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CORK Bibliography: Drug-related Morbidity

60 citations. January 2012 to present

Prepared: June 2012

Asberg K; Renk K. Substance use coping as a mediator of the relationship between trauma symptoms and substance use consequences among incarcerated females with childhood sexual abuse histories. Substance Use & Misuse 47(7): 799-808, 2012. (78 refs.)

Rates of substance use and maltreatment are alarmingly high among incarcerated women. Although the direct link between trauma and substance use has been established, less is known about potential mediators. Thus, we examined substance use coping as a mediator between trauma symptoms and substance use consequences among a sample of incarcerated females (N = 111) who were survivors of childhood sexual abuse. Trauma symptoms predicted the severity of substance use consequences, with this relationship being mediated fully by avoidance coping (e.g., using substances to cope). Overall, trauma histories are important in predicting outcomes but must be examined in the context of current coping behaviors and substance use. Findings (data collected in 2007/2008) may help promote interventions that target patterns of coping and/or emotional avoidance among trauma survivors with substance use problems in incarcerated populations. The study's limitations are noted.

Bagdure S; Smalligan RD; Sharifi H; Khandheria B. Waning effect of compulsive bathing in cannabinoid hyperemesis. American Journal on Addictions 21(2): 184-185, 2012. (7 refs.)

An uncommon adverse effect of chronic marijuana use is hyperemesis - which is marked by increasing nausea, vomiting, and abdominal pain - and which is unresponsive to all aniemetic medications, but can be relieved by a hot shower or application of a hot water bottle to the abdomen. However, with increasing number of incidents of hyperemesis, the hot shower/hot water bottle is increasingly less effective. This is a case report of cannabis hyperemesis, which involved several hosptializations, and eventually could be resolved only by abstinence from marijuana. The authors consider possible mechanisims underlying this condition.

Baumann GP. Growth hormone doping in sports: A critical review of use and detection strategies. (review). Endocrine Reviews 33(2): 155-186, 2012. (248 refs.)

GH is believed to be widely employed in sports as a performance-enhancing substance. Its use in athletic competition is banned by the World Anti-Doping Agency, and athletes are required to submit to testing for GH exposure. Detection of GH doping is challenging for several reasons including identity/similarity of exogenous to endogenous GH, short half-life, complex and fluctuating secretory dynamics of GH, and a very low urinary excretion rate. The detection test currently in use (GHisoform test) exploits the difference between recombinant GH (pure 22K-GH) and the heterogeneous nature of endogenousGH (several isoforms). Its main limitation is the short window of opportunity for detection (similar to 12-24 h after the last GH dose). A second test to be implemented soon (the biomarker test) is based on stimulation of IGF-I and collagen III synthesis by GH. It has a longer window of opportunity (1-2 wk) but is less specific and presents a variety of technical challenges. GH doping in a larger sense also includes doping with GH secretagogues and IGF-I and its analogs. The scientific evidence for the ergogenicity of GH is weak, a fact that is not widely appreciated in athletic circles or by the general public. Also insufficiently appreciated is the risk of serious health consequences associated with high-dose, prolonged GH use. This review discusses the GH biology relevant to GH doping; the virtues and limitations of detection tests in blood, urine, and saliva; secretagogue efficacy; IGF-I doping; and information about the effectiveness of GH as a performance-enhancing agent.

Bitton A. Moving towards more equitable and integrated approaches for tobacco control and non-communicable diseases: invited commentary. (editorial). Tobacco Control 21(2): 273-273, 2012. (7 refs.)

Bombard JM; Dietz PM; Galavotti C; England LJ; Tong VT; Hayes DK et al. Chronic diseases and related risk factors among low-income mothers. Maternal and Child Health Journal 16(1): 60-71, 2012. (51 refs.)

The aim is to describe the burden of chronic disease and related risk factors among low-income women of reproductive age. We analyzed population-based data from the 2005-2006 Pregnancy Risk Assessment Monitoring System (PRAMS) for 14,990 women with a live birth in 7 states. We examined the prevalence of selected chronic diseases and related risk factors (preexisting diabetes, gestational diabetes, chronic hypertension, pregnancy-induced hypertension, obesity, smoking or binge drinking prior to pregnancy, smoking or excessive weight gain during pregnancy, and postpartum depressive symptoms) by Federal Poverty Level (FPL) (a parts per thousand currency sign100% FPL; 101-250% FPL; > 250% FPL). Approximately one-third of women were low-income (a parts per thousand currency sign100% FPL), one-third were near-low-income (101-250% FPL), and one-third were higher-income (> 250% FPL). Compared to higher-income women, low-income women were significantly more likely to smoke before or during pregnancy (34.2% vs. 14.4%, and 24.8% vs. 5.4%, respectively), be obese (22.2% vs. 16.0%), experience postpartum depressive symptoms (23.3% vs. 7.9%), have 3 or more chronic diseases and/or related risk factors (28.1% vs. 14.4%) and be uninsured before pregnancy (48.9% vs. 4.8%). Low-income women of reproductive age experienced a higher prevalence of selected chronic diseases and related risk factors. Enhancing services for these women in publicly-funded family planning clinics may help reduce disparities in pregnancy and long-term health outcomes in the poor.

Borland R. The need for new strategies to combat the epidemic of smoking-related harm. (editorial). Tobacco Control 21(2): 287-288, 2012. (16 refs.)

Bramness JG; Skurtveit S; Morland J; Engeland A. An increased risk of motor vehicle accidents after prescription of methadone. Addiction 107(5): 967-972, 2012. (50 refs.)

Aims: To investigate whether exposure to methadone affects the risk of motor vehicle accident with personal injury. Design: Cohort study linking three Norwegian administrative registries using unique person identifiers. Setting: Information was retrieved from the Norwegian Prescription Database on any prescriptions ever received by the individuals for methadone and all prescriptions for benzodiazepines. The Norwegian Road Accident Registry provided information about motor vehicle accidents involving personal injuries on Norwegian roads. The Central Population Registry provided demographic information on all residents in Norway. Participants: All Norwegian adults aged 18-69 years were observed for 2.5 years. Measurements Standardized incidence ratio (SIR) was calculated by comparing the incidence of traffic accidents with personal injuries in patients exposed to methadone with the incidence in those not exposed. Findings: During the 4626 person-years observed in patients exposed to methadone, there were 26 motor vehicle accidents. There were very few accidents among the females who received methadone and they had no increased risk of being involved in motor vehicle accidents (SIR 1.1; 95% CI 0.2-3.1). We observed an increased risk of involvement in accidents among males (SIR 2.4; 95% CI 1.5-3.6). This figure did not change significantly when exposure to benzodiazepines was excluded. Conclusions: Men exposed to methadone appear to have an increased risk of being involved in motor vehicle accidents involving personal injuries. This increased risk could not be explained by exposure of benzodiazepines.

Brown A; McNeill A; Mons U; Guignard R. Do smokers in Europe think all cigarettes are equally harmful? European Journal of Public Health 22(Supplement 1): 35, 2012. (28 refs.)

Background: Despite the ban on misleading descriptors such as light or mild cigarettes in Europe, there are still widespread misperceptions of the relative harmfulness of different brands of cigarettes among smokers. This study examined the extent to which smokers in three European countries believed that some cigarette brands are less harmful and why, using data from the International Tobacco Control (ITC) Europe surveys. Methods: Cross-sectional analyses were completed among nationally representative samples of 4,956 current smokers (aged >= 18) from Germany (n = 1,515), France (n = 1,735) and the United Kingdom (n = 1,706) conducted between September 2006 and November 2007. Logistic regression models examined whether outcomes, including beliefs that some cigarettes could be less harmful than others, varied by socio-demographic and country of residence. Findings: Around a quarter of smokers in the UK and France, and a third in Germany believed some cigarettes are less harmful than others. Overall, of smokers who falsely believed that some cigarettes are less harmful, 86.3% thought that tar/nicotine yields, 48.7% taste, and 40.4% terms on packs such as 'smooth' or 'ultra' indicated less harmful brands. About a fifth of smokers across all countries chose their brand based on health reasons, and a similar proportion gave tar yields as a reason for choosing brands. Conclusions: Our research suggests that the current European Tobacco Products Directive is inadequate in eliminating misperceptions about the relative risk of brand descriptors on cigarettes. There is therefore an urgent need to protect smokers in Europe from these misperceptions via stronger measures such as plain packaging regulations.

Callaghan RC; Cunningham JK; Allebeck P; Arenovich T; Sajeev G; Remington G et al. Methamphetamine use and schizophrenia: A population-based cohort study in California. American Journal of Psychiatry 169(4): 389-396, 2012. (38 refs.)

Objective: Clinical investigators in Japan have long suggested that exposure to methamphetamine might cause a persistent schizophrenia-like psychosis. This possibility is discounted in the Western literature. To investigate the relationship between drug use and later schizophrenia, the authors conducted a large-scale cohort study of drug users initially free of persistent psychosis. Method: A population-based cohort study was conducted using data from California inpatient hospital discharge records from 1990 through 2000. Patients with methamphetamine-related conditions (N=42,412) and those with other drug use disorders (cannabis, cocaine, alcohol, and opioids) were propensity score-matched to individuals with primary appendicitis who served as a population proxy comparison group; the methamphetamine cohort was also matched to the other drug cohorts. Cox modeling was used to estimate differences between matched groups in the rates of subsequent admission with schizophrenia diagnoses. Results: The methamphetamine cohort had a significantly higher risk of schizophrenia than the appendicitis group (hazard ratio=9.37) and the cocaine, opioid, and alcohol groups (hazard ratios ranging from 1.46 to 2.81), but not significantly different from that of the cannabis group. The risk of schizophrenia was higher in all drug cohorts than in the appendicitis group. Conclusions: Study limitations include difficulty in confirming schizophrenia diagnoses independent of drug intoxication and the possibility of undetected schizophrenia predating drug exposure. The study's findings suggest that individuals with methamphetamine-related disorders have a higher risk of schizophrenia than those with other drug use disorders, with the exception of cannabis use disorders. The elevated risk in methamphetamine users may be explained by shared etiological mechanisms involved in the development of schizophrenia.

