Party's over

Kevin Lewis

January 01, 2013

Increasing Use of Nonmedical Analgesics Among Younger Cohorts in the United States: A Birth Cohort Effect

Richard Miech et al.
Journal of Adolescent Health, January 2013, Pages 35-41

Purpose: Nonmedical use of prescription pain drugs (hereafter "analgesics") has increased substantially in recent years. It is not known whether today's youth are disproportionately driving this increase or, instead, the trend is a general one that has affected cohorts of all ages similarly. To address this question we present the first age-period-cohort analysis of nonmedical use of analgesics.

Methods: Data come from the National Survey on Drug Use and Health, a series of annual, nationally representative, cross-sectional surveys of the US civilian, noninstitutionalized population. The analysis focuses on the years 1985-2009 and uses the recently developed "intrinsic estimator" algorithm to disentangle age-period-cohort effects.

Results: Substantial increases in the prevalence of nonmedical analgesics use (NAU) have occurred across all cohorts and ages in recent years, but this increase is significantly amplified among today's adolescents. The odds of past-year NAU for today's youngest cohort (born 1980-1994) are higher than would be expected on the basis of their age and broad, historical period influences that have increased use across people of all ages and cohorts. The independent influence of cohort on past-year NAU is about 40% higher for today's youth cohort than any of the cohorts that came before them. This finding is present among men, women, non-Hispanic whites, non-Hispanic blacks, and Hispanics.

Conclusions: Although nonmedical use of analgesics is evident among all ages, cohorts, and periods, today's younger cohorts warrant special attention for substance abuse policies and interventions targeted at reversing the increase in NAU.


The Promise and Peril of the Pharmacological Enhancer Modafinil

Julie Tannenbaum
Bioethics, forthcoming

The neuro-enhancement Modafinil promises to dramatically increase users' waking hours without much sacrifice to clarity of thought and without serious side effects (inducing addiction). For Modafinil to be advantageous, its usage must enable access to goods that themselves improve the quality of one's life. I draw attention to a variety of conditions that must be met for an experience, activity or object to improve the quality of one's life, such as positional, relational, and saturation conditions, as well as it's being good for its own sake. I discuss and describe the contexts in which widespread usage (legal or not) of Modafinil would undermine these conditions being met, and thus users would fail to significantly improve the quality of their lives and would in fact potentially make both themselves and nonusers worse off in important respects thus far overlooked by critics. In the right contexts, where free time is protected and prolonged, Modafinil does have a variety of potential benefits including, most interestingly, a distinctive form of agency possible only in free time. The potential disadvantages and advantages highlighted in this article are relevant not only to public institutions deciding whether to legalize Modafinil's use as an enhancement but also to individuals deciding whether to use it illegally, as well as to the questions of how and whether to alter key features of one's context (e.g. regulating work hours or extending social services) rather than, or in addition, to regulating the use of enhancement drugs such as Modafinil.


Why Have Tobacco Control Policies Stalled? Using Genetic Moderation to Examine Policy Impacts

Jason Fletcher
PLoS ONE, December 2012

Background: Research has shown that tobacco control policies have helped produce the dramatic decline in use over the decades following the 1964 surgeon general's report. However, prevalence rates have stagnated during the past two decades in the US, even with large tobacco taxes and expansions of clean air laws. The observed differences in tobacco control policy effectiveness and why policies do not help all smokers are largely unexplained.

Objective: The aim of this study was to determine the importance of genetics in explaining response to tobacco taxation policy by testing the potential of gene-policy interaction in determining adult tobacco use.

Methods: A moderated regression analysis framework was used to test interactive effects between genotype and tobacco policy in predicting tobacco use. Cross sectional data of US adults from the National Health and Nutrition Examination Survey (NHANES) linked with genotype and geocodes were used to identify tobacco use phenotypes, state-level taxation rates, and variation in the nicotinic acetylcholine receptor (CHRNA6) genotype. Tobacco use phenotypes included current use, number of cigarettes smoked per day, and blood serum cotinine measurements.

Results: Variation in the nicotinic acetylcholine receptor was found to moderate the influence of tobacco taxation on multiple measures of tobacco use. Individuals with the protective G/G polymorphism (51% of the sample) responded to taxation while others had no response. The estimated differences in response by genotype were C/C genotype: b = -0.016 se = 0.018; G/C genotype: b = 0.014 se = 0.017; G/G genotype: b = -0.071 se 0.029.

Conclusions: This study provides novel evidence of "gene-policy" interaction and suggests a genetic mechanism for the large differences in response to tobacco policies. The inability for these policies to reduce use for individuals with specific genotypes suggests alternative methods may be needed to further reduce use.


