom of the 19th and 20th centuries focused too single-mindedly on the afflicted individual. This was to overlook the obvious fact that prevalence differs markedly between societies. For example, it can be quite rare in a society for centuries, and then become common when a tribal culture is destroyed or a highly developed civilization collapses. Also of significance is that when addiction becomes common, people become addicted/dependent not only to alcohol and drugs, but other persuits be it money or power or sex or gambling or video games. Emphasis is made that a societal focus does not deny individual vulnerability and individual differences, but it simply removes them from the foreground of attention. The case is made that the nature of the emergent globalized free market society in conducive to the emergence of addiction. It subjects people to pressures towards individualism and competition, dividing rich and poor alike from the close social and spiritual ties that heretofore constitute human life. People adapt to their dislocation by finding the best substitutes for a sustaining social and spiritual life that they can, and addiction serves this function all too well. The case is made that the problems of addiction require not only the efforts of the helpfing professions but social and political initiatives that can reshape society with sufficent force to enable people to find social integration and meaning in everyday life, forces that would make it less imperative to fill their inner void with addictions.

Copyright 2011, Project Cork


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

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

Copyright 2011, Elsevier Science


Ayers JW; Ribisl K; Brownstein JS. Using search query surveillance to monitor tax avoidance and smoking cessation following the United States' 2009 "SCHIP" cigarette tax increase. PLoS ONE 6(3): article e16777, 2011. (52 refs.)

Smokers can use the web to continue or quit their habit. Online vendors sell reduced or tax-free cigarettes lowering smoking costs, while health advocates use the web to promote cessation. We examined how smokers' tax avoidance and smoking cessation Internet search queries were motivated by the United States' (US) 2009 State Children's Health Insurance Program (SCHIP) federal cigarette excise tax increase and two other state specific tax increases. Google keyword searches among residents in a taxed geography (US or US state) were compared to an untaxed geography (Canada) for two years around each tax increase. Search data were normalized to a relative search volume (RSV) scale, where the highest search proportion was labeled 100 with lesser proportions scaled by how they relatively compared to the highest proportion. Changes in RSV were estimated by comparing means during and after the tax increase to means before the tax increase, across taxed and untaxed geographies. The SCHIP tax was associated with an 11.8% (95% confidence interval [95% CI], 5.7 to 17.9; p<.001) immediate increase in cessation searches; however, searches quickly abated and approximated differences from pre-tax levels in Canada during the months after the tax. Tax avoidance searches increased 27.9% (95% CI, 15.9 to 39.9; p<.001) and 5.3% (95% CI, 3.6 to 7.1; p<.001) during and in the months after the tax compared to Canada, respectively, suggesting avoidance is the more pronounced and durable response. Trends were similar for state-specific tax increases but suggest strong interactive processes across taxes. When the SCHIP tax followed Florida's tax, versus not, it promoted more cessation and avoidance searches. Efforts to combat tax avoidance and increase cessation may be enhanced by using interventions targeted and tailored to smokers' searches. Search query surveillance is a valuable real-time, free and public method, that may be generalized to other behavioral, biological, informational or psychological outcomes manifested online.

Copyright 2011, Public Library of Science


Baler RD; Volkow ND. Addiction as a systems failure: Focus on adolescence and smoking. (review). Journal of the American Academy of Child and Adolescent Psychiatry 50(4): 329-339, 2011. (115 refs.)

Objective: Scientific advances in the field of addiction have forever debunked the notion that addiction reflects a character flaw under voluntary control, demonstrating instead that it is a bona fide disease of the brain. The aim of this review is to go beyond this consensus understanding and explore the most current evidence regarding the vast number of genetic, developmental, and environmental factors whose complex interactions modulate addiction risk and trajectory. Method: Focusing on childhood and adolescent smoking as a paradigm, we review the important risk factors for the development of addictions, starting at the level of genetics and closing with a focus on sociocultural and policy factors. Results: A critical review of the pertinent literature provides a detailed view of the cumulative power of risk and protection factors across different phenomenological levels to modulate the risk of undesirable outcomes, particularly for young people. The result represents a compelling argument for the need to engage in comprehensive, multilevel approaches to promoting health. Conclusions: Today, the field of medicine understands more about disease than about health; however it need not be that way. The view of drug addiction as a systems failure should help refocus our general approach to developing dynamic models and early comprehensive interventions that optimize the ways in which we prevent and treat a complex, developmental disorder such as drug addiction.

Copyright 2011, Elsevier Science


Benowitz NL; Samet JM. The threat of menthol cigarettes to U.S. public health. (editorial). New England Journal of Medicine 364(23): 2179-2181, 2011. (2 refs.)


Biglan A. Corporate externalities: A challenge to the further success of prevention science. Prevention Science 12(1): 1-11, 2011. (107 refs.)

The full benefit of prevention science will not be realized until we learn how to influence organizational practices. The marketing of tobacco, alcohol, and food and corporate advocacy for economic policies that maintain family poverty are examples of practices we must influence. This paper analyzes the evolution of such practices in terms of their selection by economic consequences. A strategy for addressing these critical risk factors should include: (a) systematic research on the impact of corporate practices on each of the most common and costly psychological and behavior problems; (b) empirical analyses of the consequences that select harmful corporate practices; (c) assessment of the impact of policies that could affect problematic corporate practices; and (d) research on advocacy organizations to understand the factors that influence their growth and to help them develop effective strategies for influencing corporate externalities.

Copyright 2011, Springer


Bitton A; Green C; Colbert J. Improving the delivery of global tobacco control. Mount Sinai Journal of Medicine 78(3): 382-393, 2011. (43 refs.)

Tobacco control must remain a critical global health priority given the growing burden of tobacco-induced disease in the developing world. Insights from the emerging field of global health delivery suggest that tobacco control could be improved through a systematic, granular analysis of the processes through which it is promoted, implemented, and combated. Using this framework, a critical bottleneck to the delivery of proven health promotion emerges in the role that the tobacco industry plays in promoting tobacco use and blocking effective tobacco-control policies. This "corporate bottleneck" can also be understood as a root cause of massive disease and suffering upon vulnerable populations worldwide, for the goal of maximizing corporate profit. Naming, understanding, and responding to this corporate bottleneck is crucial to the success of tobacco-control policies. Three case studies of tobacco-control policy South Africa, the Framework Convention on Tobacco Control, and Uruguay are presented to explore and understand the implications of this analysis.

Copyright 2011, Wiley-Blackwell


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

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

Copyright 2011, Public Library of Science


Burkhart G. Environmental drug prevention in the EU. Why is it so unpopular? (editorial). Adicciones 23(2): 87-100, 2011. (92 refs.)

Adolescents go through changes in their neurobehavioural and psychosocial functioning that can result in their desire to conform to peer norms taking predominance over cognitive impulse control mechanisms. This can help explain why, when peers are present, adolescent behaviour may not be significantly modified by what they know about risks and consequences. This finding has implications for prevention as it points to the importance of responses that actively target the environment in which substance use takes place, and where social norms are formed and supported. In practice however, across Europe information-only prevention approaches - despite a weak evidence for their effectiveness - continue to be most commonly used. Why this is the case is the question addressed by this editorial. A definition for environmental prevention is also provided: as strategies that aim to alter physical, social and economic environment without relying on persuasion. Boundaries of the definition with health promotion are discussed and the available evidence for the efficacy of this perspective reviewed, as is the information on the availability of environmental prevention within Europe. These data do not support the contention made by some member states that their prevention strategies are comprehensive and cover all addictive substances. Overall, although environmental approaches are becoming more common, they are disproportionately found in the North of Europe, and are most noticeable in three areas: at the macro-level in tobacco bans and alcohol policies, in strategies to improve the school environment and ethos, and in local level policies to regulate recreational settings.

Copyright 2011, Socidrogalcohol


Caixeta RB; Blanco A; Fouad H; Khoury RN; Sinha DN; Rarick J et al. Cigarette package health warnings and interest in quitting smoking -- 14 countries, 2008-2010. MMWR. Morbidity and Mortality Weekly Review 60(20): 645-651, 2011. (10 refs.)

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires health warnings on tobacco product packages sold in countries that ratified the WHO FCTC treaty. These warnings are expected to 1) describe the harmful effects of tobacco use; 2) be approved by the appropriate national authority; 3) appear on at least 30%, and ideally 50% or more, of the package's principal display areas; 4) be large, clear, visible, and legible in the country's principal language(s); 5) have multiple, rotating messages; and 6) preferably use pictures or pictograms. To assess the effects of cigarette package health warnings, this report examines 2008--2010 data from the Global Adult Tobacco Survey (GATS) in 14 WHO FCTC countries. Among men, the prevalence of manufactured cigarette smoking ranged from 9.6% in India to 59.3% in Russia. Among men in 12 of the countries and women in seven countries, >90% of smokers reported noticing a package warning in the previous 30 days. The percentage of smokers thinking about quitting because of the warnings was >50% in six countries and >25% in men and women in all countries except Poland.

Public Domain


Campbell RB; Balbach ED. Manufacturing credibility: The National Energy Management Institute and the Tobacco Institute's strategy for indoor air quality. American Journal of Public Health 101(3): 497-503, 2011. (95 refs.)

