Serving Substance Abuse Professionals Since 1993

Last Update: 14.10.08

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Research, Methodology

54 citations. January 2008 to present

Prepared: September 2008

Babor TF. Regression to the mean: elephant in the living room or the delusions of a Swedish student 'out bicycling'? (editorial). Addiction 103(1): 4-5, 2008. (6 refs.)

Baldwin S; Boisen N; Power R. Managing information: Using systematic data collection to estimate process and impact indicators related to harm reduction services in Myanmar. International Journal of Drug Policy 19(Supplement 1): s74-s79, 2008. (17 refs.)

Background: Discussion about coverage has primarily focused on answering the question: what level of coverage is required to reduce the spread of HIV among people who inject drugs? This paper documents the process involved in designing a Monitoring Information System (MIS) that provides a tool to estimate coverage, frequency of contacts as well as provides a mechanism for correlating these data with changes in risk behaviour among the surveyed population. Methods: The system uses paper and pencil data collection forms to record information about the type and location of a contact. Information about the content of the contact such as the services, equipment or education that is delivered is also collected. This data is then entered into a computer program that manages the information and allows for simple standardised reports to be generated. The reports provide a simple mechanism for analysing process indicators such as the number and frequency of contacts, where the contact occurred as well as what the contact consisted of (i.e. education content or distribution of equipment). The system also allows correlations to be made between exposure to services and changes in behaviour thus providing a. mechanism for assessing impact indicators. Conclusion and discussion: We present a brief description of the Monitoring Information System, its structure and functions and encourage practitioners to consider the importance of adopting standardised monitoring systems to measure coverage. We also explore some potential ethical limitations around using the system.

Bertol E; Trignano C; Di Milia MG; Di Padua M; Mari F. Cocaine-related deaths: An enigma still under investigation. Forensic Science International 176(2-3): 121-123, 2008. (14 refs.)

In recent years there has been an increase interest in cocaine-related death reflecting the rising trend in cocaine use in Europe. Nevertheless is still now very difficult to attribute a death to cocaine. We can affirm that cocaine can be responsible for the cause of death only when there is a reasonably complete understanding of the circumstances or facts surrounding the death. Isolated blood cocaine levels are not enough to assess lethality, should be always considered and evaluated in relation to concentrations of cocaine and benzoylecgonine concentrations in body tissue compartments, especially in brain and blood. We have reanalyzed all of our cocaine-related case from 1990 to 2005, applying the methodology used by Spielher and Reed over 30 years ago. Our aim was to try to validate this model and verify its applicability and effectiveness after 20 years.

Brown CH; Wang W; Kellam SG; Muthen BO; Petras H; Toyinbo P et al. Methods for testing theory and evaluating impact in randomized field trials: Intent-to-treat analyses for integrating the perspectives of person, place, and time. (review). Drug and Alcohol Dependence 95(Supplement 1): S74-S104, 2008. (148 refs.)

Randomized field trials provide unique opportunities to examine the effectiveness of an intervention in real world settings and to test and extend both theory of etiology and theory of intervention. These trials are designed not only to test for overall intervention impact but also to examine how impact varies as a function of individual level characteristics, context, and across time. Examination of such variation in impact requires analytical methods that take into account the trial's multiple nested structure and the evolving changes in outcomes over time. The models that we describe here merge multilevel modeling with growth modeling, allowing for variation in impact to be represented through discrete mixtures-growth mixture models-and nonparametric smooth functions-generalized additive mixed models. These methods are part of an emerging class of multilevel growth mixture models, and we illustrate these with models that examine overall impact and variation in impact. In this paper, we define intent-to-treat analyses in group-randomized multilevel field trials and discuss appropriate ways to identify, examine, and test for variation in impact without inflating the Type I error rate. We describe how to make causal inferences more robust to misspecification of covariates in such analyses and how to summarize and present these interactive intervention effects clearly. Practical strategies for reducing model complexity, checking model fit, and handling missing data are discussed using six randomized field trials to show how these methods may be used across trials randomized at different levels.

Cunningham R; Walton MA; Tripathi SP; Outman R; Murray R; Booth BM. Tracking inner city substance users from the emergency department: How many contacts does it take? Academic Emergency Medicine 15(2): 136-143, 2008. (34 refs.)

Background: Longitudinal studies of substance users report difficulty in locating and completing 12-month interviews, which may compromise study validity. Objectives: This study examined rates and predictors of contact difficulty and in-person follow-up completion among patients presenting with cocaine-related chest pain to an inner-city emergency department (ED). The authors hypothesize that less staff effort in contacting patients and lower follow-up rates would bias subsequent substance use analysis by missing those with heavier substance misuse. Methods: A total of 219 patients aged 19 to 60 years (65% males; 78% African American) with cocaine-related chest pain were interviewed in the ED and then in person at 3, 6, and 12 months. Demographics, substance use measures, and amount/type of research staff contacts (telephone, letters, home visits, and locating patient during return ED visits) were recorded. Poisson and negative binomial regression analyses were conducted to predict quantity of patient contacts for the 12-month follow-up. Results: Interview completion rates at 3, 6, and 12 months were 78, 82, and 80%, respectively. Average contact attempts to obtain each interview were 10 at 3 months (range 3-44), 8 at 6 months (1-31), and 8 at 12 months (1-49); 13% of patients required a home visit to complete the 12-month interview. Participants requiring more contact attempts by staff were younger and reported more frequent binge drinking at baseline (p < 0.05), but were less likely to meet criteria for substance abuse or dependence (p < 0.5), or to report prior mental health treatment (p < 0.05). Comparisons of parallel regressions predicting contact difficulty based on the entire sample, the low-effort group, and the difficult-to-reach group showed variation in findings. Conclusions: This study demonstrates that substantial staff effort is required to achieve adequate retention over 12 months of patients with substance misuse. Without these extensive efforts at follow-up, longitudinal analyses may be biased.

Degenhardt L; Bohnert KM; Anthony JC. Assessment of cocaine and other drug dependence in the general population: "Gated" versus "ungated" approaches. Drug and Alcohol Dependence 93(3): 227-232, 2008. (26 refs.)

Background: There is a need for large-scale epidemiological surveys to be (a) faithful to diagnostic specifications and (b) constrain time and participant burden associated with each section of a possibly lengthy interview. Obiective: To examine whether one "gating" approach devised for recent large-scale international psychiatric surveys results in a reduced number of identified cases of drug dependence and/or biases in estimated associations with background characteristics. Design and setting: Data from a recently released cross-sectional, nationally representative household survey, the United States National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analysed. Participants: Forty-three thousand ninety-three English speaking adults aged 18 years and over. Main outcome measures: Dependence upon cocaine and other illegal drug dependence, defined in two ways: "ungated" and "gated". "Ungated" dependence included all persons meeting criteria for DSM-IV dependence, without regard for DSM-IV drug abuse clinical features. "Gated" dependence required at least one feature of DSM-IV drug abuse. Results: There was no statistically robust decrement in the estimated prevalence of cocaine or other drug dependence using a "gated" assessment. Patterns of association of cocaine dependence with background characteristics were not appreciably different when the gated and ungated approaches were applied. Conclusions: In panoramic mental health surveys, the inefficiency of an ungated approach must be balanced against the anticipated number of cases of dependence without associated social role impairments or harm. In this study, the reduction in the number of identified cocaine dependence cases appeared to be so small that even in a sample of over 40,000 participants, attenuation in population prevalence would prove difficult to detect.

Delnevo CD; Gundersen DA; Hagman BT. Declining estimated prevalence of alcohol drinking and smoking among young adults nationally: Artifacts of sample undercoverage? American Journal of Epidemiology 167(1): 15-19, 2008. (19 refs.)