Carson KV; Brinn MP; Peters M; Veale A; Esterman AJ; Smith BJ. Interventions for smoking cessation in Indigenous populations. (review). Cochrane Database of Systematic Reviews 1: article CD009046, 2012. (117 refs.)

Background: Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that of the non-Indigenous population. A disproportionate burden of substance-related morbidity and mortality exists as a result. Objectives: To evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. Search methods: The Cochrane Tobacco Addiction Group Specialised Register of Trials was searched (April 2011), with additional searches of MEDLINE (May 2011). Online clinical trial databases and publication references were also searched for potential studies. Selection criteria: We included randomized and non-randomized controlled trials for smoking cessation interventions in Indigenous populations. Interventions could include pharmacotherapies, cognitive and behavioural therapies, alternative therapies, public policy and combination therapies. No attempts were made to re-define Indigenous status for the purpose of including a study in this review. Data collection and analysis: Data pertaining to methodology, participants, interventions and outcomes were extracted by one reviewer and checked by a second, whilst methodological quality was extracted independently by two reviewers. Studies were assessed by qualitative narrative synthesis and where possible meta-analysis. The review process was examined by an Indigenous (Aboriginal) Australian for applicability, acceptability and content. Main results: Four studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with cognitive and behavioural therapies, whilst the remaining two used cognitive and behavioural therapy through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (risk ratio 1.43, 95% CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non-significant but clinically significant effect was observed in favour of the intervention (risk ratio 1.33, 95% CI 0.95 to 1.85, p=NS). Authors' conclusions: A significant health disparity exists, whereby Indigenous populations, a minority, are over-represented in the burden of smoking-related morbidity and mortality. This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non-Indigenous populations. Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results. The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence. However this evidence base is not strong with a small number of methodologically sound trials investigating these interventions. More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non-Indigenous populations.

Catalano RF; Fagan AA; Gavin LE; Greenberg MT; Irwin CE; Ross DA et al. Adolescent health 3: Worldwide application of prevention science in adolescent health. Lancet 379(9826): 1653-1664, 2012. (115 refs.)

The burden of morbidity and mortality from non-communicable disease has risen worldwide and is accelerating in low-income and middle-income countries, whereas the burden from infectious diseases has declined. Since this transition, the prevention of non-communicable disease as well as communicable disease causes of adolescent mortality has risen in importance. Problem behaviours that increase the short-term or long-term likelihood of morbidity and mortality, including alcohol, tobacco, and other drug misuse, mental health problems, unsafe sex, risky and unsafe driving, and violence are largely preventable. In the past 30 years new discoveries have led to prevention science being established as a discipline designed to mitigate these problem behaviours. Longitudinal studies have provided an understanding of risk and protective factors across the life course for many of these problem behaviours. Risks cluster across development to produce early accumulation of risk in childhood and more pervasive risk in adolescence. This understanding has led to the construction of developmentally appropriate prevention policies and programmes that have shown short-term and long-term reductions in these adolescent problem behaviours. We describe the principles of prevention science, provide examples of efficacious preventive interventions, describe challenges and potential solutions to take efficacious prevention policies and programmes to scale, and conclude with recommendations to reduce the burden of adolescent mortality and morbidity worldwide through preventive intervention.

Chatzikonstantinou A; Wolf ME; Hennerici MG. Ischemic stroke in young adults: Classification and risk factors. Journal of Neurology 259(4): 653-659, 2012. (26 refs.)

Our aim was to analyze an important subgroup represented by young adult patients (19-45 years) with acute ischemic stroke according to stroke classification (including the novel ASCO score), infarct types and risk factors. All patients up to 45 years of age with an acute ischemic stroke confirmed by MRI and treated in our stroke unit from 2006 to 2009 were recruited for this study. Patients were neurologically examined and underwent thorough stroke work-up. One hundred four patients (58 women, 46 men) with a mean age of 38 +/- 6.9 years were evaluated. The mean NIHSS score (+/- SD) was 3 +/- 5 on admission and 1 +/- 4 on discharge. The classification using TOAST/ASCO (grade 1) was as follows: Macroangiopathic 10.6%/8.7%, cardiac origin 21.2%/10.6%, microangiopathic 9.6%/9.6%, other causes 19.2%/13.5% and undetermined 39.4%/19.2% (for A0S0C0O0). The most common risk factors were smoking (55.2%), hypertension (31.4%) and hyperlipidemia (27.6%). Twenty nine of 74 patients with TEE (39.2%) had a patent foramen ovale (PFO). Hypoplastic posterior circulation (21.9%) and migraine (21.0%) were also quite common. Young adult ischemic stroke patients share many of the characteristic risk factors with the general elderly ischemic stroke population. If regular work-up includes TEE, a high percentage of young patients reveal comorbidities with PFO, hypoplasia of the posterior circulation and migraine. The ASCO classification should be favored for a better classification of coexisting stroke subtypes and lower number of undetermined etiologies in this patient group.

Clark DB; Chung T; Thatcher DL; Pajtek S; Long EC. Psychological dysregulation, white matter disorganization and substance use disorders in adolescence. Addiction 107(1): 206-214, 2012. (68 refs.)

Aims: Adolescents with substance use disorders (SUD) have difficulties with cognitive, behavioral and affective regulation. White matter (WM) disorganization has been observed in adolescents with SUD and may be related to psychological dysregulation. This study compared adolescents with SUD and control adolescents to investigate relationships among psychological dysregulation, WM disorganization and SUD symptoms. Design: Cross-sectional observation. Setting:Adolescents with SUD were recruited from SUD treatment programs. Controls were recruited from the community. Participants The 55 participants were aged 14-19; 35 with SUD and 20 controls without SUD. Measurements Psychological dysregulation was characterized by the Behavior Rating Inventory of Executive Function. WM disorganization was measured by diffusion tensor imaging, and fractional anisotropy, radial diffusivity and axial diffusivity were examined within cortical regions of interest. Findings: Compared to controls, SUD adolescents showed significantly greater psychological dysregulation and prefrontal and parietal WM disorganization. WM disorganization was correlated positively with psychological dysregulation and cannabis-related symptoms. In multivariate mediation models, the results were consistent with both the neurodevelopmental immaturity model, in which WM disorganization leads to psychological dysregulation and cannabis-related symptoms, and with the substance effects model, in which cannabis-related symptoms lead to WM disorganization and psychological dysregulation. Conclusions: In adolescents, substance use disorder and psychological dysregulation appear to be associated with reduced frontoparietal network white matter maturation.

Coffin PO; Coffin LS; Murphy S; Jenkins LM; Golden MR. Prevalence and characteristics of femoral injection among Seattle-area injection drug users. Journal of Urban Health 89(2): 365-372, 2012. (20 refs.)

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5-6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3-5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2-32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.

Coggins CRE; Ballantyne M; Curvall M; Rutqvist LE. The in vitro toxicology of Swedish snus. (review). Critical Reviews in Toxicology 42(4): 304-313, 2012. (48 refs.)

Three commercial brands of Swedish snus (SWS), an experimental SWS, and the 2S3 reference moist snuff were each tested in four in vitro toxicology assays. These assays were: Salmonella reverse mutation, mouse lymphoma, in vitro micronucleus, and cytotoxicity. Water extractions of each of the 5 products were tested using several different concentrations; the experimental SWS was also extracted using dimethyl sulfoxide (DMSO). Extraction procedures were verified by nicotine determinations. Results for SWS in the mutagenicity assays were broadly negative: there were occasional positive responses, but these were effectively at the highest concentration only (concentrations well above those suggested by regulatory guidelines), and were often associated with cytotoxicity. The 2S3 reference was unequivocally positive in one of the three conditions of the micronucleus assay (MNA), at the highest concentration only. Positive controls produced the expected responses in each assay. The SWS data are contrasted with data reported for combusted tobacco in the form of cigarettes, where strongly positive responses have been routinely reported for mutagenicity and cytotoxicity. These negative findings in a laboratory setting concur with the large amount of epidemiological data from Sweden, data showing that SWS are associated with considerably lower carcinogenic potential when compared with cigarettes.

Coppola M; Mondola R. 3,4-Methylenedioxypyrovalerone (MDPV): Chemistry, pharmacology and toxicology of a new designer drug of abuse marketed online. (review). Toxicology Letters 208(1): 12, 2012. (33 refs.)

The illicit marketplace of substances of abuse continually offers for sale legal alternatives to controlled drugs to a large public. In recent years, a new group of designer drugs, the synthetic cathinones, has emerged as a new trend, particularly among young people. The 3,4-methylenedioxypyrovalerone (MDPV), one of this synthetic compounds, caused an international alert for its cardiovascular and neurological toxicity. This substance, sold as bath salts, has caused many serious intoxications and some deaths in several countries. The aim of this paper is summarise the clinical, pharmacological and toxicological information about this new designer drug.