Objectives. We studied tobacco industry efforts during the 1980s and 1990s to promote the National Energy Management Institute (NEMI), a nonprofit organization, as an authority on indoor air quality as part of the industry's strategy to oppose smoke-free worksite policies. Methods. We analyzed tobacco industry documents, conducted literature searches in Lexis-Nexis for background and historical literature, and reviewed relevant public health and policy literature. Results. The tobacco industry provided more than US $6 million to NEMI to establish it as an authority on indoor air quality and to work with it to undermine support for smoke-free air policies by promoting ventilation as a solution to indoor air quality problems. Tobacco industry support for NEMI was not publicly disclosed. Conclusions. NEMI was a valuable ally for the tobacco industry through NEMI's ties to organized labor, its technical background, and its status as a third-party actor. NEMI also helped the industry to portray ventilation to improve overall indoor air quality and smoke-free worksites as an either-or choice; in fact, both can improve worker health.

Copyright 2011, American Public Health Association


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

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

Copyright 2011, Springer


Carkaxhiu L; Huseyin K; Berisha M; Botica MV. Problem of substance misuse and lack of national strategy in Kosovo. Central European Journal of Public Health 19(2): 108-114, 2011. (40 refs.)

The aim of this project was to explore the problem of substance misuse among adolescent town dwellers in Kosovo, as a result of lack of a national strategy related to this problem. Design: 261 students from 4 secondary schools took part in cross sectional survey performed in October 2005. The survey was carried out in Gjilan town in south-east of Kosovo. Main results: From all questioned students, 36% smoked cigarettes every day, 12.6% consumed alcohol occasionally and 1.4% consumed all kind of drugs regularly. Girls consumed more cigarettes, whereas boys consumed more alcohol and other drugs. The prevalence of substance misuse was higher among students in their last year of high school attendance. Students in Gjilan continue to smoke, consume alcohol and drugs despite their knowledge about the adverse health consequences of substance misuse, but in the same time, most of them consider information and counselling the best way of substance misuse prevention. Conclusions: The prevalence and trends of substance misuse among students in our survey indicates that it is time to start acting. It is assumed that results of survey may be a very useful source of information for policy-makers, government and ministry of health in developing and implementing national strategy that would address the most important issues in connection with addiction among adolescents.

Copyright 2011, National Institute of Public Health (Czech Republic)


Cavanaugh D; Kraft MK; Muck R; Merrigan DM. Toward an effective treatment system for adolescents with substance use disorders: The role of the states. Children and Youth Services Review 33(1, special issue): s16-s22, 2011. (14 refs.)

A 2002 national expert panel found that the treatment system for adolescents with substance use disorders was inadequate and underdeveloped. The panel recommended immediate improvement in five areas: youth-serving agency collaboration, treatment system financing, workforce development, the implementation of evidence-based practices, and family involvement in all aspects of treatment. In 2004, the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA), designed the State Adolescent Substance Abuse Treatment Coordination Grant program (SAC) and implemented it in 2005 to address the critical need in the field. This paper reviews the adolescent substance use disorders treatment system, discusses selected drivers for change and the design of the SAC grant program, and summarizes some of the program's results. Both quantitative and qualitative data analysis document that substantive systems development occurred within each of the sixteen grantees and that federal-state partnerships are useful in creating systemic change.

Copyright 2011, Elsevier Science


Chaloupka FJ. Commentary on Ross et al. (2011): Beyond cigarette taxes - the need for research on other cigarette pricing policies. (commentary). Addiction 106(3): 620-621, 2011. (9 refs.)


Colgrove J; Bayer R; Bachynski KE. Nowhere left to hide? The banishment of smoking from public spaces. (editorial). New England Journal of Medicine 364(25): 2375-2377, 2011. (5 refs.)


Cummings KM; Borland R. Individualized versus population-based approaches to tobacco control. A false dichotomy. (editorial). Addiction 106(9): 1556-1558, 2011. (19 refs.)


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

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

Copyright 2011, Cambridge University Press


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

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

Copyright 2011, Wiley-Blackwell


Devi S. USA hones in on prescription drug abuse. (editorial). Lancet 378(9790): 473-474, 2011. (0 refs.)


Deyton LR. FDA tobacco product regulations: A powerful tool for tobacco control (editorial). Public Health Reports 126(2): 167-169, 2011. (7 refs.)


Diehr P; Hannon P; Pizacani B; Forehand M; Meischke H; Curry S et al. Social marketing, stages of change, and public health smoking interventions. Health Education & Behavior 38(2): 123-131, 2011. (22 refs.)

As a "thought experiment," the authors used a modified stages of change model for smoking to define homogeneous segments within various hypothetical populations. The authors then estimated the population effect of public health interventions that targeted the different segments. Under most assumptions, interventions that emphasized primary and secondary prevention, by targeting the Never Smoker, Maintenance, or Action segments, resulted in the highest nonsmoking life expectancy. This result is consistent with both social marketing and public health principles. Although the best thing for an individual smoker is to stop smoking, the greatest public health benefit is achieved by interventions that target nonsmokers.

Copyright 2011, Sage Publication


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

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

Copyright 2011, Society for the Study of Addiction to Alcohol and Other Drugs


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

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

Copyright 2011, BioMed Central


Efroymson D; Pham HA; Jones L; FitzGerald S; Thu LT; Le TTH. Tobacco and poverty: Evidence from Vietnam. (review). Tobacco Control 20(4): 296-301, 2011. (34 refs.)

This review examined existing evidence to investigate the link between tobacco and poverty in Vietnam, to assess the impact of tobacco control policies on employment related to tobacco consumption and to identify information gaps that require further research for the purposes of advocating stronger tobacco control policies. A Medline, PubMed and Google Scholar search identified studies addressing the tobacco and poverty association in Vietnam using extensive criteria. In all, 22 articles related either to tobacco and health or economics, or to the potential impact of tobacco control policies, were identified from titles, abstracts or the full text. 28 additional publications were identified by other means. PHA, LTT and LTTH reviewed the publications and prepared the initial literature review. There is extensive evidence that tobacco use contributes to poverty and inequality in Vietnam and that tobacco control policies would not have a negative impact on overall employment. Tobacco use wastes household and national financial resources and widens social inequality. The implementation and enforcement of a range of tobacco control measures could prove beneficial not only to improve public health but also to alleviate poverty.

Copyright 2011, BMJ Publishing Group


Eriksson C; Geidne S; Larsson M; Pettersson C. A research strategy case study of alcohol and drug prevention by non-governmental organizations in Sweden 2003-2009. Substance Abuse Treatment, Prevention and Policy 6: e article 8, 2011. (83 refs.)

Background: Alcohol and drug prevention is high on the public health agenda in many countries. An increasing trend is the call for evidence-based practice. In Sweden in 2002 an innovative project portfolio including an integrated research and competence-building strategy for non-governmental organisations (NGOs) was designed by the National Board of Health and Welfare (NBHW). This research strategy case study is based on this initiative. Methods: The embedded case study includes 135 projects in 69 organisations and 14 in-depth process or effect studies. The data in the case study has been compiled using multiple methods - administrative data; interviews and questionnaires to project leaders; focus group discussions and seminars; direct and participatory observations, interviews, and documentation of implementation; consultations with the NBHW and the NGOs; and a literature review. Annual reports have been submitted each year and three bi-national conferences. Reflections on preventions have been held. Results: A broad range of organisations have been included in the NBHW project portfolio. A minority of the project were run by alcohol or drug organisations, while a majority has children or adolescents as target groups. In order to develop a trustful partnership between practitioners, national agencies and researchers a series of measures were developed and implemented: meeting with project leaders, project dialogues and consultations, competence strengthening, support to documentation, in-depth studies and national conferences. A common element was that the projects were program-driven and not research-driven interventions. The role of researchers-as-technical advisors was suitable for the fostering of a trustful partnership for research and development. The independence of the NGOs was regarded as important for the momentum in the project implementation. The research strategy also includes elements of participatory research. Conclusions: This research strategy case study shows that it is possible to integrate research into alcohol and drug prevention programs run by NGOs, and thereby contribute to a more evidence-based practice. A core element is developing a trustful partnership between the researchers and the organisations. Moreover, the funding agency must acknowledge the importance of knowledge development and allocating resources to research groups that is capable of cooperating with practitioners and NGOs.

Copyright 2011, BioMed Central


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

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

Copyright 2011, Elsevier Science


Fischer B; Jeffries V; Hall W; Room R; Goldner E; Rehm J. Lower Risk Cannabis Use Guidelines for Canada (LRCUG): A narrative review of evidence and recommendations. (review). Canadian Journal of Public Health 102(5): 324-327, 2011. (49 refs.)

Objectives: More than one in ten adults - and about one in three young adults - report past year cannabis use in Canada. While cannabis use is associated with a variety of health risks, current policy prohibits all use, rather than adopting a public health approach focusing on interventions to address specific risks and harms as do policies for alcohol. The objective of this paper was to develop 'Lower Risk Cannabis Use Guidelines' (LRCUG) based on research evidence on the adverse health effects of cannabis and factors that appear to modify the risk of these harms. Methods: Relevant English-language peer-reviewed publications on health harms of cannabis use were reviewed and LRCUG were drafted by the authors on the basis of a consensus process. Synthesis: The review suggested that health harms related to cannabis use increase with intensity of use although the risk curve is not well characterized. These harms are associated with a number of potentially modifiable factors related to: frequency of use; early onset of use; driving after using cannabis; methods and practices of use and substance potency; and characteristics of specific populations. LRCUG recommending ways to reduce risks related to cannabis use on an individual and population level - analogous to 'Low Risk Drinking Guidelines' for alcohol - are presented. Conclusions: Given the prevalence and age distribution of cannabis use in Canada, a public health approach to cannabis use is overdue. LRCUG constitute a potentially valuable tool in facilitating a reduction of health harms from cannabis use on a population level.

Copyright 2011, Canadian Public Health Association


Fooks GJ; Gilmore AB; Smith KE; Collin J; Holden C; Lee K. Corporate social responsibility and access to policy elites: An analysis of tobacco industry documents. PLoS Mediciine 8(8): e1001076, 2011. (92 refs.)