A growing concern in public health surveillance surveys that rely on random digit dialing for sampling is the exclusion of adults in cell-phone-only households. The purpose of this study was to examine whether recent increases in wireless substitution have affected estimates of tobacco and alcohol use in the Behavioral Risk Factor Surveillance System (BRFSS) in a subpopulation with notable cell-phone usage (i.e., young adults). BRFSS data from 2001-2005 were examined. Analyses were limited to participants aged 18-24 years, and the sample contained approximately 18,500 persons in each year. Prevalence estimates were generated with SUDAAN software for three health behaviors: cigarette smoking, binge drinking, and heavy alcohol consumption. In addition, the authors examined sample completeness for young adults relative to US Census estimates. Overall, prevalences of all three health behaviors among young adults were fairly stable between 2001 and 2003 but significantly decreased between 2003 and 2005. These trends are not replicated in national surveys that use area probability samples. The authors found a declining trend in the sample completeness ratio for young adults; it declined from 0.32 in 2001 to 0.15 in 2005. Given the high prevalence of wireless substitution among young adults and the declining sample completeness ratio, the authors suspect that the observed decreases in prevalence are artifacts of undercoverage.

Finney JW. Regression to the mean in substance use disorder treatment research. Addiction 103(1): 42-52, 2008. (38 refs.)

Aims: Regression to the mean (RTM) refers to the tendency for a group of cases that differ from the population mean to move (regress) towards the mean, on average, when re-assessed, if scores at the two points are less than perfectly correlated. This paper considers factors that affect the magnitude of RTM and how RTM may impact findings from primary studies and reviews of substance use disorder (SUD) treatment. Design and methods The paper is guided largely by A Primer on Regression Artifacts by Campbell and Kenny. It reviews potential RTM effects in three areas of SUD treatment research. One is the extent to which within-group improvement in comparative treatment trials, including 'placebo effects', is a function of RTM. The second is the vulnerability of treatment evaluations employing non-equivalent control group designs to RTM and biased estimates of treatment effects when matching, or statistical equating is used to adjust for pre-existing group differences. The final issue is the impact of RTM in syntheses of research findings on SUD treatments. In particular, the tendency for later studies of a particular intervention to have smaller treatment effect sizes relative to earlier studies is considered as an RTM phenomenon. Findings: RTM is a pervasive, but often unrecognized phenomenon that can bias findings in SUD treatment studies and in systematic reviews of that research. Conclusion: SUD treatment researchers should be aware of RTM, take any available steps to reduce it, and try to diagnose whether it is still affecting research findings.

Fischer HP. Mathematical modeling of complex biological systems: From parts lists to understanding systems behavior. Alcohol Research & Health 31(1): 49-59, 2008. (19 refs.)

To understand complex biological systems such as cells, tissues, or even the human body, it is not sufficient to identify and characterize the individual molecules in the system. It also is necessary to obtain a thorough understanding of the interaction between molecules and pathways. This is even truer for understanding complex diseases such as cancer, Alzheimer's disease, or alcoholism. With recent technological advances enabling researchers to monitor complex cellular processes on the molecular level, the focus is shifting toward interpreting the data generated by these so-called "-omics" technologies. Mathematical models allow researchers to investigate how complex regulatory processes are connected and how disruptions of these processes may contribute to the development of disease. In addition, computational models help investigators to systematically analyze systems perturbations, develop hypotheses to guide the design of new experimental tests, and ultimately assess the suitability of specific molecules as novel therapeutic targets. Numerous mathematical methods have been developed to address different categories of biological processes, such as metabolic processes or signaling and regulatory pathways. Today, modeling approaches are essential for biologists, enabling them to analyze complex physiological processes, as well as for the pharmaceutical industry, as a means for supporting drug discovery and development programs.

Public Domain

Gmel G; Wicki M; Rehm J; Heeb JL. Estimating regression to the mean and true effects of an intervention in a four-wave panel study. Addiction 103(1): 32-41, 2008. (30 refs.)

Objectives: First, to analyse whether a taxation-related decrease in spirit prices had a similar effect on spirit consumption for low-, medium- and high-level drinkers. Secondly, as the relationship between baseline values and post-intervention changes is confounded with regression to the mean (RTM) effects, to apply different approaches for estimating the RTM effect and true change. Sample: Consumption of spirits and total alcohol consumption were analysed in a four- wave panel study (one pre-intervention and three post-intervention measurements) of 889 alcohol consumers sampled from the general population of Switzerland. Methods: Two correlational methods, one method quantitatively estimating the RTM effect and one growth curve approach based on hierarchical linear models (HLM), were used to estimate RTM effects among low-, medium- and high-level drinkers. Results Adjusted for RTM effects, high-level drinkers increased consumption more than lighter drinkers in the short term, but this was not a persisting effect. Changes in taxation affected mainly light and moderate drinkers in the long term. All methods concurred that RTM effects were present to a considerable degree, and methods quantifying the RTM effect or adjusting for it yielded similar estimates. Conclusion: Intervention studies have to consider RTM effects both in the study design and in the evaluation methods. Observed changes can be adjusted for RTM effects and true change can be estimated. The recommended method, particularly if the aim is to estimate change not only for the sample as a whole, but for groups of drinkers with different baseline consumption levels, is growth curve modelling. If reliability of measurement instruments cannot be increased, the incorporation of more than one pre-intervention measurement point may be a valuable adjustment of the study design.

Gottdiener WH; Murawski P; Kucharski LT. Using the delay discounting task to test for failures in ego control in substance abusers. Psychoanalytic Psychology 25(3): 533-549, 2008. (75 refs.)

A meta-analysis was conducted to test a core feature of the self-medication hypothesis of substance use disorders (SUDs) that posits that SUDs are associated with failures of ego control. This hypothesis was tested by quantitatively synthesizing studies that used the delay discounting task in individuals with SUDs compared with nonclinical controls. An additional aim of the study was to identify variables that might moderate the relationship between SUDs and delay discounting task performance. The results were based on 10 studies that consisted of 925 participants who used a variety of psychoactive substances, and all studies used matched-groups designs. Participants with SUDs showed significant failures in ego control compared with nonclinical controls (d = 0.587). Variance across studies was nil, and therefore no moderators were sought. The results of this study support the self-medication hypothesis and suggest that SUD treatment should focus on improving ego control. The results also show that the delay discounting task is an experimental method that can be used to operationalize a number of psychoanalytic constructs and thus opens the door to further psychoanalytic experimental research on failures of ego control.

Greenfield TK; Kerr WC. Alcohol measurement methodology in epidemiology: Recent advances and opportunities. (review). Addiction 103(7): 1082-1099, 2008. (173 refs.)

Aim: To review and discuss measurement issues in survey assessment of alcohol consumption for epidemiological studies. Methods The following areas are considered: implications of cognitive studies of question answering such as self-referenced schemata of drinking, reference period and retrospective recall, as well as the assets and liabilities of types of current (e.g. food frequency, quantity-frequency, graduated frequencies and heavy drinking indicators) and life-time drinking measures. Finally we consider units of measurement and improving measurement by detailing the ethanol content of drinks in natural settings. Results and conclusions Cognitive studies suggest inherent limitations in the measurement enterprise, yet diary studies show promise of broadly validating methods that assess a range of drinking amounts per occasion; improvements in survey measures of drinking in the life course are indicated; attending in detail to on- and off-premise drink pour sizes and ethanol concentrations of various beverages shows promise of narrowing the coverage gap plaguing survey alcohol measurement.

Greenwald MK. Behavioral economic analysis of drug preference using multiple choice procedure data. Drug and Alcohol Dependence 93(1/2): 103-110, 2008. (31 refs.)

