Altered state

Kevin Lewis

October 28, 2012

Is an International Treaty Needed to Fight Corruption and the Narco-Insurgency in Mexico?

Stuart Yeh
International Criminal Justice Review, September 2012, Pages 233-257

Mexican government corruption prevents effective law enforcement against drug traffickers and the violence associated with drug trafficking. This article reviews the nature and scope of government corruption, including a first-hand account by a Mexican state police commander, then suggests how and why an international treaty establishing United Nation (UN) inspectors who are empowered to investigate corruption at all levels of government could be effective in deterring corruption and restoring the rule of law in the U.S.-Mexico border region. The article suggests that the Rome Statute provides a model for establishing this type of treaty and a precedent for all of the powers envisioned for UN inspectors, and suggests that government leaders may be compelled by their own citizens to sign and ratify such a treaty if it is posed as a public litmus test of their leaders' willingness to fight corruption.


The isoflavone puerarin reduces alcohol intake in heavy drinkers: A pilot study

David Penetar et al.
Drug and Alcohol Dependence, 1 November 2012, Pages 251-256

Background: Isoflavone compounds naturally occurring in the root of the kudzu plant have been used historically to treat alcohol-related problems. A pilot study was conducted to assess the effects of one primary isoflavone - puerarin - for its ability to modify alcohol intake in humans.

Methods: Ten (10) healthy adult volunteers were administered puerarin (1200 mg daily) in a double-blind, placebo-controlled, crossover design experiment for one week prior to an afternoon drinking session lasting 1.5 h. Participants had access to up to six bottles of their preferred brand of beer in addition to juice and water. A time course of drinking, sip volumes, and total amount consumed were recorded.

Results: Participants consumed on average 3.5 (±0.55) beers when treated with placebo and 2.4 (±0.41) beers when treated with puerarin. In contrast to drinking following placebo treatment when 3 participants drank 5 beers and 1 participant drank all 6 beers, none drank 5 or 6 beers when treated with puerarin. Drinking topography also changed. When treated with puerarin, participants decreased sip size, took more sips to finish a beer, and took longer to consume each beer. Additionally, after finishing a beer, latency to opening the next beer was increased.

Conclusions: This study is the first demonstration that a single isoflavone found in the kudzu root can alter alcohol drinking in humans. These results suggest that alcohol consumption patterns are influenced by puerarin administration and this botanical medication may be a useful adjunct in the treatment of excessive alcohol intake.


Deaths From Secondhand Smoke Exposure in the United States: Economic Implications

Wendy Max, Hai-Yen Sung & Yanling Shi
American Journal of Public Health, November 2012, Pages 2173-2180

Objectives: We estimated the number of deaths attributable to secondhand smoke (SHS), years of potential life lost (YPLL), and value of lost productivity for different US racial/ethnic groups in 2006.

Methods: We determined the number of SHS-related deaths among nonsmokers from 2 adult and 4 infant conditions using an epidemiological approach. We estimated adult SHS exposure using detectable serum cotinine. For each death, we determined the YPLL and the value of lost productivity.

Results: SHS exposure resulted in more than 42 000 deaths: more than 41 000 adults and nearly 900 infants. Blacks accounted for 13% of all deaths but 24% to 36% of infant deaths. SHS-attributable deaths resulted in a loss of nearly 600 000 YPLL and $6.6 billion of lost productivity, or $158 000 per death. The value of lost productivity per death was highest among Blacks ($238 000) and Hispanics ($193 000).

Conclusions: The economic toll of SHS exposure is substantial, with communities of color having the greatest losses. Interventions need to be designed to reduce the health and economic burden of smoking on smokers and nonsmokers alike and on particularly vulnerable groups.


The Effect of Cigarette Taxation on Prices: An Empirical Analysis Using Local-Level Data

Ryan Sullivan & Donald Dutkowsky
Public Finance Review, November 2012, Pages 687-711

This article combines new, author-collected tax data with data both from the American Chamber of Commerce Researchers Association cost of living index and from the Tax Burden on Tobacco to measure the relative effects of city, county, and state excise cigarette taxation on cigarette prices. The results indicate that a $1 increase in the state excise cigarette tax increases cigarette prices between $1.10 and $1.14, but that a $1 increase in a city- or county-level excise tax increases prices by $1.07. These findings are similar between premium and generic cigarette brands. Additionally, urban areas located near states with lower cigarette taxes tend to have lower cigarette prices relative to urban areas located near states with the same or higher tax rates.