How Risky Is Marijuana Possession? Considering the Role of Age, Race, and Gender

Holly Nguyen & Peter Reuter
Crime & Delinquency, November 2012, Pages 879-910

Arrest rates per capita for possession of marijuana have increased threefold over the last 20 years and now constitute the largest single arrest offense category. Despite the increase in arrest numbers, rates of use have remained stable during much of the same period. This article presents the first estimates of the arrest probabilities for marijuana, conditional on use in the previous 12 months; this is an appropriate measure of the intensity of enforcement against users. We analyze differences by age, race, and gender from 1982 to 2008. The probabilities of arrest for a marijuana user were similar across age and race categories until 1991. By 2006, that had changed sharply. Arrest rates among current marijuana users are disproportionately high for adolescents, Blacks, and males. The rate has varied between 0.8% and 1.8% across years; the rate per incident of use has ranged between about 1/3,000 and 1/6,000. There is no compelling account of why marijuana arrest probabilities have increased nationally or why the focus has been on youth, minorities, and males but the disproportionate increase for young Black males raises issues of disparate impact.


Smoke Gets in Your Eyes: Cigarette Tax Salience and Regressivity

Jacob Goldin & Tatiana Homonoff
American Economic Journal: Economic Policy, forthcoming

Recent evidence suggests consumers pay less attention to commodity taxes levied at the register than to taxes included in a good's posted price. If this attention gap is larger for high-income consumers than for low-income consumers, policymakers can manipulate a tax's regressivity by altering the fraction of the tax imposed at the register. We investigate income differences in attentiveness to cigarette taxes, exploiting state and time variation in cigarette excise and sales tax rates. Whereas all consumers respond to taxes that appear in cigarettes' posted price, our results suggest that only low-income consumers respond to taxes levied at the register.


Simulation Of Quitting Smoking In The Military Shows Higher Lifetime Medical Spending More Than Offset By Productivity Gains

Wenya Yang et al.
Health Affairs, December 2012, Pages 2717-2726

Despite the documented benefits of quitting smoking, studies have found that smokers who quit may have higher lifetime medical costs, in part because of increased risk for medical conditions, such as type 2 diabetes, brought on by associated weight gain. Using a simulation model and data on 612,332 adult smokers in the US Department of Defense's TRICARE Prime health plan in 2008, we estimated that cessation accompanied by weight gain would increase average life expectancy by 3.7 years, and that the average lifetime reduction in medical expenditures from improved health ($5,600) would be offset by additional expenditures resulting from prolonged life ($7,300). Results varied by age and sex: For females ages 18-44 at time of cessation, there would be net savings of $1,200 despite additional medical expenditures from prolonged life. Avoidance of weight gain after quitting smoking would increase average life expectancy by four additional months and reduce mean extra spending resulting from prolonged life by $700. Overall, the average net lifetime health care cost increase of $1,700 or less per ex-smoker would be modest and, for employed people, more than offset by even one year's worth of productivity gains. These results boost the case for smoking cessation programs in the military in particular, along with not selling cigarettes in commissaries or at reduced prices.


Cognitive deficits in long-term anabolic-androgenic steroid users

Gen Kanayama et al.
Drug and Alcohol Dependence, forthcoming

Background: Millions of individuals worldwide have used anabolic-androgenic steroids (AAS) to gain muscle or improve athletic performance. Recently, in vitro investigations have suggested that supraphysiologic AAS doses cause apoptosis of neuronal cells. These findings raise the possibility, apparently still untested, that humans using high-dose AAS might eventually develop cognitive deficits.

Methods: We administered five cognitive tests from the computerized CANTAB battery (Pattern Recognition Memory, Verbal Recognition Memory, Paired Associates Learning, Choice Reaction Time, and Rapid Visual Information Processing) to 31 male AAS users and 13 non-AAS-using weightlifters age 29-55, recruited and studied in May 2012 in Middlesbrough, UK. Testers were blinded to participants' AAS status and other historical data.

Results: Long-term AAS users showed no significant differences from nonusers on measures of response speed, sustained attention, and verbal memory. On visuospatial memory, however, AAS users performed significantly more poorly than nonusers, and within the user group, visuospatial performance showed a significant negative correlation with total lifetime AAS dose. These were large effects: on Pattern Recognition Memory, long-term AAS users underperformed nonusers by almost one standard deviation, based on normative population scores (adjusted mean difference in z-scores = 0.89; p = 0.036), and performance on this test declined markedly with increasing lifetime AAS dose (adjusted change in z-score = -0.13 per 100 g of lifetime AAS dose; p = 0.002). These results remained stable in sensitivity analyses addressing potential confounding factors.