The multiple choice procedure has been used to evaluate preference for psychoactive drugs, relative to money amounts (price), in human subjects. The present re-analysis shows that MCP data are compatible with behavioral economic analysis of drug choices. Demand curves were constructed from studies with intravenous fentanyl, intramuscular hydromorphone and oral methadone in opioid-dependent individuals; oral d-amphetamine, oral MDMA alone and during fluoxetine treatment, and smoked marijuana alone or following naltrexone pretreatment in recreational drug users. For each participant and dose, the MCP crossover point was converted into unit price (UP) by dividing the money value ($) by the drug dose (mg/70 kg). At the crossover value, the dose ceases to function as a reinforcer, so "0" was entered for this and higher UPs to reflect lack of drug choice. At lower UPs, the dose functions as a reinforcer and "1" was entered to reflect drug choice. Data for UP vs. average percent choice were plotted in log-log space to generate demand functions. Rank of order of opioid inelasticity (slope of non-linear regression) was: fentanyl > hydromorphone (continuing heroin users) > methadone > hydromorphone (heroin abstainers). Rank order of psychostimulant inelasticity was d-amphetamine > MDMA > MDMA + fluoxetine. Smoked marijuana was more inelastic with high-dose naltrexone. These findings show this method translates individuals' drug preferences into estimates of population demand, which has the potential to yield insights into pharmacotherapy efficacy, abuse liability assessment, and individual differences in susceptibility to drug abuse.

Griesler PC; Kandel DB; Schaffran C; Hu MC; Davies M. Adolescents' inconsistency in self-reported smoking - A comparison of reports in school and in household settings. Public Opinion Quarterly 72(2): 260-290, 2008. (68 refs.)

Extent and sources of inconsistency in self-reported cigarette smoking between self-administered school surveys and household interviews was examined in two longitudinal multiethnic adolescent samples, the urban Transition to Nicotine Dependence in Adolescence (TND) (N = 832) and the National Longitudinal Study of Adolescent Health (Add Health) (N = 4,414). Inconsistency was defined as a positive report of smoking in school followed by a negative report in the household. Smoking questions were ascertained with paper-and-pencil instruments (PAPI-SAQ) in school in both studies, and computer-assisted personal interviewing (CAPI) in TND but audio computer-assisted self-interviewing (ACASI) in Add Health in the household. In TND, 23.5 percent of youths who reported smoking lifetime and 20.4 percent of those who reported smoking the last 12 months in the school survey reported in the household never having smoked; in Add Health, the latter was 8.6 percent. Logistic regressions identified five common correlates of inconsistency across the two studies: younger age, ethnic minority status, lesser involvement in deviant activities, having nonsmoking parents and friends. In TND, interviewing of youth and parent by the same interviewer increased inconsistent reporting. Matching the definition of inconsistent reporting and the age, gender and race/ethnic distributions of TND on an urban Add Health subsample reduced the predicted rate of inconsistency in TND. The estimated bias attributable to CAPI compared with ACASI methodology did not reach significance in the aggregated matched samples suggesting that irrespective of administration mode, household interviews decrease reporting of smoking, especially among younger, minority and more conventional youths embedded in a social network of nonsmokers.

Gual A. Translational research: A necessary and difficult step forward in the addictions field. (editorial). Addiction 103(7): 1065-1066, 2008. (9 refs.)

Guo QM; Zakhari S. Commentary: Systems biology and its relevance to alcohol research. (editorial). Alcohol Research & Health 31(1): 5-10, 2008. (14 refs.)

Systems biology, a new scientific discipline, aims to study the behavior of a biological organization or process in order to understand the function of a dynamic system. This commentary will put into perspective topics discussed in this issue of Alcohol Research & Health, provide insight into why alcohol-induced disorders exemplify the kinds of conditions for which a systems biological approach would be fruitful, and discuss the opportunities and challenges facing alcohol researchers.

Public Domain

Harrigan GG; Maguire G; Boros L. Metabolomics in alcohol research and drug development. Alcohol Research & Health 31(1): 26-35, 2008. (37 refs.)

Developers of new medications need to describe and predict the functional attributes of test compounds administered to cells, animals, and humans. Today, researchers increasingly appreciate the role that intermediary products (i.e., metabolites) generated in the course of various metabolic pathways play in both health and disease states and how their analysis can support development of new medications. Advances in analytical and computational techniques have facilitated the rise of new and powerful tools for measuring metabolic and biochemical pathways in such complex systems. Metabolomics -- a systems biology approach to characterizing metabolites produced in biochemical pathways -- is contributing to many studies of disease progression and treatment, although it has not yet been extensively applied in research on metabolic perturbations associated with alcohol abuse. However, numerous metabolomic approaches may contribute to alcohol-related research, as illustrated by studies on alcohol-related metabolic dysfunctions such as (1) alterations in fat metabolism and (2) thiamine deficiency. By further increasing the number and types of metabolites that can be measured in a given biological sample, metabolomic approaches may be able to help define the role of the many different metabolic pathways affected by alcohol abuse and support discovery and development of novel medications for the treatment of alcoholism and related conditions.

Public Domain

Heeren T; Edwards EM; Dennis JM; Rodkin S; Hingson RW; Rosenbloom DL. A comparison of results from an alcohol survey of a prerecruited Internet panel and the National Epidemiologic Survey on Alcohol and Related Conditions. Alcoholism: Clinical and Experimental Research 32(2): 222-229, 2008. (14 refs.)

Background: Given today's telecommunications environment, random digit dial (RDD) telephone surveys face declining response rates and coverage, and increasing costs. As an alternative to RDD, we surveyed participants in a randomly recruited standing Internet panel supplemented with a randomly sampled telephone survey of nonpanel members for a study of associations between onset of alcohol use and later alcohol-related problems. The purpose of this paper was to compare results from our survey with results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face probability sample survey of 43,093 adults, with a focus on associations between demographics, age of drinking onset, and alcohol dependence. Methods: Demographic and drinking characteristics from our survey of 4,021 ever-drinkers between the ages of 18 and 39 years were compared with the characteristics of 11,549 similarly aged ever-drinkers from the NESARC. Weighted analyses accounting for sampling design compared these 2 samples on drinking characteristics over the past year and during a respondent's heaviest period of drinking, and in multivariate models examining associations between demographics, age of drinking onset, and lifetime alcohol dependence. Results: Participants in the supplemented Internet panel were similar to the national population of 18- to 39-year-old ever drinkers on gender, education, and race/ethnicity, while adults who were aged 18 to 25 years were under-represented in the Internet panel. The supplemented Internet panel reported higher rates of moderate risk drinking over the past 12 months, lifetime high-risk drinking, and lifetime (ever) alcohol dependence. Estimates of the associations between alcohol dependence and age of drinking onset, risky drinking, and family history of alcohol problems did not significantly differ between the supplemented Internet sample and the NESARC survey. Conclusions: Randomly recruited Internet-based panels may provide an alternative to random digit dial telephone surveys and in-person surveys for some studies of factors associated with alcohol-related problems.

Heiman GA; Ogburn E; Gorroochurn P; Keyes KA; Hasin D. Evidence for a two-stage model of dependence using the NESARC and its implications for genetic association studies. Drug and Alcohol Dependence 92(1/3): 258-266, 2008. (73 refs.)

Some twin studies suggest that substance initiation and dependence are part of a complex, two-stage process and that some genetic influences are stage-specific, acting on either the transition from abstinence to initiation, or on the transition from use to dependence. However, questions remain about the two-stage model, especially for illicit drugs. Using a familial aggregation design, we tested the hypothesized two-stage model of dependence on illicit substances and alcohol in a large, nationally representative sample. Family history of drug or alcohol problems is significantly associated with initiation that does not progress to dependence (i.e., conditional initiation). Furthermore, family history of drug or alcohol problems is significantly associated with dependence even after conditioning on factors influencing initiation (i.e., conditional dependence). These results suggest that substance initiation and dependence involve at least partially distinct familial factors. The possibility that different genetic factors affect initiation and dependence has important implications for control group selection in case-control genetic association studies, and may explain some inconsistent results for drug dependence. If some genetic factors are stage-specific (i.e., not common across initiation and dependence), inclusion of abstainers in the control group may mix the genetic effects for initiation with those for transition to dependence, providing unclear results. Depending on the specific question about the nature of the genetic effect (whether on initiation, on dependence, or both), investigators designing case-control genetic association studies should carefully consider inclusion and exclusion criteria of the control group.