Degenhardt L; Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 379(9810): 55-70, 2012. (143 refs.)

This paper summarises data for the prevalence, correlates, and probable adverse health consequences of problem use of amphetamines, cannabis, cocaine, and opioids. We discuss findings from systematic reviews of the prevalence of illicit drug use and dependence, remission from dependence, and mortality in illicit drug users, and evidence for acute and chronic effects of illicit drug use. We outline the regional and global distribution of use and estimated health burden from illicit drugs. These distributions are likely to be underestimates because they have not included all adverse outcomes of drug use and exclude those of cannabis-the mostly widely used illicit drug. In high-income countries, illicit drug use contributes less to the burden of disease than does tobacco but a substantial proportion of that due to alcohol. The major adverse health effects of cannabis use are dependence and probably psychotic disorders and other mental disorders. The health-related harms of cannabis use differ from those of amphetamine, cocaine, and opioid use, in that cannabis contributes little to mortality. Intelligent policy responses to drug problems need better data for the prevalence of different types of illicit drug use and the harms that their use causes globally. This need is especially urgent in high-income countries with substantial rates of illicit drug use and in low-income and middle-income countries close to illicit drug production areas.

Dinis-Oliveira RJ; Santos A; Magalhaes T. "Foam cone" exuding from the mouth and nostrils following heroin overdose. Toxicology Mechanisms and Methods 22(2): 159-160, 2012. (16 refs.)

A "foam cone" exuding the mouth and nostrils is a recognized consequence of anoxia following pulmonary edema. In this report, we illustrate and explain this phenomenon in victims of heroin overdose.

Dray A; Perez P; Moore D; Dietze P; Bammer G; Jenkinson R et al. Are drug detection dogs and mass-media campaigns likely to be effective policy responses to psychostimulant use and related harm? Results from an agent-based simulation model. International Journal of Drug Policy 23(2): 148-153, 2012. (17 refs.)

Background: Agent-based simulation models can be used to explore the impact of policy and practice on drug use and related consequences. In a linked paper (Perez et al., 2011), we described SimAmph, an agent-based simulation model for exploring the use of psycho-stimulants and related harm amongst young Australians. Methods: In this paper, we use the model to simulate the impact of two policy scenarios on engagement in drug use and experience of drug-related harm: (i) the use of passive-alert detection (PAD) dogs by police at public venues and (ii) the introduction of a mass-media drug prevention campaign. Results: The findings of the first simulation suggest that only very high rates of detection by PAD dogs reduce the intensity of drug use, and that this decrease is driven mainly by a four-fold increase in negative health consequences as detection rates rise. In the second simulation, our modelling showed that the mass-media prevention campaign had little effect on the behaviour and experience of heavier drug users. However, it led to reductions in the prevalence of health-related conditions amongst moderate drug users and prevented them from becoming heavier users. Conclusion: Agent-based modelling has great potential as a tool for exploring the reciprocal relationships between environments and individuals, and for highlighting how intended changes in one domain of a system may produce unintended consequences in other domains. The exploration of these linkages is important in an environment as complex as the drug policy and intervention arena.

Durazzo TC; Meyerhoff DJ; Nixon SJ. A comprehensive assessment of neurocognition in middle-aged chronic cigarette smokers. Drug and Alcohol Dependence 122(1-2): 105-111, 2012. (63 refs.)

Background: The majority of studies investigating the neurocognitive consequences of chronic smoking have been conducted with adults 60 years and older. Therefore, the scope of neurocognitive dysfunction associated with chronic cigarette smoking in middle age (i.e., 30-60 age range) has not been fully delineated. Methods: Twenty-seven (44 +/- 9 years of age; 4 females) non-smoking and 30 smoking (49 +/- 8 years of age; 4 females) participants completed a comprehensive neurocognitive battery and measures of fine motor dexterity and postural stability. All participants were free of biomedical or psychiatric conditions that may have influenced neurocognitive and motor function. Results: Smokers performed significantly worse than non-smokers on the following domains: auditory-verbal and visuospatial learning, visuospatial memory, cognitive efficiency, executive skills, general intelligence, processing speed, fine motor dexterity and postural stability. The differences between smokers and non-smokers evidenced moderate to strong effect sizes and were not mediated by age, education, vocational level, estimated verbal intelligence or alcohol consumption. In smokers, a greater number of lifetime years of smoking was related to poorer performance on measures of cognitive efficiency, processing speed and visuospatial skills. Conclusions: Results from this middle-aged cohort replicated previous research and provides novel findings indicating that chronic smoking was associated with inferior performance on measures of general intelligence, visuospatial learning and memory and fine motor dexterity. Research that relates measures of neurobiological function/integrity to neurocognition is needed to better understand the mechanisms contributing to the poorer performance across multiple domains demonstrated by smokers.

Ezeabogu I; Copenhaver MM; Potrepka J. The influence of neurocognitive impairment on HIV treatment outcomes among drug-involved people living with HIV/AIDS. AIDS Care 24(3): 386-393, 2012. (27 refs.)

Findings to date indicate that it is feasible to deliver a brief behavioral risk reduction/medication adherence group intervention to HIV-infected injection drug users in a community-based setting. HIV infection and substance abuse can result in neurocognitive impairment and this is directly relevant to intervention development, because a significant number of people living with HIV/AIDS have a positive history of substance abuse and being able to successfully participate in behavioral interventions often requires a relatively high level of cognitive performance. The aim of the current study was to evaluate if changes in information, motivation, and behavior skills with respect to medication adherence, sex-and drug-risk behavior outcomes from baseline to post-intervention are predicted by cognitive impairment following the brief four-session Holistic Health for HIV intervention for HIV-infected Drug Users (3H+). Significant associations were found between change in motivation and certain neurocognitive performance domains. Findings suggest that it may be helpful to specifically tailor such behavioral interventions to accommodate cognitive impairment.

Ferrara G; Murray M; Winthrop K; Centis R; Sotgiu G; Migliori GB et al. Risk factors associated with pulmonary tuberculosis: Smoking, diabetes and anti-TNF alpha drugs. (review). Current Opinion in Pulmonary Medicine 18(3): 233-240, 2012. (69 refs.)

Purpose of review: Tuberculosis (TB) remains a global emergency and continues to kill 1.4 million people every year. The interaction between noncommunicable and infectious diseases like TB has important implications with regard to the attainment of the Millennium Development Goals (MDGs). Smoking, diabetes mellitus, anti-TNF alpha drugs and other immunosuppressive therapies are well known major risk factors associated with TB. The purpose of this review is to summarize the recent literature on these risk factors and interventions that reduce the risk. Recent findings: Mathematical models and aggregate data from the field show that smoking, diabetes and anti-TNF alpha drugs independently increase the risk of developing active TB. There is consensus on the great need for screening for active TB disease in patients with these conditions and targeted preventive interventions through a combined multidisciplinary approach. Summary: Smoking, diabetes mellitus, anti-TNF alpha drugs and new immunosuppressive treatments represent important common risk factors for TB. A high degree of clinical awareness of the possibility of TB should be considered in patients with these risk factors, and active screening and prevention should be undertaken. Further operational research is needed to optimize screening for latent Mycobacterium tuberculosis infection, instituting preventive intervention measures.

Fischer B; Dawe M; Mcguire F; Shuper PA; Jones W; Rudzinski K et al. Characteristics and predictors of health problems from use among high-frequency cannabis users in a Canadian university student population. Drugs: Education, Prevention and Policy 19(1): 49-58, 2012. (68 refs.)

Aims: Assess key cannabis use, risk and outcome characteristics among high-frequency cannabis users within a university student sample in Toronto, Canada. Methods: N = 134 active universities students (ages of 18-28) using cannabis at least three times per week were recruited by mass advertisement, telephone-screened and anonymously assessed by an interviewer-administered questionnaire. Relevant descriptive statistics are presented; subsequent univariate and multivariate logistic regression analyses (MLRA) identified independent predictors of experiencing physical or mental health problems. Findings: The majority of respondents used cannabis >5 years, almost daily and >1 times/day, socially and medically on occasion. In past 30 days, 79% used cannabis by deep inhalation, 38% drove a car after use, 45% had difficulty controlling or limiting use and 52% experienced negative mental/physical health effects, with few respondents reporting any past treatment. The MLRA identified 'difficulty controlling or limiting use' (OR = 3.40, 95% CI = 1.58-7.30), 'non-white ethnicity' (OR = 2.78, 95% CI = 1.13-6.83), and 'living with others' (OR = 2.37, 95% CI = 1.02-5.55) as independent predictors (p < 0.01) of negative health problems. Conclusions: Our sample was characterized by several use-related risks and problems, which may result in long-term burden of disease. University environment may offer suitable settings for targeted interventions. Determinants of future cannabis use and problems should be assessed in this population.

Gao JL; Chapman S; Sun SJ; Fu H; Zheng PP. The growth in newspaper coverage of tobacco control in China, 2000-2010. BMC Public Health 12: e-article 160, 2012. (26 refs.)