A Ban on Menthol Cigarettes: Impact on Public Opinion and Smokers' Intention to Quit

Jennifer Pearson et al.
American Journal of Public Health, November 2012, Pages e107-e114

Objectives: We assessed support for a ban by the Food and Drug Administration on menthol in cigarettes and behavioral intentions among menthol smokers in the event of such a ban.

Methods: We surveyed 2649 never, former, and current smokers and used ordinal logistic regression to calculate weighted point estimates and predictors of support for a menthol ban among the adult population and menthol smokers only. For menthol smokers, we also calculated weighted point estimates and predictors of behavioral intentions.

Results: Overall, 28.2% of adults opposed, 20.0% supported, and 51.9% lacked a strong opinion about a menthol ban. Support was highest among Hispanics (36.4%), African Americans (29.0%), never smokers (26.8%), and respondents with less than a high school education (28.8%). Nearly 40% of menthol smokers said they would quit if menthol cigarettes were no longer available, 12.5% would switch to a nonmenthol brand, and 25.2% would both switch and try to quit.

Conclusions: Support for a menthol ban is strongest among populations with the highest prevalence of menthol cigarette use. A menthol ban might motivate many menthol smokers to quit.


Increases in the availability of prescribed opioids in a Canadian setting

B. Nosyk et al.
Drug and Alcohol Dependence, 1 November 2012, Pages 7-12

Background: The nonmedical use of prescribed opioids (POs) has increased across North America over the past decade. Our objective was to identify changes in the availability of POs and other illicit drugs among drug users in a Canadian setting.

Methods: Information on the availability of illicit drugs was collected in standardized interviews from a large observational research program involving illicit drug users in Vancouver, British Columbia from 2006 to 2010. The primary outcome was the perceived availability of a set of six POs (aspirin/oxycodone, hydromorphone, oxycodone, morphine, acetaminophen/codeine and methadone) among individuals reporting ever using POs. Availability was measured in three levels: not available, delayed availability (available ≥10 min), and immediate availability (available <10 min). Multivariate ordinal logistic regression models were executed to estimate the trend in PO availability, controlling for individual characteristics hypothesized to influence availability.

Results: 1871 individuals were followed during the study period (2006-2010), including 583 (31.2%) women. The availability of POs increased over time, regardless of changes in the characteristics of cohort entrants. These increases were observed while the availability of traditional drugs of abuse (e.g., heroin and cocaine) remained constant. The adjusted odds of delayed availability vs. unavailability were between 34% (hydromorphone) and 71% (acetaminophen/codeine) greater in each calendar year.

Discussion: The availability of POs among drug users in a Canadian setting increased markedly over a relatively short timeframe, despite persistent and high availability of heroin and cocaine. Further study is required to determine the context of use of POs, associated harms, as well as policy responses to increasing availability.


Dispelling the myth of "smart drugs": Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying

Amelia Arria et al.
Addictive Behaviors, forthcoming

This study tested the hypothesis that college students' substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories with NPS for studying was then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines.


Continued Increases in the Relative Risk of Death From Smoking

Neil Mehta & Samuel Preston
American Journal of Public Health, November 2012, Pages 2181-2186

Objectives: We examined changes in the relative risk of death among current and former smokers over recent decades in the United States.

Methods: Data from the National Health Interview Survey (NHIS) and National Health and Nutrition Examination Survey (NHANES) were linked to subsequent deaths. We calculated age-standardized death rates by gender and smoking status, and estimated multivariate discrete time logit regression models.

Results: The risk of death for a smoker compared with that for a never-smoker increased by 25.4% from 1987 to 2006 based on NHIS data. Analysis of NHANES data from 1971 to 2006 showed an even faster annual increase in the relative risk of death for current smokers. Former smokers also showed an increasing relative risk of death, although the increase was slower than that among current smokers and not always statistically significant. These trends were not related to increasing educational selectivity of smokers or increased smoking intensity or duration among current smokers. Smokers may have become more adversely selected on other health-related variables.

Conclusions: A continuing increase in the relative risk of death for current and former smokers suggests that the contribution of smoking to national mortality patterns is not decreasing as rapidly as would be implied by the decreasing prevalence of smoking among Americans.


Regional differences in drug use rates among American Indian youth

Kimberly Miller, Linda Stanley & Fred Beauvais
Drug and Alcohol Dependence, 1 November 2012, Pages 35-41

Background: Research over the past several decades has shown that, compared to other American ethnic and racial groups, American Indian (AI) youth use alcohol and other drugs at significantly higher rates than their non-AI peers. However, to date, much of the research on AI adolescent substance use has been limited in the types of data used.