Hickman M; Lingford-Hughes A; Bailey C; Macleod J; Nutt D; Henderson G. Does alcohol increase the risk of overdose death: The need for a translational approach. Addiction 103(7): 1060-1062, 2008. (26 refs.)

Background: We argue for a translational approach to addiction science, using an important current research question as a case study. Case study: What is the evidence in support of the hypothesis that alcohol increases the risk of a heroin/opiate overdose through a pharmacological interaction? Findings: The positive epidemiological evidence shows that opiate overdose deaths rarely involve a single drug; that alcohol is the most common other drug involved; that there is a negative association between alcohol and morphine concentration at post mortem; and that post-mortem levels of morphine are often below the levels expected of highly tolerant individuals. The evidence is consistent with the hypothesis that heroin users who drink may require less heroin to overdose than those who do not drink (all other factors being equal) because of a pharmacological interaction. However, the evidence is consistent with, and does not rule out, other causal (and non-causal) pathways. Alcohol could be associated negatively with tolerance, or confounded by other factors. Experimental evidence is required which is unlikely to be obtained through further epidemiological study or through randomized clinical trials. Conclusions: We believe that animal models could provide the key evidence to test the hypothesis for a 'pharmacodynamic' or 'pharmacokinetic' interaction, which could be corroborated in clinical challenge studies and epidemiological studies. Such a translational approach demands greater collaboration between addiction scientists from basic to applied science and from neuroscience to social science, and would be able to address other key research questions and hypotheses in addiction.

Hickman M; Lingford-Hughes A; Bailey C; Macleod J; Nutt D; Henderson G. Understanding causal pathways: A response to the commentaries. (editorial). Addiction 103(7): 1067-1068, 2008. (6 refs.)

Hodgins DC. What we see depends mainly on what we look for (John Lubbock, British Anthropologist, 1834-1913). (editorial). Addiction 103(7): 1118-1119, 2008. (8 refs.)

Jansen H; Lahaut V; Garretsen H; van de Mheen D. Measuring the year consumption of alcohol: The development of a questionnaire. Substance Use & Misuse 43(7): 880-894, 2008. (37 refs.)

Most general alcohol consumption population surveys are meant to represent the year consumption, although they actually ask only for habitual drinking and/or frequencies and quantities of binge drinking in the past months. These surveys typically cover about half of the alcohol sales figures. In order to enhance sales coverage and to reduce seasonal bias, we developed a year consumption questionnaire on the basis of daily and weekly drinking adding 13 categories of less-than-weekly drinking occasions over the year. As a first test we offered the new questionnaire together with a traditional typical week questionnaire, in different modes to various groups adding up to a purposive high diversity sample of 101 drinking persons (56 women, 44 men, 16-69 years old, mean age 34 years). After correction for overlaps between weekly habits and less-than-weekly occasions, the new questionnaire produces considerably higher reports of annual consumption, compared with the typical-week-based estimates of year consumption. Limitations of the study are discussed.

Kaskutas LA; Kerr WC. Accuracy of photographs to capture respondent-defined drink size. Journal of Studies on Alcohol and Drugs 69(4): 605-610, 2008. (13 refs.)

Objective: Evidence suggests that people misjudge the size of their drinks, calling into question the validity of data from surveys and screening instruments assessing alcohol quantity in terms of standard drinks. This article studied the validity of photographs of glasses to assess drink size. Method: In a U.S. national sample of 323 drinkers, respondents were mailed a measuring beaker and a set of photographs of wine, beer, and other drinking glasses for use in a subsequent telephone survey. In the interview, they were asked to pick the glass most similar to what they use at home and to identify the letter associated with their usual pour level. Then, a protocol where subjects measured the actual number of ounces in their typical drink, by pouring water into their usual glass and measuring this volume using the measuring beaker, gave a direct measure of home drink volume. We compared drink sizes using the two approaches. Results: Photographs worked well for certain groups, including women, young people, and nonwhites (for wine) and whites (for beer). The greatest magnitude of error arising from the use of photographs was for wine drinks among those age 50 and older, those with a 4-year degree, frequent 5+ drinkers in general, and heavy-volume wine drinkers. Average drink size based on the most popular wine and beer glasses in the photographs were 0.62 oz (18 ml) and 1.62 oz (48 ml) larger than beaker pours, respectively. Error between actual drinks and photographs was especially high for a large balloon-shaped wine glass, chosen by only 3% of wine drinkers. Conclusions: Whenever possible, researchers and clinicians should incorporate protocols that allow for some type of direct measurement using the actual vessels from home. When this is not viable, photographs represent a solution that is practical, shows promise for beer and wine drinks, and is relevant to any drinking context.

Lopes C; Andreozzi VL; Ramos E; Carvalho MS. Modelling over week patterns of alcohol consumption. Alcohol and Alcoholism 43(2): 215-222, 2008. (43 refs.)

Aims: This study aims to analyze alcohol consumption patterns throughout a week, controlled by socio-demographic characteristics, and to discuss the adequacy of the complex models employed. Methods: The sample included 496 participants, from both sexes, 40 years old and with 7-day dietary records. Bayesian generalized additive mixed models (GAMM) were applied using two approaches: a multinomial model, with three categories of alcohol consumption behaviour including; non-drinkers, alcohol during meals only and alcohol at any time; and a gamma model for drinkers which considered the total amount of alcohol ingested per day. Results: The multinomial model captured two different patterns of alcohol consumption: a sharp increase in consumption on weekends for mealtime only drinkers, the dominant behaviour among drinkers and a linear increase from Monday towards Sunday for those who drank at anytime. The effect of higher education changed from slightly protective for mealtime only drinkers to risky for anytime drinkers. The amount of alcohol consumed presents a pattern similar to the meals-only drinking. Conclusions: Alcohol consumption increased during the week. Two different alcohol consumption patterns were identified according to drinking behaviours. The methodological approach utilized was essential in uncovering these patterns.

Lopez EN; Simmons VN; Quinn GP; Meade CD; Chirikos TN; Brandon TH. Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention. Nicotine & Tobacco Research 10(1): 87-96, 2008. (45 refs.)

The development of smoking cessation and relapse prevention interventions for pregnant and postpartum women is a public health priority. However, researchers have consistently reported substantial difficulty in recruiting this population into clinical trials. The problem is particularly acute for relapse prevention studies, which must recruit women who have already quit smoking because of their pregnancy. Although these individuals are an important target for tobacco control efforts, they represent an extremely small subgroup of the general population. This paper describes multiple recruitment strategies used for a clinical trial of a self-help relapse prevention program for pregnant women. The effectiveness of the strategies and the direct expense per participant recruited are provided. A proactive recruitment strategy (telephoning women whose phone numbers were purchased from a marketing firm) was ultimately much more successful than a variety of reactive strategies (advertisements, press releases, direct mail, Web placement, health care provider outreach). We found few differences between proactively and reactively recruited participants on baseline variables. The primary difference was that the former had smoked fewer cigarettes per day and reported lower nicotine dependence prior to quitting. Strengths and limitations of the recruitment strategies are discussed.

Lynskey MT; Agrawal A. Differential criterion functioning of alcohol use symptomatology in major depressive disorder? Psychological Medicine 38(3): 441-449, 2008. (49 refs.)