Background: Media coverage of tobacco-related issues can potentially shape individual beliefs, attitudes and behaviors about tobacco use. This study aims to describe news coverage of tobacco control related issues in Chinese newspapers from 2000 to 2010. Methods: All 1149 articles related to tobacco control were extracted from the Database of Chinese Important Newspapers and content analyzed for the period Jan 1, 2000 to Dec 31, 2010. The changing pattern of tobacco control topic, article type, viewpoint, and article origin, and their relationship were analysed. Results: News coverage of tobacco control related issues increased significantly (p < 0.01) from 2000 to 2010, with news coverage being relatively intensive in May and June (p < 0.01), around World No Tobacco Day. 24.9% (n = 286) of all articles focused on secondhand smoke, 25.3% (n = 291) warned about the dangers of active smoking, and 10.0% (n = 115) focused on prevention and cessation programs and campaigns. Tobacco control topics varied significantly between national vs city/regional newspapers (chi(2) = 24.09, p = 0.002) and article types (chi(2) = 193.35, p < 0.001). Articles in national newspapers had more coverage of the dangers of tobacco and on enforcing bans on tobacco-advertising. News stories centered around monitoring tobacco use and smoke free activity, while editorials focused on enforcing bans on tobacco-advertising, youth access and programs and campaigns. Letters to editors focused on the dangers of smoking, raising tax, and smoking cessation. More articles (50.4%) took an anti-tobacco position (compared with 10.5% which were pro-smoking), with the amount of negative coverage growing significantly across the decade. National articles tended to lean toward anti-tobacco, however, local articles tended mix of pro-tobacco and neutral/balance positions. Editorials seemed to be more anti-tobacco oriented, but letters to the editor tended to show a mix of anti-tobacco and pro-tobacco positions. Conclusion: Chinese newspapers are giving increasing attention to tobacco control, but coverage remains lower than in the USA and Australia. Health workers need to give higher priority to efforts to increase news coverage beyond the present concentration around World No Tobacco Day and to develop strategies for making tobacco control issues more newsworthy to both national and local news outlets.

Giraudon I; Vicente J; Matias J; Mounteney J; Griffiths P. Reducing drug related mortality in Europe: A seemingly intractable. public health issue. (editorial). Adicciones 24(1): 3-7, 2012. (20 refs.)

Drawing on an analysis of data from over 30 cohort studies, it can be estimated that between 10.000 and 20.000 opioid users die each year in Europe. Typically, annual mortality rates are between 10-20/1000, representing an excess mortality 10 to 20 times greater than expected. Most deaths occur among males in their mid-thirties. Four broad categories of cause of death can be identified: overdoses, diseases, suicide and trauma. While the long term trend in HIV related mortality among drug users is downwards, other causes of mortality have shown little sign of decreasing in recent years. Of particular concern are overdoses which account for 6300 to 8400 deaths reported annually. The fact that deaths have not decreased is surprising given the scaling up of treatment and other services. Opioid substitution treatment in particular is known to be protective and the numbers of those in substitution treatment in Europe has increased dramatically. A number of interrelated factors may help explain this intractable problem. These include: the possibility of an aging cohort becoming more vulnerable; the use of alcohol and other drugs; high levels of ill-health, risk behaviour, and co-morbidity; and social exclusion and marginalisation. Reducing overall morbidity among heroin users remains a key issue for Europe's public health services. More efforts are required to better understand and target both the direct and indirect factors associated with mortality among problem drugs users, if this major health cost associated with drug consumption is to be reduced.

Grant JE; Chamberlain SR; Schreiber L; Odlaug BL. Neuropsychological deficits associated with cannabis use in young adults. Drug and Alcohol Dependence 121(1-2): 159-162, 2012. (29 refs.)

Background: Cannabis is the most widely used illicit substance and has been associated with cognitive impairment. It is unclear whether such impairment can occur in the absence of potential confounding influences of co-morbid axis-I disorders and use of other illicit substances. Method: Young adult volunteers (18-29 years) were recruited from the general community on the basis of having no axis-I disorders or history of illicit substance use other than cannabis use. Subjects were then grouped according to presence or absence of cannabis use (>1 time/week over past 12 months). Cognition was compared between groups using selected paradigms from the CANTAB. Results: Cannabis users (N=16) and controls (N=214) did not differ significantly on salient demographic characteristics. Compared to controls, cannabis users showed significant impairments on quality of decision-making (Cambridge Gamble task), and executive planning (One Touch Stockings of Cambridge task). Response inhibition, spatial working memory, and sustained attention were intact. Conclusions: This study identified cognitive deficits in cannabis users even in the absence of axis-I disorders and a history of using other illicit drugs. Future work should use longitudinal designs to track whether these deficits predate cannabis use or are due to its consumption.

Hart H; Rubia K. Neuroimaging of child abuse: A critical review. (review). Frontiers in Human Neuroscience 6: e-article 52, 2012. (188 refs.)

Childhood maltreatment is a stressor that can lead to the development of behavior problems and affect brain structure and function. This review summarizes the current evidence for the effects of childhood maltreatment on behavior, cognition and the brain in adults and children. Neuropsychological studies suggest an association between child abuse and deficits in IQ, memory, working memory, attention, response inhibition and emotion discrimination. Structural neuroimaging studies provide evidence for deficits in brain volume, gray and white matter of several regions, most prominently the dorsolateral and ventromedial prefrontal cortex but also hippocampus, amygdala, and corpus callosum (CC). Diffusion tensor imaging (DTI) studies show evidence for deficits in structural interregional connectivity between these areas, suggesting neural network abnormalities. Functional imaging studies support this evidence by reporting atypical activation in the same brain regions during response inhibition, working memory, and emotion processing. There are, however, several limitations of the abuse research literature which are discussed, most prominently the lack of control for co-morbid psychiatric disorders, which make it difficult to disentangle which of the above effects are due to maltreatment, the associated psychiatric conditions or a combination or interaction between both. Overall, the better controlled studies that show a direct correlation between childhood abuse and brain measures suggest that the most prominent deficits associated with early childhood abuse are in the function and structure of lateral and ventromedial fronto-limbic brain areas and networks that mediate behavior and affect control. Future, large scale multimodal neuroimaging studies in medication-naive subjects, however, are needed that control for psychiatric co-morbidities in order to elucidate the structural and functional brain sequelae that are associated with early environmental adversity, independently of secondary co-morbid conditions.

Hays JT; McFadden DD; Ebbert JO. Pharmacologic agents for tobacco dependence treatment: 2011 update. Current Atherosclerosis Reports 14(1): 85-92, 2012. (48 refs.)

Tobacco use remains the most important worldwide cause of preventable death due mainly to cancer, cardiovascular disease, and chronic lung disease. If the current tobacco pandemic continues for another 20 years, the annual global tobacco-attributable mortality will exceed 8 million. In the US and many European countries, public health and tobacco control efforts combined with effective tobacco dependence treatment using combined behavioral treatment and pharmacotherapy have contributed significantly to steadily declining rates of tobacco use. Subsequent declines in cardiovascular disease and lung cancer death rates are directly attributable to these lower rates of tobacco use. Despite smoking bans, health warnings and effective pharmacotherapy, one in five Americans continue to smoke. Continued research in tobacco dependence treatment has resulted in newer and more effective pharmacotherapy. In this review, we provide a current update of pharmacologic agents for tobacco dependence treatment and a discussion of recent controversy regarding adverse effects of some these medications.

Hser YI; Kagihara J; Huang D; Evans E; Messina N. Mortality among substance-using mothers in California: A 10-year prospective study. Addiction 107(1): 215-222, 2012. (60 refs.)

Aims: To examine mortality rates and causes of death among a cohort of substance-using mothers and to identify risk factors that predict mortality. Design, setting, participants This is a prospective study of a cohort of 4447 substance using mothers (pregnant or parenting) who were enrolled during 2000-02 in 40 drug abuse treatment programs across California. Methods: All mothers were assessed at baseline using the Addiction Severity Index. Mortality data were obtained from the National Death Index and causes of death were coded using ICD-10. Standardized mortality ratios (SMR) were calculated relative to women in the general population adjusted for age. Proportional hazard (Cox) regression was used to identify risk factors predicting death. Results: At the end of 2010, 194 deaths were confirmed, corresponding to a crude mortality rate of 4.47 per 1000 person-years and SMR of 8.4 (95% confidence interval: 7.2-9.6). Drug overdose (28.8%), cardiovascular disease (10%), and alcohol or drug disorders (8.9%) were the leading causes of death. Baseline factors associated with higher mortality included older age, being white (relative to African American or Hispanic), heroin, alcohol, cocaine or marijuana (relative to methamphetamine) as the primary drug problem, drug injection and greater severity of employment, medical /health and psychiatric problems. Conclusions: Substance-using mothers have 8.4 times the mortality than that observed among US women of similar age. Greater severity of employment, medical/ health and psychiatric problems contributed to the elevated mortality.

Hussaarts P; Roozen HG; Meyers RJ; van de Wetering BJM; McCrady BS. Problem areas reported by substance abusing individuals and their concerned significant others. American Journal on Addictions 21(1): 38-46, 2012. (52 refs.)

Substance use disorders (SUDs) have a serious impact on several life areas, including family functioning. This study examined problem areas that patients with SUDs and their family members experience in terms of quality of relations, psychological problems, physical distress, and quality of life. A sample of 32 dyad-persons with SUDs and a family member were recruited from a substance abuse treatment program, and completed the Maudsley Addiction Profile health symptoms section, EuroQol-5D, Relationship Happiness Scale, Dyadic Adjustment Scale, and the Dedication Scale. Family members reported that four significant others were directly affected by patients addiction-related problems, while patients reported that less than three family members were affected by their addiction. Consistently, family members indicated that they were less content with their relationship than patients and evaluated the consequences of patients SUDs as more negative and severe than the patients themselves. Furthermore, patients and their family members reported comparable levels of physical and psychological distress and quality of life scores. These systematically obtained findings support the notion that relationships of patients and family members are disrupted and both need help to improve their physical and psychological well-being.