Methods: We used a national sample of AI youth living on or near reservations to estimate how lifetime and 30-day use of four substances (alcohol, marijuana, inhalants, and methamphetamine) differ by gender, grade in school, and region of the country.

Results: Female use was equal to or greater than use by otherwise similar males for all substances assessed. Substance use also increased as grade increased except in the case of inhalants, where use peaked in the 8th grade and then decreased. Regional differences proved to be one of the most salient findings in that individuals in the Northern Plains and Upper Great Lakes were more likely to have used substances at much higher rates than those living in the Southwest and Oklahoma, except in the case of methamphetamine, where individuals in the Southwest were most likely to have used.

Conclusions: It is clear that substance use continues to be a problem for AI youth although the severity of use differs by region of the country, grade, and gender. Future research is needed to better understand the reasons behind these differences. Such research will aid in the development of targeted, regionally tailored prevention.


The Minimum Legal Drinking Age and Marijuana Use: New Estimates from the NLSY97

Benjamin Crost & Daniel Rees
Journal of Health Economics, forthcoming

In volume 30, issue 4 of this journal Bariş Yörük and Ceren Yörük (Y&EY) used data from the National Longitudinal Study of Youth, 1997 (NLSY97) and a regression discontinuity design to estimate the effect of the minimum legal drinking age on a variety of substances including marijuana. They obtained evidence that the probability of marijuana use increased sharply at the age of 21, consistent with the hypothesis that alcohol and marijuana are complements, but inadvertently conditioned on having used marijuana at least once since the last survey. Applying the Y&EY research design to all NLSY97 respondents ages 19 through 22, we find no evidence that alcohol and marijuana are complements.


Changing over-the-counter ephedrine and pseudoephedrine products to prescription only: Impacts on methamphetamine clandestine laboratory seizures

James Cunningham et al.
Drug and Alcohol Dependence, 1 November 2012, Pages 55-64

Background: Clandestine laboratory operators commonly extract ephedrine and pseudoephedrine-precursor chemicals used to synthesize methamphetamine-from over-the-counter cold/allergy/sinus products. To prevent this activity, two states, Oregon in 07/2006 and Mississippi in 07/2010, implemented regulations classifying ephedrine and pseudoephedrine as Schedule III substances, making products containing them available by prescription only. Using simple pre-regulation versus post-regulation comparisons, reports claim that the regulations have substantially reduced clandestine laboratory seizures (an indicator of laboratory prevalence) in both states, motivating efforts to implement similar regulation nationally. This study uses ARIMA-intervention time-series analysis to more rigorously evaluate the regulations' impacts on laboratory seizures.

Methods: Monthly counts of methamphetamine clandestine laboratory seizures were extracted from the Clandestine Laboratory Seizure System (2000-early 2011) for Oregon, Mississippi and selected nearby states (for quasi-control).

Findings: Seizures in Oregon and nearby western states largely bottomed out months before Oregon's regulation, and changed little thereafter. No significant impact for Oregon's regulation was found. Mississippi and nearby states generally had elevated seizures before Mississippi's regulation. Mississippi experienced a regulation-associated drop of 28.9 seizures (50.2%) in the series level (p < 0.01), while nearby states exhibited no comparable decline.

Conclusions: Oregon's regulation encountered a floor effect, making any sizable impact infeasible. Mississippi, however, realized a substantial impact, suggesting that laboratories, if sufficiently extant, can be meaningfully impacted by prescription precursor regulation. It follows that national prescription precursor regulation would have little impact in western states with low indicated laboratory prevalence, but may be of significant use in regions facing higher indicated prevalence.


Event-specific risk and ecological factors associated with prepartying among heavier drinking college students

Justin Hummer et al.
Addictive Behaviors, forthcoming

Using event-specific data, the present study sought to identify relevant risk factors and risky drinking patterns associated with prepartying. Analyses focused on drinking outcomes as a function of drinking game playing and the social context on occasions where prepartying did and did not occur. This research utilized a representative two-site sample of prepartiers who also reported a heavy episodic drinking event in the past month (n = 988). Results revealed that during a preparty event, participants drank significantly more, reached higher blood alcohol levels (BALs), and experienced significantly more negative consequences compared to the last occasion that they drank but did not preparty. Students who played drinking games when they prepartied had higher BALs and experienced more negative consequences than those who did not play drinking games. Whether females prepartied in a single-sex or coed setting had little effect on their BALs. For males, however, their BALs were greater when they prepartied in a coed setting compared to a single sex setting. Moreover, participants reported more negative consequences when they prepartied in a coed setting than in a single-sex setting. Finally, regression analyses demonstrated that participants' BAL, frequency of prepartying, and the interaction between BAL and frequency of prepartying all uniquely contributed to the prediction of event-specific alcohol-related negative consequences. As BAL increased, the number of negative consequences increased more sharply for those who prepartied infrequently, compared to those who prepartied frequently. Analyses were examined as a function of gender which revealed important gender effects and interactions. Interventions can be designed to intervene with high-risk prepartiers by using BAL education emphasizing the impact of time-limited prepartying drinking.