Background. Major depressive disorder (MDD) and alcohol use disorders (AUDs) are among the most prevalent psychiatric disorders and are frequently co-morbid. However, some component of this co-morbidity may be artifactual and arise from the influence of current mental state on self-reports of AUD. Method. This study examined whether past-year MDD is associated with differential criterion functioning (DCF) in reports of AUD symptomatology in male and female participants in the National Epidemiological Survey on Alcohol and Related Conditions (NEASRC). Results. Reports of past-year AUD symptomatology were adequately summarized by a single-factor model in which each of the 11 abuse and dependence criteria had high factor loadings (0.71-0.93) and did not vary between men and women after allowing for threshold differences. Co-morbid MDD was associated with higher AUD mean scores. There was some evidence for DCF with past-year MDD being associated with a lower endorsement of use in hazardous situations among men whereas women with MDD were more likely to endorse both social/interpersonal problems and emotional/physical problems. Conclusions. Several items assessing AUD display DCF in the presence of MDD. While these findings highlight the need to consider the possibility that mental state can influence reporting of psychiatric symptoms and potentially inflate estimates of co-morbidity, they suggest that only a negligible component of the co-morbidity between MDD and AUDs can be attributed to over-reporting of alcohol symptomatology conditional on current MDD.

McLeod AI; Vingilis ER. Power computations in time series analyses for traffic safety interventions. Accident Analysis and Prevention 40(3): 1244-1248, 2008. (32 refs.)

The evaluation of traffic safety interventions or other policies that can affect road safety often requires the collection of administrative time series data, such as monthly motor vehicle collision data that may be difficult and/or expensive to collect. Furthermore, since policy decisions may be based on the results found from the intervention analysis of the policy, it is important to ensure that the statistical tests have enough power, that is, that we have collected enough time series data both before and after the intervention so that a meaningful change in the series will likely be detected. In this short paper, we present a simple methodology for doing this. It is expected that the methodology presented will be useful for sample size determination in a wide variety of traffic safety intervention analysis applications. Our method is illustrated with a proposed traffic safety study that was funded by NIH.

Midanik LT; Greenfield TK. Interactive voice response versus computer-assisted telephone interviewing (CATI) surveys and sensitive questions: The 2005 National Alcohol Survey. Journal of Studies on Alcohol and Drugs 69(4): 580-588, 2008. (53 refs.)

Objective: Interactive voice response (IVR), a computer-based interviewing technique in which respondents interact directly with a computerized system, can increase a sense of privacy and potentially a willingness to report putatively sensitive attitudes and behaviors more accurately. The purpose of this study was to compare the prevalence rates obtained by IVR with computer-assisted telephone inter-viewing (CATI) for alcohol-related problems, physical and sexual abuse, and sexual orientation. Method: As part of the data collection effort for the 2005 National Alcohol Survey, subsamples of respondents were randomly assigned to three groups: two IVR groups, each receiving an IVR module on either alcohol-related problems (n = 562) or on physical/sexual abuse and sexual orientation (n = 563), and control groups that did not receive IVR (n = 559). Results: Analyses indicate no significant differences between IVR and the control groups on alcohol-related problems. A significantly higher proportion of reports of homosexual and bisexual sexual identity was found in the IVR group for respondents 40 years and older. The IVR group also reported higher rates of condom use for respondents 18-39 years old. Conclusions: These findings suggest that alcohol-related problems may no longer be considered sensitive items in the general adult population. However, reports of nonheterosexual sexual orientation identity remain sensitive for older respondents. Embedding IVR within a telephone interview may provide an effective way of helping assure valid responses to sensitive item content.

Moore MT; Greenway SL; Farris JL; Guerra B. Assessing caffeine as an emerging environmental concern using conventional approaches. Archives of Environmental Contamination and Toxicology 54(1): 31-35, 2008. (22 refs.)

Organic wastewater contaminants, including pharmaceuticals, caffeine, and nicotine, have received increased scrutiny because of their detection in water bodies receiving wastewater discharge. Despite recent measurement in United States streams, caffeine's effect on freshwater organisms is not well documented. The present study measured caffeine's lethal and sublethal effects on the freshwater species, Ceriodaphnia dubia, Pimephales promelas, and Chironomus dilutus. These organisms, which are used in standard testing or effluent monitoring, were exposed to aqueous caffeine solutions under static exposure for 48 hours and daily renewed static exposure for 7 days. Averaged responses of 48-hour acute end points indicated that C. dubia was more sensitive to caffeine exposures (LC50 = 60 mg/L) than either P. promelas (LC50 = 100 mg/L) or C. dilutus (LC50 = 1,230 mg/L). Exposure-response slopes confirmed these findings (3% mortality/mg/L for C. dubia; 0.5% mortality/mg/L for P. promelas; and 0.07% mortality/mg/L for C. dilutus). Comparative 7-day responses between C. dubia and P. promelas (LC50 = 46 and 55 mg/L, respectively) were more similar than the broad range of acute values. Sublethal effects measured for caffeine exposure included impaired C. dubia reproduction (IC50 = 44 mg/L) and inhibited P. promelas growth (IC50 = 71 mg/L). According to the results of this study, combined with earlier studies reporting environmental concentrations and product half-lives, caffeine should pose negligible risk for most aquatic vertebrate and invertebrate organisms.

Morgan-Lopez AA; Fals-Stewart W. Analyzing data from open enrollment groups: Current considerations and future directions. Journal of Substance Abuse Treatment 35(1): 36-40, 2008. (21 refs.)

Difficulties in modeling turnover in treatment-group membership have been cited as one of the major impediments to ecological validity of substance abuse and alcoholism treatment research. In this review, our primary foci are on (a) the discussion of approaches that draw on state-of-the-science analytic methods for modeling open-enrollment group data and (b) highlighting emerging issues that are critical to this relatively new area of methodological research (e.g., quantifying membership change, modeling "holiday" effects, and modeling membership change among group members and leaders). Continuing refinement of new modeling tools to address these analytic complexities may ultimately lead to the development of more federally funded open-enrollment trials. These developments may also facilitate the building of a "community-friendly" treatment research portfolio for funding agencies that support substance abuse and alcoholism treatment research.

Orford J. Asking the right questions in the right way: The need for a shift in research on psychological treatments for addiction. (review). Addiction 103(6): 875-885, 2008. (112 refs.)

Aim: To identify possible reasons for the disappointingly negative results of methodologically rigorous controlled trials of psychological treatments in the addictions field. Method: A selective overview of the literature on addictive behaviour change. Findings: Eight failings of existing research are described: failing to account for the outcome equivalence paradox; neglecting relationships in favour of techniques; failing to integrate treatment research and research on unaided change; imposing an inappropriate time-scale on the change process; failing to take a systems or social network view; ignoring therapists' tacit theories; not including the patient's view; and displaying an ignorance of modern developments in the philosophy of science. Conclusion: Treatment research has been asking the wrong questions in the wrong way. Three necessary shifts in ways of conducting research are proposed: (i) the field should stop studying named techniques and focus instead on change processes; (ii) change processes should be studied within the broader, longer-acting systems of which treatment is part; and (iii) science in the field should be brought up to date by acknowledging a variety of sources of useful knowledge.

Orford J. How to cook a good omelette: Asking the wrong question in the wrong way: Reply to the commentaries. Addiction 103(6): 891-892, 2008. (8 refs.)

Ouellet LJ. Cautionary comments on an ethnographic tale gone wrong. International Journal of Drug Policy 19(3): 238-240, 2008. (19 refs.)