Kagaruki LK. Environmental health impacts of tobacco farming: A review of the literature. Invited commentary. (editorial). Tobacco Control 21(2): 196-197, 2012. (7 refs.)

Khaled SM; Bulloch AG; Williams JVA; Hill JC; Lavorato DH; Patten SB. Persistent heavy smoking as risk factor for major depression (MD) incidence: Evidence from a longitudinal Canadian cohort of the National Population Health Survey. Journal of Psychiatric Research 46(4): 436-443, 2012. (67 refs.)

Background: Reports of bidirectional associations between smoking and major depression (MD) have been interpreted as providing evidence for confounding by shared-vulnerability factors (SV) that predispose individuals to both conditions. If this is true, then smoking cessation may not reduce the risk of MD. From clinical practice and public health perspectives, the long-term outcomes associated with smoking persistence and cessation are potentially important and deserve exploration. To this end, the 12-year risk of MD in persistent heavy smokers and abstainers who were former-heavy smokers with and without adjustment for potential confounders were compared. Methods: Follow-up data from the National Population Health Survey (NPHS) was used. Multinomial logistic (ML) models were fit to identify potential confounders. Using proportional hazard (PH) models, unadjusted and adjusted hazard ratios (HRs) for MD outcome were estimated for different smoking patterns. Results: The unadjusted HR relating the risk of MD among current-heavy versus former-heavy smokers was 4.3 (95% CI: 2.6-6.9, p < 0.001). Current-heavy smoking predicted onset of MD (HR = 3.1, 95% CI: 1.9 -5.2, p < 0.001) even after adjustment for age, sex and stress the main confounders. However, this was not the case for the never, former-light, and current-light categories. Evidence of decreased risk of MD among former-heavy relative to current-heavy smokers as function of smoking cessation maintenance time was also found. Conclusions: Contrary to common beliefs about the benefits of smoking for mental health, our results suggest that current-heavy rather than ever-heavy smoking is a major determinant of MD risk and point towards the benefits of smoking cessation maintenance.

Kurniali PC; Henry L; Kurl R; Meharg JV. Inhalant abuse of computer cleaner manifested as angioedema. American Journal of Emergency Medicine 30(1): 265.e3, 2012. (12 refs.)

Inhalant abuse is the intentional inhalation of chemical vapors or volatile substance to achieve a euphoric effect. Although no statistical data are reported yet, inhalant abuse is potentially life-threatening and has resulted in a wide range of toxic effects such as central nervous system depression, seizures, aspiration, cardiac arrhythmia, asphyxiation, hypoxia, metabolic acidosis, and sudden death among others. We are reporting a 25-year-old white man who was brought to the emergency department after inhaling aerosolized computer-cleaning spray composed of difluoroethane. He was found to have marked upper and lower lip facial swelling consistent with angioedema. The patient also had a prolonged QT interval, mild inspiratory stridor, but no urticaria. In this case, we believe the difluoroethane-related angioedema represents either idiopathic or bradykinin-induced angioedema.

Mackay DF; Nelson SM; Haw SJ; Pell JP. Impact of Scotland's smoke-free legislation on pregnancy complications: Retrospective cohort study. PLoS Medicine 9(3): e-article 1001175, 2012. (28 refs.)

Background: Both active smoking and environmental tobacco smoke exposure are associated with pregnancy complications. In March 2006, Scotland implemented legislation prohibiting smoking in all wholly or partially enclosed public spaces. The aim of this study was to determine the impact of this legislation on preterm delivery and small for gestational age. Methods and Findings: We conducted logistic regression analyses using national administrative pregnancy data covering the whole of Scotland. Of the two breakpoints tested, 1 January 2006 produced a better fit than the date when the legislation came into force (26 March 2006), suggesting an anticipatory effect. Among the 716,941 eligible women who conceived between August 1995 and February 2009 and subsequently delivered a live-born, singleton infant between 24 and 44 wk gestation, the prevalence of current smoking fell from 25.4% before legislation to 18.8% after legislation (p<0.001). Three months prior to the legislation, there were significant decreases in small for gestational age (-4.52%, 95% CI -8.28, -0.60, p = 0.024), overall preterm delivery (-11.72%, 95% CI -15.87, -7.35, p<0.001), and spontaneous preterm labour (-11.35%, 95% CI -17.20, -5.09, p = 0.001). In sub-group analyses, significant reductions were observed among both current and never smokers. Conclusions: Reductions were observed in the risk of preterm delivery and small for gestational age 3 mo prior to the introduction of legislation, although the former reversed partially following the legislation. There is growing evidence of the potential for tobacco control legislation to have a positive impact on health.

Marlow ML. Smoking bans and acute myocardial infarction incidence. Applied Economics Letters 19(16): 1577-1581, 2012. (17 refs.)

This article examines the effect of statewide smoking bans on Acute Myocardial Infarction (AMI) incidence. After controlling for endogeneity between smoking ban status and AMI incidence, an econometric model indicates that smoking bans exerted no significant effect over 2005-2009 in the 50 states. The evidence thus suggests that findings from previous studies that bans lowered AMI incidence from 6% to 47% were the result of possible sampling bias and/or from examining periods too short with which to fully evaluate the longer term effects from bans.

Martin JA; Campbell A; Killip T; Kotz M; Krantz MJ; Kreek MJ et al. QT interval screening in methadone maintenance treatment: Report of a SAMHSA expert panel (vol 30, pg 283, 2011) (correction). Journal of Addictive Diseases 31(1): 91, 2012. (1 refs.)

Mateja WA; Nelson DB; Kroelinger CD; Ruzek S; Segal J. The association between maternal alcohol use and smoking in early pregnancy and congenital cardiac defects. Journal of Women's Health 21(1): 26-34, 2012. (51 refs.)

Background: Alcohol use is an extremely prevalent but preventable risk factor among women seeking to become pregnant. Many women continue to use alcohol in the early stages of pregnancy before they are aware they are pregnant. Research is unclear about the role of maternal alcohol use during pregnancy and congenital cardiac defects, one of the leading types of birth defects in the United States. Methods: Data from the Pregnancy Risk Assessment Monitoring Survey (PRAMS) were used to examine maternal alcohol use and its association with congenital cardiac defects. Various measures of alcohol use in the 3 months prior to pregnancy, as well as smoking and other risk factors for congenital cardiac defects, were linked to birth certificate data for nine states over a 10-year period (1996-2005). In this case-control study, cases included infants with a congenital cardiac defect indicated on the birth certificate, and the control group consisted of healthy, normal weight infants with no indication of a congenital abnormality on their birth certificate. Complex samples logistic regression models were used to study the relationships between several measures of alcohol use, including binge drinking and binge drinking on more than once occasion, and the interaction between alcohol use and smoking with the odds of congenital cardiac defects. Results: A significant increase in congenital cardiac defects was found among mothers who reported binge drinking more than once in the 3 months prior to pregnancy compared to mothers who did not report binge drinking (adjusted odds ratio [aOR] 2.99, 95% confidence interval [CI] 1.19-7.51). There was a significant interaction between any binge drinking or binge drinking more than once and cigarette use, which corresponded to a substancial increase in congenital cardiac defects (aOR 12.65, 95% CI 3.54-45.25 and aOR 9.45, 95% CI 2.53-35.31, respectively). Conclusions: Multiple episodes of maternal binge drinking in early pregnancy may increase the odds of congenital cardiac defects, and we found this relationship was more dramatic when combined with maternal smoking.

Milne B; Vandenkerkhof E; Phelan R; Brien J; Forkert L; Nakatsu K. Does carbon monoxide play a role in cigarette smoke dependence? Addiction Research & Theory 20(2): 138-144, 2012. (23 refs.)

Purpose: Nicotine is the primary constituent of cigarette smoke responsible for dependence but other components may play a role. Carbon monoxide (CO) is one candidate since it is synthesized endogenously with multiple physiological effects. This investigation was conducted to determine whether CO alters cravings associated with cigarette smoke withdrawal. Methods: With ethics approval and consent, 131 smokers were assigned to receive: (1) inhaled CO + Nicotine nasal spray (2) Air + Nicotine nasal spray (3) CO + Placebo nasal spray or (4) Air + Placebo nasal spray. Two craving scales (adapted from Hughes and Hatsukami [Hughes, J.R., & Hatsukami, D. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43, 289-294] and Shiffman-Jarvik [Shiffman, S.M., & Jarvik, M.E. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacology, 50, 35-39] referred to as HH and SJ, respectively) and a mood state questionnaire were used to assess withdrawal relief. Results: Craving scores were reduced pre- to post-treatment to some extent in all groups. On the last test day, HH revealed time by treatment differences between CO + Nicotine and either CO Only (p = 0.03) or Nicotine Only (p = 0.02). SJ revealed overall differences in pre- to post-treatment cravings (p = 0.03) with marginal time by treatment differences between craving scores in the Placebo group versus the Nicotine Only and the Nicotine + CO groups (p = 0.06 and 0.07, respectively). Treatment subjects were almost twice as likely to inhale the maximal gas (odds ratios 1.6-2.0) compared to Placebo, suggesting that all treatments (including CO Only) were discriminated from Placebo. Conclusions: Our investigation suggests that CO exerts pharmacological effects, which may modulate craving processes associated with cigarette withdrawal, and exploration for the role of CO and other cigarette smoke constituents is warranted.