Current Tobacco Use Among Adults in the United States: Findings From the National Adult Tobacco Survey

Brian King, Shanta Dube & Michael Tynan
American Journal of Public Health, November 2012, Pages e93-e100

Objectives: We assessed the prevalence and sociodemographic correlates of tobacco use among US adults.

Methods: We used data from the 2009-2010 National Adult Tobacco Survey, a national landline and cell phone survey of adults aged 18 years and older, to estimate current use of any tobacco; cigarettes; cigars, cigarillos, or small cigars; chewing tobacco, snuff, or dip; water pipes; snus; and pipes. We stratified estimates by gender, age, race/ethnicity, education, income, sexual orientation, and US state.

Results: National prevalence of current use was 25.2% for any tobacco; 19.5% for cigarettes; 6.6% for cigars, cigarillos, or small cigars; 3.4% for chewing tobacco, snuff, or dip; 1.5% for water pipes; 1.4% for snus; and 1.1% for pipes. Tobacco use was greatest among respondents who were male, younger, of non-Hispanic "other" race/ethnicity, less educated, less wealthy, and lesbian, gay, bisexual, or transgender. Prevalence ranged from 14.1% (Utah) to 37.4% (Kentucky).

Conclusions: Tobacco use varies by geography and sociodemographic factors, but remains prevalent among US adults. Evidence-based prevention strategies are needed to decrease tobacco use and the health and economic burden of tobacco-related diseases.


Comprehensive Smoking Bans and Acute Myocardial Infarction Among Medicare Enrollees in 387 US Counties: 1999-2008

Christopher Barr et al.
American Journal of Epidemiology, 1 October 2012, Pages 642-648

Restrictions on smoking in public places have become increasingly widespread in the United States, particularly since the year 2005. National-scale studies in Europe and local-scale studies in the United States have found decreases in hospital admissions for acute myocardial infarction (AMI) following smoking bans. The authors analyzed AMI admission rates for the years 1999-2008 in 387 US counties that enacted comprehensive smoking bans across 9 US states, using a study population of approximately 6 million Medicare enrollees aged 65 years or older. Effects of smoking bans on AMI admissions were estimated by using Poisson regression with linear and nonlinear adjustment for secular trend and random effects at the county level. Under the assumption of linearity in the secular trend of declining AMI, smoking bans were associated with a statistically significant ban-associated decrease in admissions for AMI in the 12 months following the ban. However, the estimated effect was attenuated to nearly zero when the assumption of linearity in the underlying trend was relaxed. This analysis demonstrates that estimation of potential health benefits associated with comprehensive smoking bans is challenged by the need to adjust for nonlinearity in secular trend.


Attention deficit/hyperactivity disorder symptoms and depression symptoms as mediators in the intergenerational transmission of smoking

Alex Zoloto et al.
Drug and Alcohol Dependence, 1 November 2012, Pages 147-155

Background: Attention deficit/hyperactivity disorder and depression have been found to be comorbid with smoking behaviors, and all three behavioral syndromes have been shown to be familially transmitted. The present paper reports on the results of analyses testing whether child attention deficit/hyperactivity disorder and depression symptoms were mediators in the intergenerational transmission of cigarette smoking.

Method: Path analyses using bootstrapped mediation procedures were conducted on data from a community sample of 764 families (one or both parents and one adolescent offspring) from the Indiana University Smoking Survey. Parents reported on their smoking behaviors, ADHD, and depression and their child's ADHD, while offspring reported on their smoking behaviors and depression.

Results: Although fathers' and mothers' smoking status, depression, and ADHD were not significantly correlated with boys' smoking initiation, there was a significant mediated (indirect) pathway from mothers' depression to boys' smoking initiation through boys' depression. Several parental variables were significantly correlated with smoking initiation in girls, and the pathways from mothers' smoking status, mothers' ADHD, and fathers' smoking status to girls' smoking initiation were significantly mediated by girls' ADHD.

Conclusions: For adolescent girls, the intergenerational transmission of ADHD appears to be important in understanding the intergenerational transmission of cigarette smoking. Sex differences in the intergenerational transmission of psychopathology as it leads to smoking initiation were also discussed.