Background: Recent attempts by large tobacco companies to represent themselves as socially responsible have been widely dismissed as image management. Existing research supports such claims by pointing to the failings and misleading nature of corporate social responsibility (CSR) initiatives. However, few studies have focused in depth on what tobacco companies hoped to achieve through CSR or reflected on the extent to which these ambitions have been realised. Methods and Findings: Iterative searching relating to CSR strategies was undertaken of internal British American Tobacco (BAT) documents, released through litigation in the US. Relevant documents (764) were indexed and qualitatively analysed. In the past decade, BAT has actively developed a wide-ranging CSR programme. Company documents indicate that one of the key aims of this programme was to help the company secure access to policymakers and, thereby, increase the company's chances of influencing policy decisions. Taking the UK as a case study, this paper demonstrates the way in which CSR can be used to renew and maintain dialogue with policymakers, even in ostensibly unreceptive political contexts. In practice, the impact of this political use of CSR is likely to be context specific; depending on factors such as policy 'elites' understanding of the credibility of companies as a reliable source of information. Conclusions: The findings suggest that tobacco company CSR strategies can enable access to and dialogue with policymakers and provide opportunities for issue definition. CSR should therefore be seen as a form of corporate political activity. This underlines the need for broad implementation of Article 5.3 of the Framework Convention on Tobacco Control. Measures are needed to ensure transparency of interactions between all parts of government and the tobacco industry and for policy makers to be made more aware of what companies hope to achieve through CSR.

Copyright 2011, Public Library of Science


Frenk H; Dar R. If the data contradict the theory, throw out the data: Nicotine addiction in the 2010 report of the Surgeon General. Harm Reduction Journal 8: article 12, 2011. (101 refs.)

The reports of US Surgeon General on smoking are considered the authoritative statement on the scientific state of the art in this field. The previous report on nicotine addiction published in 1988 is one of the most cited references in scientific articles on smoking and often the only citation provided for specific statements of facts regarding nicotine addiction. In this commentary we review the chapter on nicotine addiction presented in the recent report of the Surgeon General. We show that the nicotine addiction model presented in this chapter, which closely resembles its 22 years old predecessor, could only be sustained by systematically ignoring all contradictory evidence. As a result, the present SG's chapter on nicotine addiction, which purportedly "documents how nicotine compares with heroin and cocaine in its hold on users and its effects on the brain," is remarkably biased and misleading.

Copyright 2011, BioMed Central


Gartner C; Hall W. Beware of allowing the ideal to be the enemy of the good. (editorial). Addiction 106(9): 1555-1556, 2011. (9 refs.)

We agree with Lawrence and colleagues that we need the most rigorous evidence possible on the effectiveness, cost-effectiveness and equity impacts of population health interventions to reduce smoking and exposure to other risk factors for chronic diseases, but for a number of reasons we would temper their advocacy for randomized controlled trials (RCTs) as the sine qua non of population health evaluation. First, there are limits to what RCTs can tell us even about drug treatments. Secondly, it is not practically or politically possible to conduct RCTs of important population level interventions such as tobacco tax increases, advertising bans and, arguably, plain packaging of cigarettes. Thirdly, RCTs cannot be used to make societal decisions about how to allocate resources to different preventive programmes (e.g. increased tobacco taxation, advertising bans, smoking restrictions, etc.). We cannot implement multi-factorial analysis of variance (ANOVA) research designs in which nation states or communities are randomized to each of the logically possible combinations of these interventions (e.g. high or low taxation; advertising bans or not; smoking restrictions or not; plain packaging or not, etc.).

2011, Society for the Study of Addiction


Givel MS. History of Bhutan's prohibition of cigarettes: Implications for neo-prohibitionists and their critics. International Journal of Drug Policy 22(4): 306-310, 2011. (64 refs.)

Background: Recently, cigarette neo-prohibitionists have argued that a cigarette ban can be obtained from a de-facto phase-out of cigarettes based on a combination of effective anti-tobacco regulations and high taxes in conjunction with aggressive application of nicotine replacement therapies. The purpose of this study was to ascertain whether these claims were valid in Bhutan, which enacted a national cigarette sales prohibition law in 2004. Did Bhutan from 2004 to 2009 eliminate or nearly eliminate cigarette consumption and avoid a significant cigarette black market and smuggling? Methods: This study is a historical, qualitative, descriptive statistical, and archival content overview from 2004 to 2009 of smoking prevalence rates and smuggling and black market trends subsequent to the enactment of the Bhutan Penal Code Act of 2004. Results: For adults in Bhutan, tobacco prevalence rates are fairly low compared with other nations but in 2008 remained a serious health issue for those who consumed cigarettes. For minors, tobacco consumption and second hand smoke exposure in 2008 was a significant health issue. In addition, the best available evidence indicates that illegal tobacco smuggling including black market sales due to the sales ban in Bhutan remains robust. Conclusions: So far, in Bhutan, cigarette neo-prohibitionist arguments that stringent anti-tobacco tax and regulatory approaches including a sales prohibition will induce tobacco consumption to cease or nearly cease has not occurred. In addition, the best scientific evidence indicates that a harm reduction-oriented nicotine replacement therapy approach will not be entirely effective. The results of this study provide an important lesson learned for health practitioners and advocates considering or advocating, albeit a gradual, but total cigarette ban as public policy.

Copyright 2011, Elsevier Science BV


Harris JK; Cohen EL; Wyrwich KW; Luke DA. Differences in smokers and nonsmokers' assessments of an educational campaign about tobacco use. Health Education & Behavior 38(6): 574-583, 2011. (44 refs.)

The authors surveyed 1,998 Missourians to evaluate (a) awareness and (b) understanding of messages about the impact of tobacco use in Missouri, (c) belief in the accuracy of the messages, and (d) intention to vote for a tobacco tax increase on the basis of the messages. Using structural equation modeling, the relationships among these four constructs were evaluated. A comparison of smokers and nonsmokers indicated that these two groups were influenced by the messages in different ways, chi(2)(8) = 20.89, p < .05, and should be modeled separately. The nonsmokers' model demonstrated significant (p < .05) relationships between understanding the messages and belief in message accuracy (b = .41; R(2) = .17) and between belief in message accuracy and intention to vote in favor of the tobacco tax (b = .54; R(2) = .29). In the smokers' model, understanding the messages was not a statistically significant predictor of belief in message accuracy. However, belief in message accuracy had a significant and positive relationship with intention to vote in favor of the tax (b = .45; R(2) = .21). These findings indicate that media campaigns about tobacco use should approach smokers and nonsmokers differently.

Copyright 2011, Sage Publications


Heilig M; Warren KR; Kunos G; Silverman PB; Hewitt BG. Addiction research centres and the nurturing of creativity. Addiction 106(6): 1052- 1060, 2011. (12 refs.)

The aim of this paper is to present a concise account of the history, mission, structure and some recent achievements of the US National Institute on Alcohol Abuse and Alcoholism (NIAAA). Created by the US Congress 40 years ago, the NIAAA has evolved from an entity charged mainly with building a national system of alcoholism treatment services to one with responsibility for developing, nurturing and supporting the biomedical and behavioral science foundation necessary to reduce the significant domestic and global public health impact of alcohol use disorders. The NIAAA is unique in that it functions both as a funding agency, supporting research at universities and other external, or 'extramural' research institutions, and is also a research institution itself, where alcohol research is carried out in-house, or 'intramurally'. Of a $450.2 million 2009 Congressional Appropriation, approximately 90% was devoted toward the former and approximately 10% towards the latter objective. The current NIAAA Strategic Plan builds on a new organizing principle for long-range research planning, based on a life-span perspective that recognizes that human biology and behavior continue to change throughout life and changes occurring throughout the life-span affect individuals' drinking patterns as well as the decisions they may make to change their drinking habits or to seek help for alcohol use problems. Within this framework, major efforts are currently being devoted to educating practitioners on clinically useful, science-based assessment and treatment methods that exist today, and development of personalized new treatments for tomorrow.

Copyright 2011, Society for the Study of Addiction


Henningfield JE. Tobacco psychopharmacology and public health policy: It takes a community. Experimental and Clinical Psychopharmacology 19(4): 249-262, 2011. (154 refs.)

This commentary is based upon the author's lecture given as the 2010 recipient of the award named in honor of Drs. Joseph V. Brady and Charles R. Schuster, given by the Psychopharmacology and Substance Abuse Division (Division 28) of the American Psychological Association (APA). The focus is on the contributions of many behavioral pharmacology researchers who collaborated very much in the spirit of an interactive community dedicated to the common cause of advancing science in service of public health. Division 28 and its members hold a prominent place in this account because, throughout the 1980s and 1990s, the Division was the lead scientific forum for bringing together researchers addressing the behavioral pharmacology of tobacco and nicotine. The commentary provides an overview of how advances utilizing animal and human models of dependence and withdrawal came to inform public health policy and more recently, tobacco product regulation. The commentary also recounts how efforts by the tobacco industry collided with those of nonindustry researchers, including Division 28 members, and how this was taken up in congressional hearings that addressed behavioral pharmacology research on tobacco. The review concludes with an overview of current challenges to behavioral pharmacology researchers to assist in guiding the regulation of tobacco products by the United States Food and Drug Administration and other national regulatory authorities, as well as guiding the implementation of the international tobacco treaty-the World Health Organization Framework Convention on Tobacco Control.

Copyright 2011, American Psychological Association


Hoffman KM; Poston WSC; Jitnarin N; Jahnke SA; Hughey J; Lando HA et al. A content analysis of tobacco control policy in the US Department of Defense. Journal of Public Health Policy 32(3): 334-349, 2011. (32 refs.)