Conclusions: These preliminary findings raise the ominous possibility that long-term high-dose AAS exposure may cause cognitive deficits, notably in visuospatial memory.


Role of Tobacco Smoking in Hangover Symptoms Among University Students

Kristina Jackson et al.
Journal of Studies on Alcohol and Drugs, January 2013, Pages 41-49

Objective: Although hangover results from excessive alcohol consumption, the specific pathways through which hangover symptoms arise have not been elucidated. Research on predictors of hangover sensitivity may provide clues about such mechanisms. The present study investigated whether tobacco smoking on days of heavy drinking affects next-day hangover incidence and severity.

Method: The study drew on diary data from a study on smoking and drinking among 113 students at a midwestern university in the United States. Participants completed a daily, web-based, 26-item survey for 8 weeks to assess prior-day alcohol and tobacco use as well as current-day hangover symptoms. Hierarchical linear modeling was used to test the hypothesis that amount of smoking is related to hangover, controlling for amount of alcohol consumed, sex, and other individual characteristics. Analyses were conducted after selecting only days with alcohol consumption levels that typically elicit hangover, then repeated on lighter drinking days for comparison. Validity of the hangover items was checked by comparing reports after such heavy drinking days with days of lighter drinking.

Results: Across all possible person-days, 92% of daily reports were obtained. When selecting only events where an estimated blood alcohol concentration of 110 mg/dl was attained, smoking significantly increased the odds of hangover incidence and hangover severity while controlling for number of drinks consumed and sex. Additional analyses controlling for age first smoked regularly, frequency of drug use, type of drug involvement, or smoking status resulted in findings that were unchanged.

Conclusions: Smoking more on heavy drinking days affects hangover sensitivity and severity, possibly because of acute pharmacological effects.


Adolescent Initiation of Drug Use: Effects of Prenatal Cocaine Exposure

Gale Richardson et al.
Journal of the American Academy of Child & Adolescent Psychiatry, January 2013, Pages 37-46

Objective: To investigate the direct effects of prenatal cocaine exposure (PCE) on adolescent drug use, while controlling for other predictors of adolescent use.

Method: Data are from a longitudinal study of PCE in which women and their offspring were assessed throughout childhood. Adolescents were interviewed at 15 years about their age at initiation of alcohol, marijuana, and tobacco. The sample consisted of 214 adolescents and their caregivers: 50% was of white ethnicity, and 50% African American.

Results: First trimester cocaine exposure significantly predicted earlier adolescent marijuana and alcohol initiation. The hazard of marijuana and alcohol initiation among exposed adolescents was almost two times greater than among nonexposed adolescents, adjusting for other significant factors. There were no differences in tobacco initiation. Other significant predictors of adolescent drug use were family history of alcohol problems, exposure to violence, and childhood maltreatment.

Conclusions: Cocaine exposure during early pregnancy was associated with initiation of marijuana and alcohol use. Exposure to violence, childhood maltreatment, and familial factors also predicted adolescent initiation, but did not mitigate the effects of PCE. The combination of these risk factors has significant implications for the development of later substance use, social, and psychiatric problems.


Self-medication and pleasure seeking as dichotomous motivations underlying behavioral disorders

Xiuping Li, Qiang Lu & Rohan Miller
Journal of Business Research, forthcoming

Social concern is increasing about the perceived negative effects from consuming a number of legal products including gambling, alcohol, and food. This study uses data from a clinic treating gambling and other behavioral disorders to test the theory that different motivations may exist in the consumption of legal products that harm health and well-being. Pathological consumers whose goal is self-medication are more likely to have correlated consumption disorders (e.g., other substance dependencies) than those whose goal is pure pleasure. Self-medicators demonstrate a positive correlation between the severity of their consumption problems and having other substance dependencies. This finding suggests that gambling and other substance dependencies are means of self-medication to one category of pathological gamblers. Furthermore, because self-medicators can more easily substitute among different problem consumptions (e.g., switch from gambling to illicit drugs) for the same goal, they are less likely than pleasure seekers to commit crimes to facilitate their gambling. The possible predictors of motivation types and their implications are further discussed.