Moran P; Coffey C; Romaniuk H; Olsson C; Borschmann R; Carlin JB et al. The natural history of self-harm from adolescence to young adulthood: A population-based cohort study. Lancet 379(9812): 236-243, 2012. (32 refs.)

Background: Knowledge about the natural history of self-harm is scarce, especially during the transition from adolescence to young adulthood, a period characterised by a sharp rise in self-inflicted deaths. From a repeated measures cohort of a representative sample, we describe the course of self-harm from middle adolescence to young adulthood. Methods: A stratified, random sample of 1943 adolescents was recruited from 44 schools across the state of Victoria, Australia, between August, 1992, and January, 2008. We obtained data pertaining to self-harm from questionnaires and telephone interviews at seven waves of follow-up, commencing at mean age 15.9 years (SD 0.49) and ending at mean age 29.0 years (SD 0.59). Summary adolescent measures (waves three to six) were obtained for cannabis use, cigarette smoking, high-risk alcohol use, depression and anxiety, antisocial behaviour and parental separation or divorce. Findings: 1802 participants responded in the adolescent phase, with 149 (8%) reporting self-harm, More girls (95/947 [10%]) than boys (54/855 [6%]) reported self-harm (risk ratio 1.6, 95% CI 1.2-2.2). We recorded a substantial reduction in the frequency of self-harm during late adolescence. 122 of 1652 (7%) participants who reported self-harm during adolescence reported no further self-harm in young adulthood, with a stronger continuity in girls (13/888) than boys (1/764). During adolescence, incident self-harm was independently associated with symptoms of depression and anxiety (HR 3.7, 95% CI 2.4-5.9), antisocial behaviour (1.9, 1.1-3.4), high-risk alcohol use (2.1, 1.2-3.7), cannabis use (2.4, 1.4-4.4), and cigarette smoking (1.8, 1.0-3.1). Adolescent symptoms of depression and anxiety were clearly associated with incident self-harm in young adulthood (5.9, 2.2-16). Interpretation Most self-harming behaviour in adolescents resolves spontaneously. The early detection and treatment of common mental disorders during adolescence might constitute an important and hitherto unrecognised component of suicide prevention in young adults.

Morgan CJA; Curran HV. Ketamine use: A review. (review). Addiction 107(1): 27-38, 2012. (105 refs.)

Aims: Ketamine remains an important medicine in both specialist anaesthesia and aspects of pain management. At the same time, its use as a recreational drug has spread in many parts of the world during the past few years. There are now increasing concerns about the harmful physical and psychological consequences of repeated misuse of this drug. The aim of this review was to survey and integrate the research literature on physical, psychological and social harms of both acute and chronic ketamine use. Method: The literature on ketamine was systematically searched and findings were classified into the matrix of Nutt et al.'s (2007) rational scale for assessing the harms of psychoactive substances. Results: A major physical harm is ketamine induced ulcerative cystitis which, although its aetiology is unclear, seems particularly associated with chronic, frequent use of the drug. Frequent, daily use is also associated with neurocognitive impairment and, most robustly, deficits in working and episodic memory. Recent studies suggest certain neurological abnormalities which may underpin these cognitive effects. Many frequent users are concerned about addiction and report trying but failing to stop using ketamine. Conclusions: The implications of these findings are drawn out for treatment of ketamine-induced ulcerative cystitis in which interventions from urologists and from addiction specialists should be coordinated. Neurocognitive impairment in frequent users can impact negatively upon achievement in education and at work, and also compound addiction problems. Prevention and harm minimization campaigns are needed to alert young people to these harmful and potentially chronic effects of ketamine.

Morgan CJA; Gardener C; Schafer G; Swan S; Demarchi C; Freeman TP et al. Sub-chronic impact of cannabinoids in street cannabis on cognition, psychotic-like symptoms and psychological well-being. Psychological Medicine 42(2): 391, 2012. (39 refs.)

Background. Cannabis varies considerably in levels of its two major constituent cannabinoids -(delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Recently, we found evidence that those who smoked cannabis containing detectable levels of CBD had fewer psychotic-like symptoms than those whose cannabis had no CBD. The present study aimed, first, to replicate those findings and, second, to determine whether protective effects of CBD may extend to other harms of cannabis, such as memory impairment and reduced psychological well-being. Method. A total of 120 current cannabis smokers, 66 daily users and 54 recreational users were classified into groups according to whether analysis of their hair revealed the presence or absence of CBD and high versus low levels of THC. All were assessed on measures of psychosis-like symptoms, memory (prose recall; source memory) and depression/anxiety. Results. Lower psychosis-like symptoms were found in those whose hair had CBD compared with those without. However, this was seen only in recreational users, who had higher levels of THC in their hair. Higher THC levels in hair were associated with increased depression and anxiety. Prose recall and source memory were poorer in daily users with high THC levels in hair while recognition memory was better in individuals with CBD present in hair. Conclusions. CBD attenuates the psychotic-like effects of cannabis over time in recreational users. Higher THC negatively impacts on memory and psychological well-being. These findings raise concerns for the harms stemming from use of varieties such as 'skunk' (sensimillia), which lack any CBD but currently dominate the supply of cannabis in many countries.

Murray DB; Potts S; Haxton C; Jackson G; Sandilands EA; Ramsey J et al. 'Ivory wave' toxicity in recreational drug users: Integration of clinical and poisons information services to manage 'legal high' poisoning. Clinical Toxicology 50(2): 108-113, 2012. (13 refs.)

Background. Novel psychoactive substances or 'legal highs' can be defined as psychoactive substances that have been developed to avoid existing drug control measures. Consistency of name, but with change in the content of the product, may cause harm. This could result in clusters of users being poisoned and developing unexpected physical and psychiatric symptoms. We describe such an event and the clinical phenotypes of a cluster of patients poisoned with a novel psychoactive substance in 'ivory wave' and analyze data from the National Poisons Information Service (NPIS) to estimate use across the United Kingdom. In addition, the likely active ingredient in this cluster of 'ivory wave' poisonings was identified. Methods. An analysis of consecutive patients attending the Royal Infirmary of Edinburgh emergency department in July and August 2010 with self-reported 'ivory wave' use was performed. Over a similar time frame, poisons enquiries regarding 'ivory wave' to the UK NPIS, by telephone and via the internet-based TOXBASE (R) poisons database (www.toxbase.org), were analyzed. A sample of 'ivory wave' powder and biological fluids from poisoned patients were investigated to determine the active ingredient. Results. Thirty four emergency attendances due to 'ivory wave' toxicity were identified. The mean +/- SD (range) age was 28.6 +/- 7.8 (16-44) years. Patients demonstrated a toxidrome which lasted several days, characterized by tachycardia (65%), tachypnoea (76%), dystonia (18%), rhabdomyolysis (96%), leucocytosis (57%), agitation (62%), hallucinations (50%), insomnia (32%) and paranoia (21%). Enquiries to NPIS suggest that 'ivory wave' poisoning occurred throughout the United Kingdom. A sample of 'ivory wave ' powder was analyzed and found to contain desoxypipradrol, which was also identified in biological fluids from 4 out of 5 patients tested. Discussion. A cluster of cases presenting after use of a novel psychoactive substance was identified in Edinburgh and desoxypipradrol was identified as the likely cause. It was associated with prolonged psychiatric symptoms as a key feature. This chemical was regulated in response to the wider UK outbreak, which NPIS data suggest was geographically widespread but probably short lived. Conclusion. Novel psychoactive substances can produce significant toxicity and data from poisons centres may be used to indirectly detect new 'legal highs' that are causing clinical toxicity.

Nyamathi A; Marfisee M; Slagle A; Greengold B; Liu YH; Leake B. Correlates of depressive symptoms among homeless young adults. Western Journal of Nursing Research 34(1): 97-117, 2012. (64 refs.)

Adolescent homelessness has received increasing attention because of its fast growth throughout the United States and the poor mental outcomes experienced by homeless young people. This cross-sectional study (N = 156) identified correlates of depressive symptomatology among homeless young adults and investigated how depressive symptoms are influenced by the coping strategies these young adults use. The findings are based on analysis of baseline data collected for a hepatitis vaccination intervention pilot study conducted in partnership with a young adult's drop-in center in Santa Monica, California. Standardized tools assessed drug use history, coping ability, and psychiatric symptomatology. Linear regression modeling was used to identify correlates of depressive symptom severity. Poor perceived physical health, recent crack cocaine use, and recent use of tranquilizers were significantly associated with increased severity of depressive symptoms. Self-destructive escape, nondisclosure/avoidance, passive problem solving, and thoughts of harming self were also associated with increased severity of depressive symptoms.

Palmer RS; McMahon TJ; Moreggi DI; Rounsaville BJ; Ball SA. College student drug use: Patterns, concerns, consequences, and interest in intervention. Journal of College Student Development 53(1): 124-132, 2012. (14 refs.)

Although previous surveys have indicated high rates of illicit and prescription drug misuse among college students, few have assessed negative consequences, personal concerns, or interest in interventions for drug use. In a survey of 262 college students who self-reported lifetime use of an illicit drug, 69% reported at least one negative consequence over the course of their lifetime and 63% in the past year. Many also reported being moderately concerned (28%) about their drug or medication misuse and moderately interested in some form of intervention (76%). The frequency of marijuana use and medication misuse in the past month was related to increased negative consequences and personal concerns even when controlling for the frequency of past month alcohol use. There were relatively few differences as a function of gender or year in college.

Paur R; Wallner C; Hermann P; Stollberger C; Finsterer J. Neurological abnormalities in opiate addicts with and without substitution therapy. American Journal of Drug and Alcohol Abuse 38(3): 239-245, 2012. (44 refs.)