We conducted a content analysis of the US military tobacco policies at the Department of Defense, each respective military service (Army, Air Force, Navy, and Marine Corps), and their Major Commands (MAJCOM). Ninety-seven policies were evaluated using the Military Tobacco Policy Rating Form (MTPRF). More than three quarters addressed the following domains: (1) deleterious health effects of tobacco use; (2) environmental tobacco smoke; (3) designation of smoking areas; (4) tobacco prevention/cessation programs; and (5) smokeless tobacco. Few policies (21 per cent) mentioned relevant Department of Defense and respective service tobacco use prevalence statistics. Smoking as non-normative or incompatible with military service, the impact of tobacco use on military readiness, and the tobacco industry were addressed infrequently (6.2. per cent, 33.0 per cent, and 8.2 per cent, respectively). Future military tobacco policies should address important omissions of critical information such as the current service tobacco use prevalence, effects on readiness, and smoking as non-normative.

Copyright 2011, Palgrave Macmillan Ltd


Humphreys K; Wagner TH; Gage M. If substance use disorder treatment more than offsets its costs, why don't more medical centers want to provide it? A budget impact analysis in the Veterans Health Administration. Journal of Substance Abuse Treatment 41(3): 243-251, 2011. (41 refs.)

Given that many studies have reported that the costs of substance use disorder (SUD) treatment are more than offset by other savings (e.g., in health care, in criminal justice, in foster care), why haven't health care system managers rushed to expand treatment? This article attempts to explain this puzzling discrepancy by analyzing 1998-2006 data from the national Veterans Affairs (VA) health care system. The main outcome measures were annual cost and utilization for VA SUD-diagnosed patients. The key independent variable was the medical centers' annual spending for SUD treatment. There was no evidence that SUD spending was associated with lower medical center costs over time within the medical center that paid for the treatment. Health care system managers may not be influenced by research suggesting that the costs of SUD treatment are more than fully offset because they bear the cost of providing treatment while the savings largely accrue to other systems.

Copyright 2011, Elsevier Science


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

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

Copyright 2011, National Medical Association


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

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

Copyright 2011, BioMed Central


Johnson BA; Messing RO; Charness ME; Crabbe JC; Goldman MS; Harris RA et al. Should the reorganization of addiction-related research across all the National Institutes of Health be structural? The devil is truly in the details. (editorial). Alcoholism: Clinical and Experimental Research 35(4): 572-580, 2011. (22 refs.)

The recent proposal to dissolve the National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse and create a new institute for substance use, abuse, and addiction will require significant effort by the staff of both institutes, the Advisory Councils, and outside experts to overcome complex challenges that could threaten its success. Although integration of the grants portfolios can be achieved, harmonization of goals and policies related to legal use of alcohol versus illegal consumption of drugs will present serious challenges. Consolidating the infrastructure of the 2 existing institutes would entail avoiding encroachment on grant funding. A new institute for substance use, abuse, and addiction would require an enormous amount of cooperation from other institutes as the portfolios of research on alcohol, tobacco, and other drug abuse should logically be transferred to the new institute. In the near term, a structural reorganization would be less efficient and more costly than the individual institutes are currently. Increasing efficiency and reducing costs over time will necessitate careful strategic planning. Success in this difficult task would be made easier and less costly by first implementing carefully placed building blocks of increasing functional reorganization. The newly created institute should increase opportunities for specialization within disorders of addiction, attract new leadership, and build a novel strategic plan that will energize scientists and staff and incorporate ideas of stakeholders to advance the public good in preventing and treating alcohol, tobacco, and all addictions. Attention must be paid to the devil in the details.

Copyright 2011, Research Society on Alcoholism


Kabir Z; Arora M; Alpert HR. Have public smoking bans resulted in an improvement in quality of life? (editorial). Expert Review of Pharmacoeconomics & Outcomes Research 11(4): 375-377, 2011. (20 refs.)


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

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

Copyright 2011, BMJ Publishing Group


Kerlikowske RG; Sabet K. Commentary on Voas et al. (2011): Drug-free roadways - can we get there from here? Steps to reducing drugged driving in the United States. (editorial). Addiction 106(7): 1228-1229, 2011. (3 refs.)


Killias M; Isenring GL; Gillieron G; Vuille J. Do drug policies affect cannabis markets? A natural experiment in Switzerland, 2000-10. European Journal of Criminology 8(3): 171- 186, 2011. (24 refs.)

Scholars and policymakers have long debated whether drug policies have any impact on demand for, supply of and prices for illegal substances. Switzerland's recent experience with changing policies offers an opportunity to study this issue. During the 1990s, the production and sale of this substance became increasingly tolerated. As a result, visible market structures (producers as well as shops) emerged. In 2004, however, traditional repressive policies were resumed and visible structures of production and distribution of cannabis disappeared again. During these critical years, market structures were monitored by a mail survey among cannabis shops and two 'fake client' studies. The results suggest that the policy shift led to decreased availability of the substance, higher prices and lower levels of cannabis use, particularly among the youngest age groups. Despite the illegal status of cannabis, other substances are still not available from the same dealers.

Copyright 2011, Sage Publications


Kim A; Stark E; Borgida E. Symbolic politics and the prediction of attitudes toward federal regulation of reduced-exposure tobacco products. Journal of Applied Social Psychology 41(2): 381-400, 2011. (31 refs.)

The present study relies on symbolic politics theory to predict public attitudes toward the federal regulation of conventional tobacco products (a familiar attitude object) and reduced-exposure tobacco products (a relatively novel attitude object). We predicted that attitudes toward most forms of regulation would be more strongly influenced by symbolic beliefs about the role of government in society than by self-interested concerns, with the exception of taxation. We predicted that the financial consequences of taxation policies would be less ambiguous for those who are affected, resulting in a stronger relationship between self-interest and policy attitudes. The results strongly supported our hypotheses, suggesting a process by which symbolic beliefs and self-interested concerns influence attitude formation. Theoretical and policy implications are discussed.

Copyright 2011, Wiley-Blackwell


Kleiman MAR; Heussler L. Crime-minimizing drug policy. Journal of Criminal Justice 39(3, special issue): 286-288, 2011. (12 refs.)

Objective: To identify changes in drug abuse control measures that would reduce non-drug crime. Method: Policy analysis. Results: Expanding current anti-drug efforts in the conventional triad of enforcement, prevention, and treatment (including drug courts) holds out little hope of reducing non-drug crime. Routine drug law enforcement risks increasing crime by raising drug prices and creating incentives for violence among dealers. Low-arrest crackdowns to break up flagrant markets promise better results. Even good prevention programs have modest effect sizes, and most prevention programs are not based on proven models. The overlap between the population. of heavy illicit drug users and the population of frequent non-drug offenders presents a problem and a policy opportunity that current programs largely fail to grasp. Drug treatment, except for opiate substitution, has difficulty recruiting and retaining clients, and weak sanctions systems render treatment mandates largely nominal. Abstinence-mandate programs such as HOPE and Sobriety 24/7 have shown superior results in reducing re-offending and incarceration. Raising alcohol taxes reduces heavy alcohol use and crime due to intoxication without generating any offsetting criminogenic effects. Conclusion: Current drug policies are not optimally designed for the control of non-drug crime. Improvements are within relatively easy reach.

Copyright 2011, Elsevier Science


Knudsen HK; Abraham AJ; Oser CB. Barriers to the implementation of medication-assisted treatment for substance use disorders: The importance of funding policies and medical infrastructure. Evaluation and Program Planning 34(4): 375-381, 2011. (28 refs.)

Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.

Copyright 2011, Elsevier Science


Kramer JM. Drug abuse in Russia: An emerging threat. Problems of Post-Communism 58(1): 31-43, 2011. (60 refs.)

In the Soviet era, drug abuse was seen as a crime. Recent developments suggest that Russia may finally be recognizing that it is a health problem with serious social implications.

Copyright 2011, M E Sharpe


Kreifels E. Passage of a prescription drug abuse bill in the spring 2011 Nebraska Unicameral. Nebraska Nurse 44(3): 6, 2011. (8 refs.)

Copyright 2011, Nebraska Nurses' Association


Lancaster K; Hughes CE; Spicer B; Matthew-Simmons F; Dillon P. Illicit drugs and the media: Models of media effects for use in drug policy research. Drug and Alcohol Review 30(4): 397-402, 2011. (64 refs.)

Issues. Illicit drugs are never far from the media gaze and although identified almost a decade ago as 'a new battleground' for the alcohol and other drug (AOD) field there has been limited research examining the role of the news media and its effects on audiences and policy. Approach. This paper draws together media theories from communication literature to examine media functions. We illustrate how each function is relevant for media and drugs research by drawing upon the existing literature examining Australian media coverage during the late 1990s of escalating heroin-related problems and proposed solutions. Key Findings. Media can influence audiences in four key ways: by setting the agenda and defining public interest; framing issues through selection and salience; indirectly shaping individual and community attitudes towards risk; and feeding into political debate and decision making. Each has relevance for the AOD field. For example, media coverage of the escalating heroin-related problems in Australia played a strong role in generating interest in heroin overdoses, framing public discourse in terms of a health and/or criminal issue and affecting political decisions. Implications and Conclusion. Media coverage in relation to illicit drugs can have multifarious effects. Incorporating media communication theories into future research and actions is critical to facilitate understanding of the short-and long-term impacts of media coverage on illicit drugs and the avenues by which the AOD field can mitigate or inform future media debates on illicit drugs.

Copyright 2011, Wiley-Blackwell


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

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

Copyright 2011, Oxford University Press


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

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

Copyright 2011, Forbes, Inc.