Prevalence and correlates of prescription drug misuse among socially active young adults

Brian Kelly et al.
International Journal of Drug Policy, forthcoming

Background: Prescription drug misuse represents an emerging global drug trend. Data indicate that young adults are misusing prescription drugs at high rates. As such, continued surveillance of the patterns of prescription drug misuse among young adults is critical, particularly for those engaged in social scenes known to accommodate drug use.

Methods: Prevalence and correlates of lifetime and recent prescription drug misuse among urban young adults recruited at nightlife venues using time-space sampling are assessed via prevalence estimates and logistic regression analyses.

Results: In a diverse sample of 1207 young adults, 44.1% reported lifetime prescription drug misuse, and 20.3% reported misuse during the past three months. Stimulants were the most common class of drug respondents misused within the past six months (16.7%), followed by pain killers (16.5%) and sedatives (14.5%). While no gender or sexual orientation differences in misuse prevalence existed, Black youth reported the lowest prevalence of misuse. In multivariate analyses, increased age was associated with lower odds of recent misuse, females report lower odds of recent use, and Black, Asian, and Latino individuals had lower odds of recent misuse than Whites. These odds varied by prescription drug type. Negative binomial regression analyses indicate that, among prescription drug misusers, women misuse prescription drugs less frequently. Younger individuals more frequently misuse stimulants and older individuals more frequently misuse sedatives. Racial variation existed with frequency of use across classes.

Conclusions: This study illustrates the need for health promotion efforts targeting prescription drug misuse among young adults who are highly socially active. Future research should focus on motivations for and factors associated with prescription drug misuse within youth cultures. Further research may provide a fuller sense of how to reduce the impact of prescription drug misuse for nations whose prescription drug problem lags behind that of the U.S.


Young Adults' Favorable Perceptions of Snus, Dissolvable Tobacco Products, and Electronic Cigarettes: Findings From a Focus Group Study

Kelvin Choi et al.
American Journal of Public Health, November 2012, Pages 2088-2093

Objectives: We explored young adults' perceptions of snus (spitless moist snuff packed in porous bags), dissolvable tobacco products, and electronic cigarettes and intention to try these products.

Methods: We conducted 11 focus group discussions involving a total of 66 young adults (18-26 years old) on these new tobacco products (e.g., harmfulness, potential as quit aids, intention to try) held between July and December 2010. We analyzed discussions using a thematic approach.

Results: Participants generally reported positive perceptions of the new products, particularly because they came in flavors. Few negative perceptions were reported. Although some participants believed these products were less harmful than cigarettes and helpful in quitting smoking, others thought the opposite, particularly regarding electronic cigarettes. Participants also commented that these products could be gateways to cigarette smoking. Half of the participants, including a mix of smokers and nonsmokers, admitted they would try these products if offered by a friend.

Conclusions: Young adults perceive the new tobacco products positively and are willing to experiment with them. Eliminating flavors in these products may reduce young adults' intentions to try these products.


Smoke-free bar policies and smokers' alcohol consumption: Findings from the International Tobacco Control Four Country Survey

Karin Kasza et al.
Drug and Alcohol Dependence, 1 November 2012, Pages 240-245

Background: Cigarette smoking and alcohol consumption are positively correlated, and the concurrent use of tobacco and alcohol exacerbates the health risks associated with the singular use of either product. Indoor smoke-free policies have been effective in reducing smoking, but little is known about any impact of these policies on drinking behavior. The purpose of this study was to evaluate the potential association between the implementation of smoke-free bar policies and smokers' alcohol consumption.

Methods: A prospective, multi-country cohort survey design was utilized. Participants were nationally representative samples of smokers from the United Kingdom, Australia, Canada, and the United States, who were interviewed as part of the International Tobacco Control Four Country Survey (ITC-4) in 2005, 2007, or 2008 (N = 11,914). Changes in the frequency and amount of alcohol consumption were assessed as functions of change in the presence of smoke-free bar policies over time.

Results: Overall, changes in alcohol consumption were statistically indistinguishable between those whose bars became smoke-free and those whose bars continued to allow smoking. However, implementation of smoke-free policies was associated with small reductions in the amount of alcohol typically consumed by those who were classified as hazardous drinkers, along with small reductions in the frequency of alcohol consumption among heavy smokers.

Conclusions: Smoking bans in public places, which protect millions of non-smokers from the harmful effects of second-hand smoke, do not appear to be associated with sizable reductions in smokers' alcohol consumption in general, but may be associated with small consumption reductions among subgroups.

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