Greg Scott's paper, "'They got their program, and I got mine": a cautionary tale concerning the ethical implications of using respondent-driven sampling to study injection drug users' (Scott, 2008) is seriously flawed by (1) a near complete lack of context in assessing ethical implications of respondent-driven sampling, (2) ignoring the ethnographer's impact on what is observed, (3) a seemingly bedrock belief that the intimacy of ethnographic interviews produces truth, and (4) a misreading of power relationships. Some scenarios depicted in the paper appear inauthentic and the consistency of reported hustles strains credibility. The paper fails further by not situating respondent-driven sampling within the broader array of word-of-mouth recruiting methods and by ignoring advantages RDS may confer both in improving the quality of data and in anticipating the possibility of coercive recruiting.

Payne BK; Govorun O; Arbuckle NL. Automatic attitudes and alcohol: Does implicit liking predict drinking? Cognition & Emotion 22(2): 238-271, 2008. (51 refs.)

Addictive behaviour has qualities that make it ideal for study using implicit techniques. Addictive behaviours are mediated in part by automatic responses to drug cues, and there is sometimes social pressure to distort self-reports. However, relationships between implicit attitudes and addictive behaviours have been inconsistent. Using a new implicit measure, the affect misattribution procedure (AMP), we found consistent evidence that drinking-related behaviours are systematically related to implicit attitudes. The procedure predicted a behavioural choice to drink beer and self-reported typical drinking tendencies, including hazardous drinking and alcohol-related problems. The AMP showed larger relationships with drinking behaviour than other implicit measures, and explained unique variance in drinking beyond those measures and beyond explicit measures. Though self-presentation distorted self-reports, it did not affect AMP scores. These studies highlight the importance of automatic affective responses in addictive behaviour and suggest a useful means for measuring those responses.

Perez-Rios M; Montes A. Methodologies used to estimate tobacco-attributable mortality: A review. BMC Public Health 8(doi: 10.1186/1471-2458-8-22), 2008. (114 refs.)

Background: One of the most important measures for ascertaining the impact of tobacco on a population is the estimation of the mortality attributable to its use. To measure this, a number of indirect methods of quantification are available, yet there is no consensus as to which furnishes the best information. This study sought to provide a critical overview of the different methods of attribution of mortality due to tobacco consumption. Method: A search was made in the Medline database until March 2005 in order to obtain papers that addressed the methodology employed for attributing mortality to tobacco use. Results: Of the total of 7 methods obtained, the most widely used were the prevalence methods, followed by the approach proposed by Peto et al, with the remainder being used in a minority of studies. Conclusion: Different methodologies are used to estimate tobacco attributable mortality, but their methodological foundations are quite similar in all. Mainly, they are based on the calculation of proportional attributable fractions. All methods show limitations of one type or another, sometimes common to all methods and sometimes specific.

Peterson JA; Reisinger HS; Schwartz RP; Mitchell SG; Kelly SM; Brown BS et al. Targeted sampling in drug abuse research: A review and case study. (review). Field Methods 20(2): 155-170, 2008. (33 refs.)

Locating and recruiting out-of-treatment drug-dependent individuals for inclusion in research studies are important and challenging tasks. Targeted sampling, a technique to reach such populations, has been described in the substance abuse literature. However this literature has generally lacked a recent detailed account of the procedures for planning and implementing targeted sampling. This article provides a review of the literature of targeted sampling in drug abuse studies and a detailed description of methodology employed in our ongoing study of entry and engagement among opioid-dependent individuals in Baltimore, Maryland. Findings indicate that the out-of-treatment samples recruited from the streets are quite similar to those recruited front new admissions to opioid treatment programs, except for their prior treatment experience. This article indicates that targeted sampling can be useful in an urban setting with pervasive drug use.

Post A; Gilljam H; Bremberg S; Galanti MR. Maternal smoking during pregnancy: a comparison between concurrent and retrospective self-reports. Paediatric and Perinatal Epidemiology 22(2): 155-161, 2008. (24 refs.)

Retrospective reports of smoking in pregnancy are of importance for clinical or scientific purposes. Careful analyses of stability and accuracy of recalled behaviour are, therefore, needed. In 1998, the mothers of 2369 pre-teens born in Sweden retrospectively reported their smoking behaviour during the first trimester of the index pregnancy. We matched these reports with those recorded by midwives at the beginning of the index pregnancy, using information from the Swedish Medical Birth Registry. Using this registry as gold standard, the sensitivity and specificity of the retrospective reports containing any smoking were 83.9% and 92.8% respectively, but the sensitivity was low for daily smoking, 56.0%. Of the 222 discordant reports, 19.0% were due to mothers recalling daily smoking which was not reported at the time of pregnancy, and 42% were due to failure to recall smoking reported at the time of pregnancy, while the remaining 39% retrospectively reported occasional smoking, whereas they were registered as non-daily smokers when pregnant. Retrospective recall of pregnancy smoking is fairly stable over time.

Prachand NG; Benbow N. Clarifying the ethnographer's role in Chicago's HIV behavioural surveillance-injecting drug users cycle, 2005: Response to Scott. International Journal of Drug Policy 19(3): 244-245, 2008. (1 refs.)

Renna F. Teens' alcohol consumption and schooling. Economics of Education Review 27(1): 69-78, 2008. (29 refs.)

While research outside economics has found that drinking has a negative effect on cognitive skills, some economists have failed to find any negative relationship between drinking and academic performance. This paper argues that the reason for this discrepancy is due to the way education is measured in the economic literature. Herein, binge drinking in the senior year of high school is found to reduce the probability of receiving a high school diploma and to increase the probability of graduating with a General Education Development (GED). Moreover, this study finds that alcohol policies do not affect the dropout rate measured at the age of 25, but they do affect the probability that a student will graduate on time. In conclusion, bingeing is found to be responsible for inducing individuals to temporarily drop out of school. Eventually, these individuals return to school to complete their education, most likely by obtaining a GED diploma.

Rojas NL; Sherrit L; Harris S; Knight JR. The role of parental consent in adolescent substance use research. Journal of Adolescent Health 42(2): 192-197, 2008. (33 refs.)

Purpose: The objective of our study was to assess the effects of requiring parental consent upon study participation and self-reported substance-related problems among 14-18-year-olds. Methods: This was a secondary analysis of combined data from two similar studies of adolescent substance use that recruited participants from the same adolescent clinic at Children's Hospital Boston. Study I waived parental consent, whereas Study 2 required parental consent. The combined dataset included demographic characteristics and Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) study screening test responses. The CRAFFT is an orally administered screen that yields a score from 0-6 and that has been shown to be a valid and reliable measure of risk for substance-related problems. Results: The participation refusal rate in Study 1, where consent was waived, was 19.7% (132 of 670 eligible individuals) and in Study 2 (243 of 411 eligible individuals), where consent was required, it was 59.1% (p <.0001). Participants did not differ significantly with respect to gender and age but did differ by self-identified race/ethnicity between the two studies. Because the CRAFFT score distributions were highly skewed, we used the nonparametric Mann-Whitney U test for differences in mean rank. The mean rank in Study I was significantly higher than in Study 2 (mean rank 362 vs. 325, p =.02). After controlling for age, gender, and race/ethnicity, the adjusted proportional odds ratio for a one-point increase in CRAFFT score was 1.47 (CI 1.03, 2.10) for Study 1 compared with Study 2. Conclusions: The research requirement of parental consent may result in substantial self-selection bias towards a lower risk sample.

Scott G. Responses on a cautionary tale concerning the ethics of using respondent-driven sampling to study injection drug users. International Journal of Drug Policy 19(3): 246-247, 2008. (5 refs.)

Scribner RA; Johnson SA; Cohen DA; Robinson W; Farley TA; Gruenewald P. Geospatial methods for identification of core groups for HIV/AIDS. Substance Use & Misuse 43(2): 203-221, 2008. (38 refs.)