Lightwood J; Glantz S. Effect of the Arizona tobacco control program on cigarette consumption and healthcare expenditures. Social Science & Medicine 72(2): 166- 172, 2011. (37 refs.)

This research investigates the relationship between per capita tobacco control expenditures, cigarette consumption, and healthcare expenditures in the state of Arizona. Arizona's tobacco control program, which was established in 1994, concentrates on youth uptake of smoking and avoids public policy and commentary on the tobacco industry. We use a cointegrating time series analysis using aggregate data on healthcare and tobacco control expenditures, cigarette consumption and prices and other data. We find there is a strong association between per capita healthcare expenditure and per capita cigarette consumption. In the long run, a marginal increase in annual cigarette consumption of one pack per capita increases per capita healthcare expenditure by $19.5 (SE $5.45) in Arizona. A cumulative increase of $1.00 in the difference between control state and Arizona per capita tobacco control expenditures increases the difference in cigarette consumption by 0.190 (SE 0.0780) packs per capita. Between 1996 and 2004, Arizona's tobacco control program was associated with a cumulative reduction in cigarette consumption of 200 million packs (95% CI 39.0 million packs, 364 million packs) worth $500 million (95% CI: $99 million, $896 million) in pre-tax cigarette sales to the tobacco industry. The cumulative healthcare savings was $2.33 billion (95% CI $0.37 billion, $5.00 billion) and the cumulative reduction in cigarette. Arizona's tobacco control expenditures are associated with reduced cigarette consumption and healthcare expenditures, amounting to about 10 times the cost of the program through 2004. This return on investment, while large, was less than the more aggressive California program, which did not limit its focus to youth and included tobacco industry denomalization messages.

Copyright 2011, Elsevier Science


Liu S-h. Passage to Manhood: Youth Migration, Heroin, and AIDS in Southwest China. Stanford CA: Sandford University Press, 2011

This book based on the author's field work describes the circumstances of Nuosu youth of a rural, poor farming community in southwest China. This community was defined by the post-revolutionary Chinese governmental as a "minority" community. Historically, the Nuosu had very limited with the Han, the majority population in China. Since the late 1980s, young Nuosu men became engaged in a circular migratory pattern, generally spending between two and four months at a time in Chinese cities attempting to make money before returning home. Often lacking fluency in Mandarin, educational opportunities and social networks in the urban centers, many young migrant Nuosu workers supplement unsteady day labor jobs with participation in theft and other illicit activities. Before long, not only the young men who travelled to the cities, but also their families at home became involved in the consumption and distribution of heroin. The heroin trade appears to have been one of the few sectors of the rural economy that improved the material quality of life in Limu during the Reform era. With the rise in heroin use, HIV and AIDS also became a growing problem in these communities. The author describes the toll on individuals, families and community relationships. Beyond the stigma arising from the minority status, the further stigma of HIV/AIDS was introduced in the process of governmental efforts at public health education. An unfortunate result was the fraying of kinship relationships which had provided a supportive network for AIDS patients. The author traces several themes, the impetus of youth to migrate as a means of improving their life circumstances; the fraying of community life, the inability of this minority population to reap the benefits accruing to the broader population. Due to high mortality rates, the numbers of heroin users has declined. Youth however have turned to newer drugs, namely ecstasy and methamphetamine.

Copyright 2011, Project Cork


Lv J; Su M; Hong ZH; Zhang T; Huang XM; Wang B et al. Implementation of the WHO Framework Convention on Tobacco Control in mainland China. Tobacco Control 20(4): 309-314, 2011. (56 refs.)

As per China's ratification of the WHO Framework Convention on Tobacco Control (FCTC), it should have implemented effective packaging and labelling measures prior to 9 January 2009 and enacted a comprehensive ban on all tobacco advertising, promotion and sponsorship prior to 9 January 2011. In addition, universal protection against secondhand tobacco smoke should have been implemented before 9 January 2011 by ensuring that all indoor workplaces, all indoor public places, all public transportation and possibly other (outdoor or quasi-outdoor) public places are free of secondhand smoke. The authors conducted a review of various sources of information to determine the current status of FCTC implementation in mainland China. Even though China has made considerable efforts to implement the FCTC, there is still a significant gap between the current state of affairs in China and the requirements of the FCTC. The Chinese tobacco monopoly under which commercial and other vested interests of the tobacco industry are jeopardising tobacco control efforts is thought to be the most crucial obstacle to the effective implementation of the FCTC across the country.

Copyright 2011, BMJ Publishing Group


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


MacCoun RJ. What can we learn from the Dutch cannabis coffeeshop system? Addiction 106(11): 1899-1910, 2011. (48 refs.)

Aims To examine the empirical consequences of officially tolerated retail sales of cannabis in the Netherlands, and possible implications for the legalization debate. Methods Available Dutch data on the prevalence and patterns of use, treatment, sanctioning, prices and purity for cannabis dating back to the 1970s are compared to similar indicators in Europe and the United States. Results The available evidence suggests that the prevalence of cannabis use among Dutch citizens rose and fell as the number of coffeeshops increased and later declined, but only modestly. The coffeeshops do not appear to encourage escalation into heavier use or lengthier using careers, although treatment rates for cannabis are higher than elsewhere in Europe. Scatterplot analyses suggest that Dutch patterns of use are very typical for Europe, and that the 'separation of markets' may indeed have somewhat weakened the link between cannabis use and the use of cocaine or amphetamines. Conclusions: Cannabis consumption in the Netherlands is lower than would be expected in an unrestricted market, perhaps because cannabis prices have remained high due to production-level prohibitions. The Dutch system serves as a nuanced alternative to both full prohibition and full legalization.

Copyright 2011, Society for the Study of Addiction


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

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

Copyright 2011, BMJ Publishing Group


MacLean SJ; d'Abbs PHN. Five challenges for volatile substance misuse policy and intervention in Australia. (editorial). Drug and Alcohol Review 30(2): 223-227, 2011. (33 refs.)


Mamudu HM; Gonzalez M; Glantz S. The nature, scope, and development of the global tobacco control epistemic community. (editorial). American Journal of Public Health 101(11): 2044-2054, 2011. (109 refs.)

Over the past 50 years, tobacco control has been transformed from a national to a global issue, becoming institutionalized in the World Health Organization (WHO) Framework Convention on Tobacco Control, the first international public health treaty negotiated under the auspices of the WHO. The global tobacco control epistemic community, a worldwide network of professionals with a common interpretation of the science in tobacco use and control, has contributed to this transformation. We investigated the development, structure, and function of this community through interviews and archival documents. Professionals in the community are bound by values and consensual knowledge developed after years of contentious debates undergirded their activities. Although these professionals play multiple roles, they recognize that scientific evidence should inform advocacy and policy activities. Public health professionals should continue to strengthen the links between science and advocacy for policy while being vigilant against industry efforts to undermine the scientific evidence on tobacco use and control.

Copyright 2011, American Public Health Association Inc


Marlow ML. Why does tobacco-control spending vary so much across states? Applied Economics Letters 18(8): 723-728, 2011. (13 refs.)

Although tobacco-control spending is considered an essential component of comprehensive programmes aimed at lowering smoking, substantial variation exists across states. This article examines if variation is systematically related to cross-state differences in smoking prevalence, holding other factors constant that are expected to influence spending. An econometric model is estimated which considers effects of tobacco-settlement revenues, income, unemployment, political party of the governor, state debt and smoking prevalence on tobacco-control spending in all states during 2000-2007. Estimations control for the possibility that spending and smoking prevalence are co-determined to clearly determine the causal link from prevalence to spending. Spending variation is determined to be inconsistent with a 'rational needs' strategy whereby states with higher prevalence choose more funding than states with lower prevalence. This empirical result is consistent with recent studies indicating that spending on tobacco control exerts little to no effect on cigarette sales or smoking prevalence.

Copyright 2011, Taylor & Francis


Mauldin JA. All smoke and no fire? Analyzing the potential effects of the Mental Health Parity and Addiction Equity Act of 2008. Law & Psychology Review 35: 193, 2011. (122 legal refs.)

... The way in which mental health services have been and continue to be regulated in this country cannot be understood without a general understanding of the larger historical context of mental health treatment. ... Specifically, the bill would have required services considered essential to the treatment of severe mental illness to be provided in a manner that "(1) was not more restrictive than coverage provided for other major physical illnesses; (2) provided adequate financial protection to the person requiring the medical treatment . . . ; and (3) was consistent with effective and common methods of controlling health care costs for other major physical illnesses." ... The GAO further found, the net effect is that consumers in states without more comprehensive laws have often seen only minor changes in their health benefits, resulting in little or no increase in their access to mental health services, and that the costs associated with the federal law have been negligible for most health plans. ... The provision reduced the incentive for insurance companies and benefit providers to make long-term shifts toward mental health parity in hopes of nonrenewal. ... What It Does In rising to support the MHPAEA, Representative Pallone stated, "the legislation before us will fully ensure equity in the coverage for mental illness and substance abuse disorders by requiring that group health plans with mental health coverage offer that coverage without the imposition of discriminatory financial requirements or discriminatory treatment limitations." ... The PPACA attempts to broaden access to care by requiring most citizens to purchase health insurance, creating state-based insurance exchanges where some individuals will be eligible for premium and cost-sharing benefits, penalizing employers whose employees obtain coverage through the exchanges, and extending Medicaid eligibility.

Copyright 2011, University of Alamba


McKetin R; Sutherland R; Bright DA; Norberg MM. A systematic review of methamphetamine precursor regulations. (review). Addiction 106(11): 1911-1924, 2011. (41 refs.)