Reducing Underage Alcohol & Tobacco Use: Evidence from the Introduction of Vertical Identification Cards

Andriana Bellou & Rachana Bhatt
Journal of Health Economics, forthcoming

From 1994-2009, forty-three states changed the design of their driver's license/state identification cards in an effort to reduce underage access to and consumption of alcohol and tobacco. In these states, individuals under the age of 21 are issued licenses that are vertically oriented, whereas licenses for individuals 21 and older retain a traditional horizontal shape. This paper examines the effect of this design change on underage alcohol and tobacco use. Using a difference-in-differences methodology, we find a reduction in drinking and smoking for 16 year olds. These results are upheld in a triple difference model that uses a within state control group of teens that did not receive a vertical license to control for state-specific unobserved factors. Interestingly, we find that the effects of the design change are concentrated in the 1-2 years after a state begins issuing vertical licenses. We consider various explanations for our findings: teen learning, the availability of false identification, and changes in retailer behavior.


Comparison of Opioid Doctor Shopping for Tapentadol and Oxycodone: A Cohort Study

Soledad Cepeda et al.
Journal of Pain, forthcoming

Obtaining opioids from multiple prescribers, known as doctor shopping, is 1 example of opioid abuse and diversion. The dual mechanism of action of tapentadol could make tapentadol less likely to be abused than other opioids. The aim of this retrospective cohort study was to compare the risk of shopping behavior between tapentadol immediate release (IR) and oxycodone IR. Subjects exposed to tapentadol or oxycodone with no recent opioid use were included and followed for 1 year. The primary outcome was the proportion of subjects who developed shopping behavior defined as subjects who had opioid prescriptions written by >1 prescriber with ≥1 day of overlap filled at ≥3 pharmacies. The opioids involved in the shopping episodes were assessed. A total of 112,821 subjects were exposed to oxycodone and 42,940 to tapentadol. Shopping behavior was seen in .8% of the subjects in the oxycodone group and in .2% of the subjects in the tapentadol group, for an adjusted odds ratio of 3.5 (95% confidence interval, 2.8 to 4.4). In the oxycodone group, 28.0% of the shopping events involved exclusively oxycodone, whereas in the tapentadol group, .6% of the shopping events involved exclusively tapentadol. Results suggest that the risk of shopping behavior is substantially lower with tapentadol than with oxycodone.


Risky Messages in Alcohol Advertising, 2003-2007: Results From Content Analysis

Elizabeth Rhoades & David Jernigan
Journal of Adolescent Health, January 2013, Pages 116-121

Purpose: To assess the content of alcohol advertising in youth-oriented U.S. magazines, with specific attention to subject matter pertaining to risk and sexual connotations and to youth exposure to these ads.

Methods: This study consisted of a content analysis of a census of 1,261 unique alcohol advertisements ("creatives") recurring 2,638 times ("occurrences") in 11 U.S. magazines with disproportionately youthful readerships between 2003 and 2007. Advertisements were assessed for content relevant to injury, overconsumption, addiction, and violations of industry guidelines (termed "risk" codes), as well as for sexism and sexual activity.

Results: During the 5-year study period, more than one-quarter of occurrences contained content pertaining to risk, sexism, or sexual activity. Problematic content was concentrated in a minority of brands, mainly beer and spirits brands. Those brands with higher youth-to-adult viewership ratios were significantly more likely to have a higher percentage of occurrences with addiction content and violations of industry guidelines. Ads with violations of industry guidelines were more likely to be found in magazines with higher youth readerships.

Conclusions: The prevalence of problematic content in magazine alcohol advertisements is concentrated in advertising for beer and spirits brands, and violations of industry guidelines and addiction content appear to increase with the size of youth readerships, suggesting that individuals aged <21 years may be more likely to see such problematic content than adults.


Influence of Tobacco Displays and Ads on Youth: A Virtual Store Experiment

Annice Kim et al.
Pediatrics, forthcoming

Objective: To examine the potential impact of banning tobacco displays and ads at the point of sale (POS) on youth outcomes.

Methods: An interactive virtual convenience store was created with scenarios in which the tobacco product display at the POS was either openly visible (status quo) or enclosed behind a cabinet (display ban), and tobacco ads in the store were either present or absent. A national convenience sample of 1216 youth aged 13 to 17 who were either smokers or nonsmokers susceptible to smoking participated in the study. Youth were randomized to 1 of 6 virtual store conditions and given a shopping task to complete in the virtual store. During the shopping task, we tracked youth's attempts to purchase tobacco products. Subsequently, youth completed a survey that assessed their perceptions about the virtual store and perceptions about the ease of buying cigarettes from the virtual store.

Results: Compared with youth in the status quo condition, youth in the display ban condition were less aware that tobacco products were for sale (32.0% vs 85.2%) and significantly less likely to try purchasing tobacco products in the virtual store (odds ratio = 0.30, 95% confidence interval = 0.13-0.67, P < .001). Banning ads had minimal impact on youth's purchase attempts.

Conclusions: Policies that ban tobacco product displays at the POS may help reduce youth smoking by deterring youth from purchasing tobacco products at retail stores.