Objectives: Disease transmission dynamics among members of a sexual network's core group make the group an ideal target for prevention for positives. Identifying the geographic territory of an HIV/AIDS core group is complicated by the numerous factors that may spatially structure cases including alcohol availability. We employ spatial analytic methods in an attempt to identify the geographic distribution of the core HIV/AIDS group. Methods: Five year HIV/AIDS detection rates were analyzed for each HIV/AIDS risk category (i.e., MSM, IDU, HRH) at the census tract level (n = 164) in New Orleans using spatial analytic techniques in multivariate models. Results: MSM was the most common risk category for newly detected HIV cases. Both MSM and IDU cases appeared to decline or enter an endemic phase. Each risk category exhibited unique spatial structure. Among IDUs and HRHs nearly all the spatial structure was explained in terms of the independent variables. However among MSMs residual spatial structure remained after controlling for independent variables. Conclusions: Residual spatial structure in the MSM HIV/AIDS detection rates after controlling for social structure could be explained by the presence of core group members. The study's limitations are noted.

Snyder JL; Bowers TG. The efficacy of acamprosate and naltrexone in the treatment of alcohol dependence: A Relative Benefits analysis of randomized controlled trials. American Journal of Drug and Alcohol Abuse 34(4): 449-461, 2008. (53 refs.)

Random controlled trials on the efficacy of naltrexone and acamprosate in the treatment of alcohol dependence were reviewed, using a Relative Benefit (RB) analysis approach. A total of 42 studies were included, showing acamprosate use demonstrated a modest improvement, with a RB of 1.76 at three month follow-up. Short-term administration of naltrexone significantly reduced the relapse rate, but was not associated with modification in the abstinence rate. There was insufficient data available to ascertain the efficacy of naltrexone and acamprosate over prolonged periods of time, or the effectiveness of the medications relative to each other.

Soyka M. Alcohol and the risk of overdose death from heroin. (editorial). Addiction 103(7): 1064-1065, 2008. (7 refs.)

Stephens R; Ling J; Heffernan TM; Heather N; Jones K. A review of the literature on the cognitive effects of alcohol hangover. (review). Alcohol and Alcoholism 43(2): 163-170, 2008. (49 refs.)

Aims: Alcohol misuse is a prime social and health problem in the UK. This paper presents a critical review of literature on the performance effects in the morning after binge drinking during the alcohol hangover. Several pathophysiological changes that both follow and outlast acute intoxication may give rise to alcohol hangover effects. We have identified 27 English language peer-reviewed studies that investigate aspects of psychological performance during alcohol hangover following controlled alcohol ingestion. However, the majority of studies had basic methodological shortcomings. Of eight laboratory studies rigorous enough to warrant serious attention, only two showed effects. We interpret these largely negative findings as evidence of an insensitivity that is intrinsic to laboratory-based studies of performance under the influence of alcohol. Several studies have investigated the cognitive consequences of hangover subsequent to naturalistic consumption, where participants have chosen what and where to drink. Although these studies have tended to show effects, participants were always informed at the outset that hangover effects were to be assessed, and participants knew which was the hangover condition. Under these circumstances expectancy effects have possibly contaminated the results significantly. Therefore, naturalistic alcohol consumption studies (and laboratory studies that did not employ a placebo) can be considered as being suggestive of hangover effects, but should not be interpreted as providing definitive evidence of such effects. In conclusion, although there is empirical evidence showing impaired performance as a result of the alcohol hangover, future studies should confirm these findings and overcome the shortcomings of previous research.

Stockwell T; Zhao JH; Chikritzhs T; Greenfield TK. What did you drink yesterday? Public health relevance of a recent recall method used in the 2004 Australian National Drug Strategy Household Survey. Addiction 103(6): 919-928, 2008. (28 refs.)

Aim To (i) compare the Yesterday method with other methods of assessing alcohol use applied in the 2004 Australian National Drug Strategy Household Survey (NDSHS) in terms of extent of under-reporting of actual consumption assessed from sales data; and (ii) illustrate applications of the Yesterday method as a means of variously measuring the size of an Australian 'standard drink', the extent of risky/high-risk alcohol use, unrecorded alcohol consumption and beverage-specific patterns of risk in the general population. Setting The homes of respondents who were eligible and willing to participate. Participants A total of 24 109 Australians aged 12 years and over. Design: The 2004 NDSHS assessed drug use, experiences and attitudes using a 'drop and collect' self-completion questionnaire with random sampling and geographic (State and Territory) and demographic (age and gender) stratification. Measures: Self-completion questionnaire using quantity-frequency (QF) and graduated-frequency (GF) methods plus two questions about consumption 'yesterday': one in standard drinks, another with empirically based estimates of drink size and strength. Results: The Yesterday method yielded an estimate of 12.8 g as the amount of ethanol in a typical Australian standard drink (versus the official 10 g). Estimated coverage of the 2003-04 age 12+ years per-capita alcohol consumption in Australia (9.33 ml of ethanol) was 69.17% for GF and 64.63% for the QF when assuming a 12.8 g standard drink. Highest coverage of 80.71% was achieved by the detailed Yesterday method. The detailed Yesterday method found that 60.1% of Australian alcohol consumption was above low-risk guidelines; 81.5% for 12-17-year-olds, 84.8% for 18-24-year-olds and 88.8% for Indigenous respondents. Spirit-based drinks and regular strength beer were most likely to be drunk in this way, low- and mid-strength beer least likely. Conclusions Compared to more widely used methods, the Yesterday method minimizes under-reporting of overall consumption and provides unique data of public health significance. It also provides an empirical basis for taxing alcoholic beverages in accordance with their contributions to harm and can be used to complement individual-level measures such as QF and GF.

Thygesen LC; Johansen C; Keiding N; Giovannucci E; Gronbaek M. Effects of sample attrition in a longitudinal study of the association between alcohol intake and all-cause mortality. Addiction 103(7): 1149-1159, 2008. (45 refs.)

Background and aims Longitudinal studies show higher mortality among abstainers and heavy drinkers than among light and moderate alcohol consumers. The influence on this association of missing information on alcohol intake due to attrition (dropout) has not been examined previously. The aims of this study were to characterize participants who dropped out and to evaluate whether the missing information influenced the association between alcohol intake and all-cause mortality. Design and participants: Data on the 18 974 participants in the Copenhagen City Heart Study, with four measures of alcohol intake and other life-style factors during 28 years of follow-up, were linked with nation-wide registers on socio-economic covariates, mortality and disease incidence. Logistic regression was used to describe life-style and socio-economic determinants of attrition, and Poisson regression was used to evaluate how attrition affected the association between alcohol intake and mortality. The statistical methods used for dealing with missing values were complete case analysis, carry last observation forward, simple imputations, multiple imputation and weighting. Findings: Abstinence and high alcohol intake, current smoking, physical inactivity and high body mass index increased the odds of dropping out, whereas being married, more years of education, skilled occupation, high income and large residential area decreased the odds. Attrition was associated with increased mortality and incidence rates of heart disease, lung and upper digestive tract cancers and alcoholic liver diseases. Increased mortality among abstainers and heavy drinkers was observed with all methods used for handling missing data on alcohol intake. Conclusions: Attrition was non-random, and the observed association between alcohol intake and all-cause mortality did not differ by statistical method for handling missing data.

Toll BA; Cooney JL; Mckee SA; O'Malley SS; Cooney NL. Correspondence of interactive voice response (IVR) reports of nicotine withdrawal, craving, and negative mood with questionnaire ratings. Nicotine & Tobacco Research 10(6): 1057-1064, 2008. (25 refs.)