Aims To assess the effectiveness of methamphetamine precursor regulations in reducing illicit methamphetamine supply and use. Methods A systematic review of 12 databases was used to identify studies that had evaluated the impact of methamphetamine precursor regulations on methamphetamine supply and/or use. The guidelines of the Effective Practice and Organization of Care Group (EPOC) of The Cochrane Collaboration were used to determine which study designs were included and assess their quality. Results Ten studies met the inclusion criteria. These studies evaluated 15 interventions (13 regulations and two related interdiction efforts), all of which were located in North America. Interventions had consistent impacts across various indicators of methamphetamine supply and use. Seven of the 15 interventions produced reductions in methamphetamine indicators (ranging from 12% to 77%). Two of the largest impacts were seen following interdiction efforts, involving the closure of rogue pharmaceutical companies. There was no evidence of a shift into other types of drug use, or injecting use, although the impact on the synthetic drug market was not examined. Null effects were related largely to the existence of alternative sources of precursor chemicals or the availability of imported methamphetamine. Conclusions: Methamphetamine precursor regulations can reduce indicators of methamphetamine supply and use. Further research is needed to determine whether regulations can be effective outside North America, particularly in developing countries, and what impact they have on the broader synthetic drug market. Improved data on precursor diversion are needed to facilitate the evaluation of precursor regulations.

Copyright 2011, Society for the Study of Addiction


Mendez D; Alshanqeety O; Warner KE; Lantz PM; Courant PN. The impact of declining smoking on radon-related lung cancer in the United States. American Journal of Public Health 101(2): 310-314, 2011. (15 refs.)

Objectives. We examined the effect of current patterns of smoking rates on future radon-related lung cancer. Methods. We combined the model developed by the National Academy of Science's Committee on Health Risks of Exposure to Radon (the BEIR VI committee) for radon risk assessment with a forecasting model of US adult smoking prevalence to estimate proportional decline in radon-related deaths during the present century with and without mitigation of high-radon houses. Results. By 2025, the reduction in radon mortality from smoking reduction (15 percentage points) will surpass the maximum expected reduction from remediation (12 percentage points). Conclusions. Although still a genuine source of public health concern, radon-induced lung cancer is likely to decline substantially, driven by reductions in smoking rates. Smoking decline will reduce radon deaths more than remediation of high-radon houses, a fact that policymakers should consider as they contemplate the future of cancer control.

Copyright 2011, American Public Health Association


Miller P; Dunlop A. Rhetoric, reality and research: What they mean for achieving the best possible treatment system for addiction-related problems. (editorial). International Journal of Drug Policy 22(3): 196-197, 2011. (17 refs.)


Millett C; Polansky JR; Glantz SA. Government inaction on ratings and government subsidies to the US film industry help promote youth smoking. (editorial). PLoS Mediciine 8(8): e1001077, 2011. (38 refs.)


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

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

Copyright 2011, Wiley-Blackwell


Mullin S. Global anti-smoking campaigns urgently needed. (editorial). Lancet 378(9795): 970-971, 2011. (9 refs.)


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

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

Copyright 2011, Wiley-Blackwell


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

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

Copyright 2011, Wiley-Blackwell


Ojeda VD; Robertson AM; Hiller SP; Lozada R; Cornelius W; Palinkas LA et al. A qualitative view of drug use behaviors of Mexican male injection drug users deported from the United States. Journal of Urban Health 88(1): 104-117, 2011. (55 refs.)

Deportees are a hidden yet highly vulnerable and numerous population. Significantly, little data exists about the substance use and deportation experiences of Mexicans deported from the United States. This pilot qualitative study describes illicit drug use behaviors among 24 Mexico-born male injection drug users (IDUs), >= 18 years old, residing in Tijuana, Mexico who self-identified as deportees from the United States. In-person interviews were conducted in Tijuana, Mexico in 2008. Content analysis of interview transcripts identified major themes in participants' experiences. Few participants had personal or family exposures to illicit drugs prior to their first U. S. migration. Participants reported numerous deportations. Social (i.e., friends/family, post-migration stressors) and environmental factors (e. g., drug availability) were perceived to contribute to substance use initiation in the U. S. Drugs consumed in the United States included marijuana, heroin, cocaine, methamphetamine, and crack. More than half of men were IDUs prior to deportation. Addiction and justice system experiences reportedly contributed to deportation. After deportation, several men injected new drugs, primarily heroin or methamphetamine, or a combination of both drugs. Many men perceived an increase in their substance use after deportation and reported shame and loss of familial social and economic support. Early intervention is needed to stem illicit drug use in Mexican migrant youths. Binational cooperation around migrant health issues is warranted. Migrant-oriented programs may expand components that address mental health and drug use behaviors in an effort to reduce transmission of blood-borne infections. Special considerations are merited for substance users in correctional systems in the United States and Mexico, as well as substance users in United States immigration detention centers. The health status and health behaviors of deportees are likely to impact receiving Mexican communities. Programs that address health, social, and economic issues may aid deportees in resettling in Mexico.

Copyright 2011, Springer


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

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

Copyright 2011, Oxford University Press


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

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

Copyright 2011, Elsevier Science


Parry C; Myers B. Beyond the rhetoric: Towards a more effective and humane drug policy framework in South Africa. (editorial). South African Medical Journal 101(10): 704-+, 2011. (12 refs.)

The March 2011 Anti-Substance Abuse Summit in Durban continued the outdated approach to policy around illicit drugs in South Africa. It missed opportunities for discussing how to impact significantly on the health and social harms associated with problematic drug use and reduce the burden of drug-related cases in the criminal justice system. The government needs to move away from the political rhetoric of a 'drug-free society' and start the real work of formulating and implementing an evidence-based drug policy that learns from the experiences of other countries around decriminalising drug use; takes into account differences in the harms resulting from different classes of drugs; adopts a rights-based, public health approach to policy; and identifies a single (accountable) agency that has the authority to oversee policy implementation. In addition, consensus is needed on the short-, medium- and long-term priorities for drug policy implementation. The 17 evidence-based drug policy strategies identified by Babor et al. may serve as a useful starting point for policy development.

Copyright 2011, South Africa Medical Association


Parry R; Prior B; Sykes AJ; Tay JL; Walsh B; Wright N et al. Smokefree streets: A pilot study of methods to inform policy. Nicotine & Tobacco Research 13(5): 389- 394, 2011. (27 refs.)

Introduction: Smokefree street policies are relatively rare, and little has been published on the methods for establishing an evidence base to inform such policy making. We aimed to (a) pilot methods for such data collection in New Zealand, a country where local governments are actively pursuing outdoor smokefree policies and (a) to provide data on smoking behavior, attitudes toward smokefree policies, and levels of smoke exposure on streets in Wellington. Methods: Three methods were piloted: (a) systematic observation of smoking behavior by observers walking a standard route of major streets, the "Golden Mile" (GM) in Wellington (n = 42 observation runs); (b) measurement of fine particulate levels (PM2.5) along this route and with purposeful sampling in selected settings; and (c) an attitudinal survey of pedestrians along sections of this route. Results: Each of the 3 methods proved to be feasible in this urban setting. A total of 932 smokers were observed during 21 hr of observation, an average of 7 smokers every 10 min of walking. Air monitoring indicated fine particulate exposure. Levels of (mean) PM2.5 were 1.5 times higher during periods when smoking was observed than when they were not (9.3 vs. 6.3 mu g/m(3), p = .002). Dose-response patterns were observed for smoking proximity and for smoker numbers. Surveying pedestrians (n = 220) with a brief questionnaire achieved an 81% response rate and was able to identify variation in support for a smokefree GM by different groups (overall support was 55.9%, 95% CI = 49.3%-62.4%). Reasons for support were also identified, for example, perceived health hazards, at 34.1%, was the main reason. Conclusions: These methods can provide information that may contribute to the smokefree streets policymaking process and may also be relevant to informing other smokefree outdoor policies.

Copyright 2011, Oxford University Press


Pawson R; Wong G; Owen L. Known knowns, known unknowns, unknown unknowns: The predicament of evidence-based policy. American Journal of Evaluation 32(4): 518-546, 2011. (66 refs.)

The authors present a case study examining the potential for policies to be "evidence-based." To what extent is it possible to say that a decision to implement a complex social intervention is warranted on the basis of available empirical data? The case chosen is whether there is sufficient evidence to justify banning smoking in cars carrying children. The numerous assumptions underpinning such legislation are elicited, the weight and validity of evidence for each is appraised, and a mixed picture emerges. Certain propositions seem well supported; others are not yet proven and possibly unknowable. The authors argue that this is the standard predicament of evidence-based policy. Evidence does not come in finite chunks offering certainty and security to policy decisions. Rather, evidence-based policy is an accumulative process in which the data pursue but never quite capture unfolding policy problems. The whole point is the steady conversion of "unknowns" to "knowns."

Copyright 2011, Sage Publications


Pedersen MU; Hesse M; Bloomfield K. Abstinence-orientated residential rehabilitation of opioid users in Denmark: Do changes in national treatment policies affect treatment outcome? Scandinavian Journal of Public Health 39(6): 582-589, 2011. (24 refs.)