Background: Opiate addicts are generally prone to comorbidities, including neurological disease, because of the toxic effect of the drug, the combined use of opiates, and other neurotoxic substances, infections, bacteriemia from intravenous drug use, atherosclerosis from smoking or hyperlipidemia, trauma, reduced primitive reflexes during intoxication, compression neuropathies, rhabdomyolysis, or rhythm abnormalities and heart failure. Objective: Few data are available about neurological abnormalities in opiate addicts. Methods: Consecutively included were all in- and outpatients of the Department for Drug Disease, Otto Wagner Hospital, Vienna, Austria, between 2003 and 2005, with and without an opiate substitution therapy. All patients underwent a clinical neurological examination alternatively by two trainees. Results: A total of 460 patients (110 women, 350 men) aged 17-54 years were investigated. Opiate consumption lasted <2 years in 19 patients, 2-8 years in 187 patients, and >8 years in 196 patients. In 58 patients, no information about the duration of opiate consumption was available. Of the 460 patients 407 were under an opiate substitution therapy, 53 without. The neurological history was positive for epilepsy in 68 and for head trauma in 18 cases. The most frequent abnormalities were abnormal, dysdiadochokinesia, impaired stance, resting tremor, and miosis. The number of neurological abnormalities most frequently found in a single patient was eight (n = 269 patients). The number of neurological abnormalities increased with duration of addiction. The neurological diagnoses most frequently established were epilepsy (n = 22), polyneuropathy (n = 12), and pressure palsies (n = 4). Absence of direct or indirect reaction to light, miosis, abnormal heel-to-knee test, lower limb sensory disturbances, and unsafe gait were more frequent in patients under substitution than in patients without and vice versa for mydriasis, myopia, and resting tremor. Conclusion: All opiate addicts under substitution therapy present with neurological abnormalities. The high prevalence of neurological abnormalities in opiate addicts implies regular referral of these patients to the neurologist to improve their outcome.

Perni UC; Wikstrom AK; Cnattingius S; Villamor E. Interpregnancy change in smoking habits and risk of preeclampsia: A population-based study. American Journal of Hypertension 25(3): 372-378, 2012. (28 refs.)

Background: Maternal smoking has been associated with decreased risk of preeclampsia; however, it is uncertain whether this association is causal. An argument for causality would be strengthened if changes in smoking status across consecutive pregnancies were related to the risk of preeclampsia. Methods: We used data from the National Swedish Birth Register to ascertain the associations between changes in smoking status during the first two successive pregnancies and risk of preeclampsia in the second pregnancy in 371,627 women between 1992 and 2006. Multivariable logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Compared to women who did not smoke in either pregnancy, the risk of preeclampsia was reduced in women who smoked in both pregnancies (adjusted OR = 0.54; 95% CI = 0.47, 0.63), in those who only smoked in second pregnancy (OR = 0.76; 95% CI = 0.58, 0.99) and, to a lesser extent, in women who smoked only in the first pregnancy (OR = 0.81; 95% CI = 0.70, 0.94). History of preeclampsia in the first pregnancy did not substantially modify these associations. Conclusion: These data add support to a causal interpretation of the observed inverse association between smoking during pregnancy and risk of preeclampsia.

Ramo DE; Liu H; Prochaska JJ. Tobacco and marijuana use among adolescents and young adults: A systematic review of their co-use. (review). Clinical Psychology Review 32(2): 105, 2012. (124 refs.)

Tobacco (TOB) and marijuana (MJ) are the most widely used drugs among adolescents and young adults. The literature on their co-use, however, has not been systematically reviewed. We identified 163 English language articles published from 1999 to 2009 examining TOB and MJ co-use, correlates or consequences of co-use, or interventions for prevention or cessation of co-use with participants aging 13-25 years. Most studies (n = 114, 70%) examined TOB and MJ co-use, and 85% of relationships studied indicated a significant association. Fifty-nine studies (36%) examined correlates or consequences of co-use. Factors consistently associated with increased likelihood of co-use, defined as significant associations in at least four studies, were African-American ethnicity, mental and physical health characteristics (e.g., high-intensity pleasure temperament), and school characteristics (e.g., good grades). The only consistent consequence of co-use was exacerbation of mental health symptoms. Few studies examined prevention (n = 3) or cessation (n = 2) interventions for TOB and MJ co-use, and the findings were stronger for prevention efforts. A sufficient literature base has documented that TOB and MJ use are strongly related in young people, yet few consistent correlates and consequences of co-use have been identified to inform intervention targets.

Rath M. Energy drinks: What is all the hype? The dangers of energy drink consumption. Journal of the American Academy of Nurse Practitioners 24(2): 70-76, 2012. (21 refs.)

Purpose: To describe the adverse effects associated with energy drink consumption among adolescents and young adults. Data sources: Review of literature utilizing Medscape, the Internet, MD Consult, and CINAHL. The following search terms were used: Energy drinks, caffeine, guarana, taurine, ginseng, sugar, and caffeine toxicity. Search was limited to English language sources from 2005 to 2010. Conclusions: The popularity of energy drinks and the rapid growth of their excessive consumption among adolescents and young adults have brought about great concern in regards to overall health and well-being. Caffeine, which is readily available to minors, is the most commonly used psychoactive substance in the world and imposes a potentially harmful influence on health, academic performance, and personal adjustments. Teens and young adults account for nearly $2.3 billion of energy drink sales. Adolescents and young adults are often unaware that various products, such as energy drinks, herbal medications, and various other medications that promote alertness, contain caffeine. When these products are taken together, caffeine toxicity and severe adverse effects can occur. Implications for practice: Practitioners need to be aware of the consequences of energy drink consumption and be prepared to provide appropriate patient education.

Safaa AM; Markham R; Jayasinghe R. Marijuana-induced recurrent acute coronary syndrome with normal coronary angiograms. Drug and Alcohol Review 31(1): 91-94, 2012. (8 refs.)

We report a case of a man in his 40s presented to the emergency department twice, 1 month apart, with severe ischaemic sounding chest pain within 1 h of smoking marijuana on both occasions. He had elevated serial biomarkers and ischaemic electrocardiogram changes. His coronary angiograms on both episodes were entirely normal along with normal echocardiogram. This potentially suggests a coronary vasospasm as an underlying mechanism for these non-ST elevation myocardial infarctions. This should alert clinicians and the public alike to this potential risk of cannabis use.

Smyk DS; Rigopoulou EI; Muratori L; Burroughs AK; Bogdanos DP. Smoking as a risk factor for autoimmune liver disease: What we can learn from primary biliary cirrhosis. (review). Annals of Hepatology 11(1): 7-14, 2012. (124 refs.)

Primary biliary cirrhosis (PBC) is a cholestatic liver disease characterised by the immune-mediated destruction of biliary epithelial cells in small intrahepatic bile ducts. The disease is characterised by circulating anti-mitochondrial antibodies (AMA) as well as disease specific anti-nuclear antibodies (ANA), cholestatic liver biochemistry, and characteristic histology. The disease primarily affects middle-aged females, and its incidence is apparently increasing worldwide. Epidemiological studies have indicated several risk factors for the development of PBC, with family history of PBC, recurrent urinary tract infection, and smoking being the most widely cited. Smoking has been implicated as a risk factor in several autoimmune diseases, including the liver, by complex mechanisms involving the endocrine and immunological systems to name a few. Studies of smoking in liver disease have also shown that smoking may progress the disease towards fibrosis and subsequent cirrhosis. This review will examine the literature surrounding smoking as a risk factor for PBC, as well as a potential factor in the progression of fibrosis in PBC patients.

Stankovic A; Nikolic M; Arandelovic M. Exposure to environmental tobacco smoke and absence from work in women in Nis, Serbia. Central European Journal of Public Health 20(1): 24-28, 2012. (29 refs.)

Exposure to environmental tobacco smoke leads to very serious health effects, especially on the respiratory system. The objective of this paper was to estimate the influence of passive smoking on absence from work because of respiratory problems in women. The study sample consisted of 497 women aged 40-56 who live in an area with identical outdoor air pollution. Environmental tobacco smoke exposure was recorded in 346 women. Data about respiratory symptoms in women were entered into a structured questionnaire. Statistics tests showed no significant difference of living conditions, keeping pets, hereditary predisposition among women. The occurrence of congested nose (OR=3.47; 95% CI=1.38-9.01), nasal secretion (OR=3.48; 95% CI=1.38-9.02) and sinusitis (OR=2.88; 95% CI=1.22-6.89) was significantly higher in women who were exposed to environmental tobacco smoke. Primary health care need for respiratory symptoms due to the effect of passive smoking is higher in the exposed women. Passive smoking can be a risk factor for the appearance of respiratory symptoms and illness in women that causes absence from work.

Tanaka K; Miyake Y; Arakawa M. Smoking and prevalence of allergic disorders in Japanese pregnant women: Baseline data from the Kyushu Okinawa Maternal and Child Health Study. Environmental Health 11: e-article 15, 2012. (33 refs.)