This study focuses on comparing reports of nicotine withdrawal, craving, and depressive symptoms obtained using an Interactive Voice Response (IVR) system and several questionnaires. As part of a smoking cessation trial, daily reports of withdrawal, craving, and negative mood were collected using an IVR system for 7 days after participants attempted to quit smoking, and several pencil and paper questionnaires (i.e., the Minnesota Nicotine Withdrawal Scale, the Questionnaire on Smoking Urges, and the Center for Epidemiological Studies-Depression) were completed a week after the target quit date. The sample was composed of 378 daily smokers. Moderate to high correlations were found between the research questionnaires obtained at the end of the week and the corresponding daily IVR reports of nicotine withdrawal, craving, and depressive symptoms. However, the sample size decreased on each day of IVR reporting due to attrition. Thus, an appealing aspect of daily assessment using an IVR system is that it can provide additional data that are not obtained with paper and pencil assessments given once per week, but it will be important for future studies to concentrate on improving adherence with the IVR system in this population.

Topp L; Iversen J; Wand H; Day C; Kaldor J; Maher L. Representativeness of injecting drug users who participate in HIV surveillance: Results from Australia's needle and syringe program survey. JAIDS-Journal of Acquired Immune Deficiency Syndromes 47(5): 632-638, 2008. (54 refs.)

Objective: Australia's annual Needle and Syringe Program (NSP) Survey forms the basis of HIV surveillance among injecting drug users (IDUs) by providing serial point prevalence estimates of patterns of infection and risk behaviors. This study examined the representativeness of NSP Survey samples. Design: National cross-sectional survey of 3920 NSP clients. Methods: Demographic and drug use characteristics of respondents and nonrespondents to the 2006 Survey were compared. Results: Relative to NSP clients who last injected heroin, methamphetamine injectors were significantly more likely to complete the Survey, as were people who had last injected an opioid maintenance pharmacotherapy or morphine. Other variables independently associated with Survey completion were female gender and being aged >= 35 years. Although the median age of NSP Survey samples has increased by 1 year per annum since 2002, the increase has occurred among both repeat and first-time respondents, allaying concerns that an ageing cohort of NSP clients repeatedly completes the Survey and unduly influences its results. Conclusions: Inferences derived from the Survey results can reasonably be applied to the population of NSP clients, although because older female pharmaceutic injectors may be overrepresented among NSP Survey participants, recruitment strategies to target specific subpopulations (younger male participants) and stratification of main outcomes by age and gender in future analyses may usefully be considered. Although the extent to which Survey results can be generalized to Australia's broader IDU population cannot be ascertained, their consistency with other sources of surveillance data suggests that NSP Survey samples reflect the changing characteristics of Australia's illicit drug markets. Consequently, these are likely to be as representative samples of injectors as it is practical to obtain, and the Australian NSP Survey provides a useful model for blood-borne virus surveillance among IDUs.

Vijgen SMC; van Baal PHM; Hoogenveen RT; de Wit GA; Feenstra TL. Cost-effectiveness analyses of health promotion programs: A case study of smoking prevention and cessation among Dutch students. Health Education Research 23(2): 310-318, 2008. (39 refs.)

Little research has been done to connect health promotion programs to outcomes in terms of life expectancy, health care costs and cost-effectiveness. For a policy maker, economic evaluation may be an important tool to support decisions on how to allocate the health care budget. The aim of this paper was to determine the cost-effectiveness of a Dutch school-based smoking education program. The incremental cost-effectiveness ratio of the school program was estimated at (sic)19 900 per quality adjusted life year gained. For a complete analysis, not only intervention costs but also savings for smoking-related diseases and differences in total health care costs should be taken into account. As several assumptions had to be made in order to estimate cost-effectiveness, the study outcomes should be interpreted with caution. Main problem in estimating the cost-effectiveness was the lack of proper effectiveness data on daily smokers among adolescents. Absence of specific effectiveness data often is an obstacle in the economic evaluation of public health interventions. While some problems may be the result of insufficient sample size or follow-up, another possible explanation might be the different basic principles of analysis of health promoters and economists.

Wiers RW. Alcohol and drug expectancies as anticipated changes in affect: Negative reinforcement is not sedation. Substance Use & Misuse 43(3/4): 429-444, 2008. (62 refs.)

Goldman and Darkes (2004) argued that all three basic alcohol-expectancy factors can be assessed with a brief questionnaire (AEMax), related to the circumplex model of emotion. I argue that negative reinforcement, one of the three basic expectancy factors, is not assessed with the AEMax. Importantly, negative reinforcement is positively related to problem drinking while sedation (the AEMax-factor that comes closest) is not. In a new dataset (from 119 students, collected in 2002), I demonstrate that sedation is related to negative expectancies and not to negative reinforcement. Different ways to assess all major expectancy factors are proposed.

Zimmermann US; Mick I; Vitvitskyi V; Plawecki MH; Mann KF; O'Connor S. Development and pilot validation of computer-assisted self-infusion of ethanol (CASE): A new method to study alcohol self-administration in humans. Alcoholism: Clinical and Experimental Research 32(7): 1321-1328, 2008. (22 refs.)

Background: Human alcohol self-administration studies employing oral intake are subject to high variability of the resulting blood alcohol concentrations because of idiosyncrasies of gastrointestinal absorption kinetics among subjects. We sought to improve the subjects' opportunity to control their brain alcohol exposure by computer-assisted i.v. self-administration. Methods: Instead of drinking, subjects could request increments of their arterial blood alcohol concentration (aBAC) of precisely 7.5 mg% at any time they wanted by pressing a button, provided their aBAC would not exceed 100 mg%. The latency between pushing the button and reaching the new aBAC peak was preset to be 2.5 minutes on the first day and was randomly changed to 1.5 or 3.5 minutes on days 2 and 3 in a crossover design. The necessary rate and amount of alcohol infusion was calculated by the software about once every second. Nine healthy social drinkers (4 females/5 males; mean age 25.0 +/- 4.0 year) participated in 3 sessions each. Outcome measures were mean and maximum observed aBAC, and the number of alcohol requests. Results: Maximum aBAC was 76.5 +/- 26.3 mg% on average over all experiments. When grouping days 2 and 3 according to latency (1.5 vs. 3.5 minutes), maximum aBAC and the number of requests in the session were significantly higher with the faster rise and all 3 outcome measures were significantly correlated between days. No such correlations were found between the first and either of the following days. Conclusions: These data suggest that CASE is practical and safe, and results in considerable alcohol exposure that can be manipulated with parameters chosen for the incremental exposure. Following 1 practice day, test-retest stability was good, suggesting a potential for use in scientific studies.

Zuccato E; Chiabrando C; Castiglioni S; Bagnati R; Fanelli R. Estimating community drug abuse by wastewater analysis. Environmental Health Perspectives 116(8): 1027-1032, 2008. (23 refs.)

BACKGROUND: The social and medical problems of drug abuse are a matter of increasing global concern. To tackle drug abuse in changing scenarios, international drug agencies need fresh methods to monitor trends and patterns of illicit drug consumption. OBJECTIIVE: We tested a sewage epidemiology approach, using levels of excreted drug residues in wastewater, to monitor collective use of the major drugs of abuse in near real time. METHODS: Selected drug target residues derived from use of cocaine, opiates, cannabis, and amphetamines were measured by mass spectrometry in wastewater collected at major sewage treatment plants in Milan (Italy), Lugano (Switzerland), and London (United Kingdom). The amounts of drug residues conveyed to the treatment plants, reflecting the amounts collectively excreted with urine, were used to estimate consumption of the active parent drugs. RESULTS: Reproducible and characteristic profiles of illicit drug use were obtained in the three cities, thus for the first time quickly revealing changes in local consumption (e.g., cocaine consumption rose significantly on weekends in Milan). Profiles of local drug consumption based on wastewater measurements are in line with national annual prevalence estimates. CONCLUSIONS: Patterns and trends of drug abuse in local communities can be promptly monitored by this tool, a convenient new complement to more complex, lengthy survey methods. In principle, searching the sewage for excreted compounds relevant to public health issues appears to have the potential to become a convenient source of real-time epidemiologic information.