Aims: Significant changes in the Danish drug-abuse treatment system occurred from 1998 to 2008, allowing the opportunity to study their impact on outcomes for opiate dependent patients. This paper examines whether such changes are related to possible changes in abstinence rates of two cohorts of drug users. Methods: We compared survival curves and the month-by-month probability of abstinence between cohorts of drug abusers who were followed for one year after treatment for opioid dependence in 1998 (n = 305) and in 2008 (n = 204). Of the 1998 cohort, 192 were interviewed face-to-face and 61 were found through national drug-abuse treatment registers. Of the 2008 cohort 112 were interviewed face-to-face and 42 were found through national drug-abuse treatment registers. Results: Survival curves did not differ between the two cohorts. After controlling for age and gender, people from the 2008 cohort had a higher frequency of month-to-month rates of abstinence. A higher proportion of clients received new treatment after their index treatment in 2008. Clients from the 1998 cohort who did not receive new treatment used drugs more often than clients who did not receive treatment in 2008. At the same time, the proportion of clients who received residential rehabilitation treatment for opiate dependence increased substantially by 2008. Conclusions: Total abstinence rates are highly consistent over time and seem to change little with changes in systems of care. However, changes in care that improve access to treatment may reduce the overall burden of opioid addiction to both individuals and society.

Copyright 2011, Sage Publications


Petticrew MP; Lee K. The "Father of Stress" meets "Big Tobacco": Hans Selye and the tobacco industry. American Journal of Public Health 101(3): 411-418, 2011. (98 refs.)

The concept of stress remains prominent in public health and owes much to the work of Hans Selye (1907-1982), the "father of stress." One of his main allies in this work has never been discussed as such: the tobacco industry. After an analysis of tobacco industry documents, we found that Selye received extensive tobacco industry funding and that his research on stress and health was used in litigation to defend the industry's interests and argue against a causal role for smoking in coronary heart disease and cancer. These findings have implications for assessing the scientific integrity of certain areas of stress research and for understanding corporate influences on public health research, including research on the social determinants of health.

Copyright 2011, American Public Health Association


Pratt CB. China's tobacco industry's communication practices: Paradoxes and proposals for public policymaking. Public Relations Review 37(3): 318-320, 2011. (10 refs.)

The People's Republic of China's expanding tobacco-control efforts call for additional, urgent government action on two major fronts: (a) conducting comprehensive health-communication campaigns on the clinical and economic effects of tobacco use; and (b) requiring major policy changes in the (structural and administrative) relationships between the State Tobacco Monopoly Administration (STMA) and the industry at large, that is, primarily, the China National Tobacco Company (CNTC). China's signing (in 2003) and ratifying (in 2005) the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) place it in a position to adopt some of the anti-smoking measures common in some developed nations. Even though the country's tobacco industry acknowledges publicly health concerns over its products, it engages in communication practices that are paradoxical, in that they circumvent public-health initiatives and the expanding regulatory regimes of product-risk reduction even as the government promotes tobacco use. That paradox calls for three public-policymaking proposals: to conduct more comprehensive, nationwide health-communication campaigns; to use legislation to reduce tobacco use; and to restructure the tobacco industry.

Copyright 2011, Elsevier Science


Purkis SW; Cahours X; Rey M; Teillet B; Troude V; Verron T. Some consequences of using cigarette machine smoking regimes with different intensities on smoke yields and their variability. Regulatory Toxicology and Pharmacology 59(2): 293-309, 2011. (46 refs.)

When smoking cigarettes under an intense regime with a combination of 100% ventilation blocking and high flow rates, as currently mandated by Health Canada, significant increases in filter temperatures and disproportionately high levels of mainstream smoke water and moisture accumulating in the spent filter were found when compared to other smoking regimes, especially for highly filter ventilated cigarettes. These effects have been reported to decrease cigarette firmness during the course of smoking, to alter filtration properties and efficiencies and to confound the measurement of particulate matter. The high filter temperatures generated also lead to significant amounts of vapour phase compounds desorbing from carbon filters and an over-estimation of the yields of these components. Less adsorption on or more desorption from carbon filters was found for compounds with the highest volatility. Therefore, yield data from the intense regime may not reflect the effectiveness of cigarette design features to reduce certain smoke components that occurs when products are smoked under conditions closer to those used by the majority of smokers in real world situations. In addition, a combination of these interacting factors may explain the worse level of between-laboratory reproducibility data for particulate matter measurement obtained during intense machine smoking. Among-laboratory data variability for vapour phase components, other than carbon monoxide, and for particulate phase components, other than nicotine, still needs to be evaluated in collaborative studies. Before proposing smoking regimes as tools to evaluate smoke emissions, it is essential to understand these various interacting factors and subsequent uncontrolled effects that such regimes can generate and the limitations of their use. These observations imply that higher tolerances may need to be set and taken into account when smoking under the intense regime before deciding that, for a given product, there are real differences between the yields determined in different laboratories.

Copyright 2011, Elsevier Science


Rieckmann TR; Kovas AE; Cassidy EF; McCarty D. Employing policy and purchasing levers to increase the use of evidence-based practices in community-based substance abuse treatment settings: Reports from single state authorities. Evaluation and Program Planning 34(4): 366-374, 2011. (53 refs.)

State public health authorities are critical to the successful implementation of science based addiction treatment practices by community-based providers. The literature to date, however, lacks examples of state level policy strategies that promote evidence-based practices (EBPs). This mixed-methods study documents changes in two critical state-to-provider strategies aimed at accelerating use of evidence-based practices: purchasing levers (financial incentives and mechanisms) and policy or regulatory levers. A sample of 51 state representatives was interviewed. Single State Authorities for substance abuse treatment (SSAs) that fund providers directly or through managed care were significantly more likely to have contracts that required or encouraged evidence-based interventions, as compared to SSAs that fund providers indirectly through sub-state entities. Policy levers included EBP-related legislation, language in rules and regulations, and evidence-based criteria in state plans and standards. These differences in state policy are likely to result in significant state level variations regarding both the extent to which EBPs are implemented by community-based treatment providers and the quality of implementation.

Copyright 2011, Elsevier Science


Semaan S; Fleming P; Worrell C; Stolp H; Baack B; Miller M. Potential role of safer injection facilities in reducing HIV and Hepatitis C infections and overdose mortality in the United States. (review article). Drug and Alcohol Dependence 118(2-3): 100-110, 2011. (206 refs.)

Background: Safer injection facilities (SIFs) reduce risks associated with injecting drugs, particularly public injection and overdose mortality. They exist in many countries, but do not exist in the United States. We assessed several ethical, operational, and public health considerations for establishing SIFs in the United States. Method: We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns), summarized needs of persons who inject drugs in the United States, and reviewed global evidence for SIFs. Results: SIFs offer a hygienic environment to inject drugs, provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs, purchased by persons who inject drugs, happens in a facility where trained personnel provide on-site counseling and referral to addiction treatment and health care and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality) without evidence for negative health or social consequences. SIFs serve most-at-risk persons, including those who inject in public or inject frequently, and those who do not use other public health programs. It is critical to address legal, ethical, and local concerns, develop and implement relevant policies and procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data. Conclusions: SIFs have the potential to reduce viral and bacterial infections and overdose mortality among those who engage in high-risk injection behaviors by offering unique public health services that are complementary to other interventions.

Copyright 2011, Elsevier Science


Shaffer DK; Hartman JL; Listwan SJ; Howell T; Latessa EJ. Outcomes among drug court participants: Does drug of choice matter? International Journal of Offender Therapy and Comparative Criminology 55(1): 155-174, 2011. (76 refs.)

The link between drug and alcohol abuse and criminal behavior is clearly illustrated in the literature. The options of how to respond to these offenders, however, has widely fluctuated over time. Currently, many states have reconsidered their "get tough" approach to one that is more rehabilitative in nature. One particular community-based intervention that has gained in popularity is the drug court model. The literature on drug courts is generally supportive; however, there is a need to examine effectiveness by target population. The purpose of this study is to explore recidivism rates of drug court clients by drug of choice. Using a 2-year follow-up period, this study finds that drug of choice does not significantly influence either successful graduation or arrest. Policy implications are discussed.

Copyright 2011, Sage Publication


Shelley D; Jannat-Khah D; Wolff M. Tobacco-use treatment in dental practice How Healthy People 2020 aligns federal policy with the evidence. (editorial). Journal of the American Dental Association 142(6): 592-+, 2011. (26 refs.)


Stevens A. Drug policy, harm and human rights: A rationalist approach. International Journal of Drug Policy 22(3): 233-238, 2011. (58 refs.)

Background: It has recently been argued that drug-related harms cannot be compared, so making it impossible to choose rationally between various drug policy options. Attempts to apply international human rights law to this area are valid, but have found it difficult to overcome the problems in applying codified human rights to issues of drug policy. Method: This article applies the rationalist ethical argument of Gewirth (1978) to this issue. It outlines his argument to the 'principle of generic consistency' and the hierarchy of basic, nonsubtractive and additive rights that it entails. It then applies these ideas to drug policy issues, such as whether there is a right to use drugs, whether the rights of drug 'addicts' can be limited, and how different harms can be compared in choosing between policies. Result: There is an additive right to use drugs, but only insofar as this right does not conflict with the basic and nonsubtractive rights of others. People whose freedom to choose whether to use drugs is compromised by compulsion have a right to receive treatment. They retain enforceable duties not to inflict harms on others. Policies which reduce harms to basic and nonsubtractive rights should be pursued, even if they lead to harms to additive rights. Conclusion: There exists a sound, rational, extra-legal basis for the discussion of drug policy and related harms which enables commensurable discussion of drug policy options.

Copyright 2011, Elsevier Science


Sumnall HR; Evans-Brown M; McVeigh J. Social, policy, and public health perspectives on new psychoactive substances. (review). Drug Testing and Analysis 3(7-8, special issue): 515-523, 2011. (119 refs.)