Background: Studies on the associations between smoking and allergic diseases have mostly focused on asthma. Epidemiological studies in adults on the effects of smoking on allergic diseases other than asthma, such as eczema and rhinoconjunctivitis, have been limited, and the information that is available has been inconsistent. The aim of this study was to investigate the association between smoking status and environmental tobacco smoke (ETS) exposure and the prevalence of allergic diseases. Methods: Study subjects were 1743 pregnant Japanese women. The definitions of wheeze and asthma were based on criteria from the European Community Respiratory Health Survey whereas those of eczema and rhinoconjunctivitis were based on criteria from the International Study of Asthma and Allergies in Childhood. Adjustment was made for age; region of residence; family history of asthma, atopic eczema, and allergic rhinitis; household income; and education. Results: Compared with never smoking, current smoking and >= 4 pack-years of smoking were independently positively associated with the prevalence of wheeze. There were no associations between smoking status and the prevalence of asthma, eczema, or rhinoconjunctivitis. When subjects who had never smoked were classified into four categories based on the source of ETS exposure (never, only at home, only at work, and both), exposure occurring both at home and at work was independently associated with an increased prevalence of two outcomes: wheeze and rhinoconjunctivitis. No relationships were observed between exposure to ETS and the prevalence of asthma or eczema. Conclusions: Our results provide evidence that current smoking and ETS exposure may increase the likelihood of wheeze. The possibility of a positive association between ETS exposure and rhinoconjunctivitis was also suggested.

Thun M; Peto R; Boreham J; Lopez AD. Stages of the cigarette epidemic on entering its second century. Tobacco Control 21(2): 96-101, 2012. (18 refs.)

Objectives: A four-stage model of the cigarette epidemic was proposed in 1994 to communicate the long delay between the widespread uptake of cigarette smoking and its full effects on mortality, as had been experienced in economically developed countries where cigarette smoking became entrenched decades earlier in men than in women. In the present work, the question of whether qualitative predictions from the model have matched recent trends in smoking and deaths from smoking in countries at various levels of economic development is assessed, and possible projections to the year 2025 are considered. Methods The proportion of all deaths attributed to tobacco was estimated indirectly for 41 high-resource and medium-resource countries from 1950 to the most recent year for which data were available, generally about 2005-2009. The trends in tobacco-attributed mortality in later middle age were then projected forward to 2025, based on recent trends in tobacco-attributed mortality in early middle age. Results: In developed countries the prevalence of smoking has continued to decrease in both sexes, although the rate of decrease has slowed and is less than that predicted by the original version of the model. Over the past 20 years the proportionate contribution of smoking to all deaths has decreased in men while continuing to increase or plateau among women. Although the proportion of all deaths at ages 35-69 that are attributed to smoking is still generally greater in men than in women, the male and female proportions are converging and will probably cross over in some high resource countries. Projections through to 2025 suggest that male and female smoking prevalence and smoking-attributed mortality will decrease in parallel in most developed countries towards lower limits that are not yet defined. In developing countries the model seems generally applicable to men but cannot predict whether or when women will begin smoking in large numbers. Modified criteria that describe the stages of the epidemic separately for men and women would be more generalisable to developing countries. Conclusions: The four-stage model of the cigarette epidemic still provides a reasonably useful description in many developed countries. Its relevance to developing countries could be improved by describing the stages of the epidemic separately for men and women.

Tiffany ST; Friedman L; Greenfield SF; Hasin DS; Jackson R. Beyond drug use: A systematic consideration of other outcomes in evaluations of treatments for substance use disorders. Addiction 107(4): 709-718, 2012. (115 refs.)

Across the addictions field, the primary outcome in treatment research has been reduction in drug consumption. A comprehensive view of the impact of substance use disorders on human functioning suggests that effective treatments should address the many consequences and features of addiction beyond drug use, a recommendation forwarded by multiple expert panels and review papers. Despite recurring proposals, and a compelling general rationale for moving beyond drug use as the sole standard for evaluating addiction treatment, the field has yet to adopt any core set of other measures that are routinely incorporated into treatment research. Among the many reasons for the limited impact of previous proposals has been the absence of a clear set of guidelines for selecting candidate outcomes. This paper is the result of the deliberations of a panel of substance abuse treatment and research experts convened by the National Institute on Drug Abuse to discuss appropriate outcome measures for clinical trials of substance abuse treatments. This paper provides an overview of previous recommendations and outlines specific guidelines for consideration of candidate outcomes. A list of outcomes meeting those guidelines is described and illustrated in detail with two outcomes: craving and quality of life. The paper concludes with specific recommendations for moving beyond the outcome listing offered in this paper to promote the programmatic incorporation of these outcomes into treatment research.

Wild K; Wilson H. Cannabinoid hyperemesis. (editorial). Emergency Medicine Journal 29(1): 67-69, 2012. (14 refs.)

A 21-year-old woman with a 4-week history of sudden onset vomiting, nausea and anorexia. Questioning revealed that she had a 7-year history of heavy cannabis use (smoking). She did not describe abdominal pain, change in bowel habit, antibiotic use, foreign travel or contact with gastroenteritis. Biochemistry results demonstrated mild metabolic derangement with a low potassium and a low bicarbonate, and urine toxicology was positive for cannabinoids. Other investigations, including a full blood count, renal function tests, liver function tests, a coagulation sample, an ECG, urinary beta-hCG and CT head scan, were all normal. A diagnosis of cannabinoid hyperemesis was made and her symptoms resolved after treatment with intravenous fluids, a and abstinence from cannabis. Since her discharge and abstinence she has had several relapses, each related to cannabis use and each resolving with abstinence. The patient is now seeking cognitive behavioral therapy to achieve permanent abstinence.

Winter DC. Kicking society's tobacco habit: Does the butt stop here? (editorial). Archives of Surgery 147(4): 383-383, 2012. (2 refs.)

Wipfli HL; Samet JM. Moving beyond global tobacco control to global disease control. (editorial). Tobacco Control 21(2): 269-272, 2012. (17 refs.)

Yap MBH; Reavley NJ; Jorm AF. Young people's beliefs about the harmfulness of alcohol, cannabis and tobacco for mental disorders: Findings from two Australian national youth surveys. Addiction 107(4): 838-847, 2012. (35 refs.)

Aims: Using cross-sectional national survey data, we assessed young peoples' beliefs about the role of alcohol, tobacco and marijuana in the prevention and treatment of mental disorders as well as the predictors of these beliefs. We also compared these findings with those from a similar survey carried out in 2006. Design, setting and participants Between January and May 2011, a national computer-assisted telephone survey was conducted on a representative sample of Australian youths aged 15-25 years. A total of 3021 young people were presented with a case vignette portraying depression, depression with suicidal thoughts, psychosis, social phobia, depression with alcohol misuse or post-traumatic stress disorder in a young person. Measurements Respondents were asked about their beliefs regarding the role of using alcohol, tobacco and marijuana in preventing or dealing with the mental disorders described in the vignettes. Level of psychological distress was assessed by the Kessler 6 scale (K6). Findings More than 75% of respondents agreed that the three substances were harmful for the young people in the vignettes, and that not using marijuana or drinking alcohol in excess is preventive. Males, young adults and more distressed respondents were less likely to endorse these beliefs. No significant changes were observed between surveys. Conclusions: Most young people in Australia are aware of the negative impact of substance use on mental disorders, but a few high-risk groups remain: males, young adults and those with more psychological distress. Future public health campaigns need to target these groups and focus on translating young people's substance use beliefs into behavioural change.

Zatonski WA; Bhala N. Changing trends of diseases in Eastern Europe: Closing the gap. Public Health 126(3): 248-252, 2012. (21 refs.)

One of the greatest challenges in Europe at the beginning of the 21st Century is the wide east-west health gap. In 2008, the difference in life expectancy between men in some Western European countries and Russia was 20 years. Whilst trends for life expectancy at birth have improved in many areas around the world, those for Russia, as well as those for some other former Soviet Union countries, have fluctuated greatly and have not shown signs of growth since the middle of the 20th Century. In contrast to the significant progress in economic development seen in many Eastern European countries, especially the new European Union (EU) member states, health gaps have not been closed in the first decade of the new millennium and, indeed, some of the differences are widening. Recent estimates from 2008 on the probability of death before the age of 65 years for men are of the order of 16% in Western Europe, compared with 31% for Eastern Europe and 54% in Russia. This article discusses some of the distributions and determinants of disease burden in Eastern Europe, especially for preventable causes such as smoking, diet and alcohol. Half of all premature deaths of young men in Russia are attributed to alcohol.

Zeisser C; Thompson K; Stockwell T; Duff C; Chow C; Vallance K et al. A 'standard joint'? The role of quantity in predicting cannabis-related problems. Addiction Research & Theory 20(1): 82-92, 2012. (37 refs.)

The 'standard drink' concept is widely used as a standardized measure of alcohol consumption. There is no equivalent measure of cannabis consumption, perhaps due to challenges such as varied joint size, tetrahydrocannabinol content, and means of delivery. This study introduces a new measure of cannabis quantity and examines whether it predicts cannabis-related social problems with and without controlling for frequency of use. Cannabis-related problems, measured by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), were predicted from cannabis use frequency (days in past month) and quantity (one joint = 0.5 g, five bong or pipe hits, 10 puffs), controlling for age and gender. The sample consisted of 665 participants aged 15-67 (mean = 28.2, SD = 11.8) from the British Columbia Alcohol and Other Drug Monitoring Project, High Risk Group Surveys, 2008 to 2009. Cannabis use frequency and quantity were positively associated with cannabis-related problems. Individuals who consumed cannabis daily and consumed more than one joint per day were at the greatest risk of problems. Controlling for frequency, the effect of quantity remained significant for failure to do what is expected due to cannabis use. This study suggests that quantity, above and beyond frequency, is an important predictor of cannabis problems. We discuss the potential usefulness and validity of this new measure in harm reduction.