New psychoactive substances pose a particular challenge to those formulating drugs policy and related public health responses. This paper outlines some of the main issues arising from their use, with a particular focus on user perspectives. Such substances are often (at least initially) produced and distributed for different reasons than controlled drugs. They emerge in users' repertoires undetected by most monitoring systems and general population drug surveys. While reasons for use by innovators and early adopters are often in the spirit of self-experimentation, such substances may rapidly diffuse to the recreational arena as a result of enthusiastic user propagation where they act as substitutes or complements to controlled drugs. The majority of substances are believed to be sourced, albeit not exclusively, from manufacturers based in China. They are retailed to consumers through the Internet and physical shops (such as 'head' and 'smart' shops), as well as traditional 'street dealers' (although data on the significance of this latter route of supply are limited). The data required for risk assessment of the harms such substances may pose, as well as information required for accurate user-derived harm reduction advice, are often limited. Moreover, some involved in the commercial supply have deliberately misbranded products, including substituting the active substance, in apparent attempts to circumvent regulatory frameworks. This leaves users susceptible to both health and criminal justice harms. Despite various attempts to restrict the supply, they often continue to be available through the illicit market, although it is not yet possible to predict whether they will join other drugs such as MDMA and LSD as mainstays of the recreational pharmacopeia.

Copyright 2011, Wiley-Blackwell


Thickett A. Khat use - What direction for policy? (editorial). Drugs: Education, Prevention and Policy 18(6, special issue): 405-407, 2011. (13 refs.)


Tran-Leung MC; Rosenthal E. Advocacy Story: Advocates and community groups defeat punitive housing authority proposals. Clearinghouse Review: Journal of Poverty Law and Policy 45(November-December): 363, 2011

. . . The Chicago Housing Authority (CHA) stirred controversy in the spring of 2011 when it proposed to change its lease and its admission and continued occupancy policy to require drug tests for all public housing applicants and residents and to eliminate the innocent-tenant defense in eviction proceedings (Chicago Housing Authority, FY 2011 Admissions and Continued Occupancy Policy (2011), http://bit.ly/tW8tV7 (scheduled to be presented to the Board of Commissioners July 19, 2011)). ... In defending the drug-testing proposal, CHA also alleged that the policy would promote public safety by identifying and removing drug users, thereby reducing demand for drugs and causing drug traffickers to take their business away from public housing (Maudlyne Ihejirika, CHA Plan for Required Drug Testing of Residents Called "A Slap in the Face," CHICAGO SUNTIMES (May 27, 2011), http://bit.ly/vBeEJR). ... Another legal deficiency was the issue of consent since CHA's proposed drug-testing plan would have required all applicants and residents "to sign all consent forms which permit the CHA to obtain information about . . . any substance abuse treatment facility activities" (Chicago Housing Authority at 53-54). ... The Innocent-Tenant Defense While CHA's proposed mandatory drug-testing policy drew the lion's share of attention, the new lease released in May proposed another change that, advocates knew, could pose significant harm to CHA residents: elimination of the innocent-tenant defense. ... Legal Assistance Foundation reached out to the Central Advisory Committee and local community organizations -- Kenwood Oakland Community Organization, Logan Square Neighborhood Association, and Metropolitan Tenants Organization -- to fill them in on the background of the innocent-tenant defense and its relevance to public housing residents.

Copyright 2011, Sargent Shriver National Center on Poverty Law


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

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

Copyright 2011, BMJ Publishing


Tsiachristas A; Hipple-Walters B; Lemmens KMM; Nieboer AP; Rutten-van Molken MPMH. Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers. Health Policy 101(2): 122-132, 2011. (51 refs.)

Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system - the chain-DTC - is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system. The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs). The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between care-givers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs.

Copyright 2011, Elsevier Science


Tumwine J. Implementation of the Framework Convention on Tobacco Control in Africa: Current status of legislation. International Journal of Environmental Research and Public Health 8(11): 4312-4331, 2011. (27 refs.)

Objective: To describe, as of July 2011, the status of tobacco control legislation in Africa in three key areas of the Framework Convention on Tobacco Control (FCTC)-(1) Protection from exposure to tobacco smoke, (2) Packaging and labelling of tobacco products, and (3) Tobacco advertising, promotion and sponsorship. Methods: Review and analysis of tobacco control legislation in Africa, media reports, journal articles, tobacco industry documents and data published in the 2011 WHO Report on the Global Tobacco Epidemic. Results: Modest progress in FCTC implementation in Africa with many countries having legislation or policies on the protection from exposure to tobacco smoke, however, only a handful of countries meet the standards of the FCTC Article 8 and its Guidelines particularly with regards to designated smoking areas. Little progress on packaging and labelling of tobacco products, with few countries having legislation meeting the minimum standards of the FCTC Article 11 and its Guidelines. Mauritius is the only African country with graphic or pictorial health warnings in place and has the largest warning labels in Africa. Slightly better progress in banning tobacco advertising, promotion and sponsorship has been shown by African countries, although the majority of legislation falls short of the standards of the FCTC Article 13 and its Guidelines. Despite their efforts, African countries' FCTC implementation at national level has not matched the strong regional commitment demonstrated during the FCTC treaty negotiations. Conclusion: This study highlights the need for Africa to step up efforts to adopt and implement effective tobacco control legislation that is fully compliant with the FCTC. In order to achieve this, countries should prioritise resources for capacity building for drafting strong FCTC compliant legislation, research to inform policy and boost political will, and countering the tobacco industry which is a major obstacle to FCTC implementation in Africa.

Copyright 2011, MDPI AG


Ueda H; Armada F; Kashiwabara M; Yoshimi I. Street smoking bans in Japan: A hope for smoke-free cities? Health Policy 102(1): 49-55, 2011. (43 refs.)

Objectives:This study analysed 112 municipalities enforcing municipal smoking restrictions on streets in Japan to examine anti-smoking measures implemented in urban settings from a health perspective and derive lessons for future tobacco control. Methods: Municipal governments implementing ordinances which restrict smoking on streets were identified through grey literature review. Implementation period, characteristics, scope, and department responsible were examined. Results: Since the first municipal regulation was introduced in 1997, many other municipalities have followed. Enforcement of fines started in 2002, which is now a common practice nationwide. Nevertheless, the health impact of exposure to secondhand smoke is not clearly articulated in the ordinances. Street smoking bans have been developed in connection with "beautification" and littering prevention for environmental purposes, and local health departments do not have responsibility for these ordinances. Conclusions: There is potential to further prevent secondhand smoke exposure if such measures are expanded to indoor environments and integrated into broader policies. For policy-makers and advocates, the Japanese experience provides information on an additional tobacco control intervention as well as clues in the process of design, implementation and enforcement of such municipal measures. A more comprehensive and health-driven approach is required to effectively address the harm of secondhand smoke in Japan.

Copyright 2011, Elsevier Science


Van Hout MC. Travellers and substance use in Ireland: Recommendations for drug and alcohol policy. Drugs: Education, Prevention and Policy 18(1): 53-59, 2011. (32 refs.)

The Traveller community was traditionally protected from drug use by distinct traditional anti-drug norms and potent family networks within their 'separateness' from the 'settled' community. Estimations of Traveller substance use remain clouded due to lack of ethnic monitoring in drug reporting systems, and poor service utilization by Travellers. This article draws on a Traveller and substance use regional needs analysis in Ireland, comprising 12 Traveller focus groups and 45 interviews with key stakeholders. Drug activity in terms of both drug dealing and drug use among Travellers is increasing in recent years [Van Hout, M.C. (2009a). Substance misuse in the traveller community: A regional needs assessment. Western Regional Drug Task Force. Series 2. ISBN 978-0-9561479-2-9]. Traditional resiliency factors are dissipating in strength due to increased Traveller housing within marginalized areas experiencing drug activity and increased levels of young Travellers encountering youth drug use within school settings, by way of their attempts 'to fit in' and integrate with their 'settled peers' [Van Hout, M.C. (2009b). Irish travellers and drug use - An exploratory study. Ethnicity and Inequalities in Health and Social Care, 2(1), 42-49]. Fragmentation of Traveller culture is occurring as Travellers strive to retain their identity within the assimilation process into modern sedentarist Irish society. Treatment and outreach policies need to protect Traveller identity by reducing discriminatory experiences, promoting cultural acceptance with service staff and addressing literacy, implementing peer led approaches and offering flexible therapy modalities.

Copyright 2011, Taylor & Francis


Vaughn M. Addiction and criminal justice: Empirical findings and theory for advancing public safety and health. (editorial). Journal of Criminal Justice 39(3, special issue): 205-206, 2011. (14 refs.)


Volkow ND; McLellan TA. Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. (editorial). Journal of the American Medical Association 305(13): 1346-1347, 2011. (10 refs.)


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

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

Copyright 2011, Oxford University Press


Wechsler J. Policy-makers move to curb drug abuse, diversion and disruptions to ensure quality supply. (editorial). Formulary 46(6): 242-243, 2011. (0 refs.)


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

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

Copyright 2011, Wiley-Blackwell


Wettenhall R. State enterprise for ethical reasons: Mostly alcohol and tobacco. Policy Studies 32(3, special isssue): 243-261, 2011. (83 refs.)

The impact of the global financial crisis (GFC) in 2007-2010 directed attention once more to the role of the state in the economy, with many observers accepting that that role would be larger in the foreseeable future than it had been during the privatising era of the later twentieth century. But the interventions of the GFC period and the debates about them focused very largely on commercial functions - banking and industrial production. Going beyond these particular interventions and debates, there has always been a strong, though often forgotten, case for government intervention for ethical rather than commercial reasons. This article reviews that case as it manifests itself in the alcohol and tobacco industries, with a brief indication that the betting/gambling industry presents many similar features.

Copyright 2011, Taylor & Francis Ltd


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

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

Copyright 2011, Wiley-Blackwell