Similarities in Adolescent Siblings' Substance Use: Testing Competing Pathways of Influence

Shawn Whiteman, Alexander Jensen & Jennifer Maggs
Journal of Studies on Alcohol and Drugs, January 2013, Pages 104-113

Objective: An accumulating body of work indicates that siblings uniquely influence each other's alcohol and substance use behaviors during adolescence. The mechanisms underlying these associations, however, are unknown because most studies have not measured sibling influence processes. The present study addressed this gap by exploring the links between multiple influence processes and sibling similarities in alcohol and substance use.

Method: The sample included one parent and two adolescent siblings (earlier born age: M = 17.17 years, SD = 0.94; later born age: M = 14.52 years, SD = 1.27) from 326 families. Data were collected via telephone interviews with parents and the two siblings.

Results: A series of logistic regressions revealed that, after parents' and peers' use as well as other variables including parenting was statistically controlled for, older siblings' alcohol and other substance use was positively associated with younger siblings' patterns of use. Furthermore, sibling modeling and shared friends were significant moderators of these associations. For adolescents' alcohol use, the links between sibling modeling and shared peer networks were interactive, such that the associations between modeling and similarity in alcohol use were stronger when siblings shared friends.

Conclusions: Future research should continue to investigate the ways in which siblings influence each other because such processes are emerging targets for intervention and prevention efforts.


Pubertal maturation and sex steroids are related to alcohol use in adolescents

Erik de Water et al.
Hormones and Behavior, forthcoming

Adolescents often show risk-taking behavior, including experimentation with alcohol. Previous studies have shown that advanced pubertal maturation is related to increased alcohol use in adolescents, even when controlling for age. Little is known about the underlying mechanisms of this relation between pubertal maturation and alcohol use. The goal of the present study was twofold. In experiment 1, we investigated whether advanced pubertal maturation is associated with higher levels of alcohol use, when controlling for age. To this end, questionnaires on pubertal development and alcohol use were administered to a large sample of 797 Dutch adolescents (405 boys) aged 11-16 years. In experiment 2, we explored whether sex steroids contribute to this relation between pubertal maturation and alcohol use by examining the association between salivary sex steroid levels and alcohol use in 168 adolescents (86 boys). It was found that, when controlling for age, advanced pubertal maturation is related to increased alcohol use in adolescent boys and girls. Controlling for age, higher testosterone and estradiol levels correlated with the onset of alcohol use in boys. In addition, higher estradiol levels were associated with a larger quantity of alcohol use in boys. Correlations between sex steroids and alcohol use were not significant in girls. These findings show that advanced pubertal maturation is related to advanced alcohol use, and that higher sex steroid levels could be one of the underlying mechanisms of this relation in boys. Sex steroids might promote alcohol use by stimulating brain regions implicated in reward processing.


The Impact of the Antitobacco Norm on the Selected Mode of Cognitive Dissonance Reduction

Dimitri Voisin, Jeff Stone & Maja Becker
Journal of Applied Social Psychology, forthcoming

Two experiments tested the hypothesis that when behavior violates an antismoking injunctive norm, dissonance is aroused, but the injunctive norm constrains how people reduce their discomfort. In Experiment 1, participants with positive or negative attitudes toward public smoking wrote an essay for or against a ban on public smoking. Whereas attitude change occurred for those whose counter-attitudinal essay supported the antismoking norm, those whose counter-attitudinal essay violated the antismoking norm did not change their attitudes to reduce dissonance. In Experiment 2, participants who wrote against the ban on public smoking eschewed attitude change in favor of reducing dissonance through trivialization and act rationalization. The discussion focuses on how maintaining social connections makes cognitions resistant to change when dissonance is aroused.


Smoking and the Bandit: A Preliminary Study of Smoker and Nonsmoker Differences in Exploratory Behavior Measured With a Multiarmed Bandit Task

Merideth Addicott et al.
Experimental and Clinical Psychopharmacology, forthcoming

Advantageous decision-making is an adaptive trade-off between exploring alternatives and exploiting the most rewarding option. This trade-off may be related to maladaptive decision-making associated with nicotine dependence; however, explore/exploit behavior has not been previously investigated in the context of addiction. The explore/exploit trade-off is captured by the multiarmed bandit task, in which different arms of a slot machine are chosen to discover the relative payoffs. The goal of this study was to preliminarily investigate whether smokers differ from nonsmokers in their degree of exploratory behavior. Smokers (n = 18) and nonsmokers (n = 17) completed a 6-armed bandit task as well as self-report measures of behavior and personality traits. Smokers were found to exhibit less exploratory behavior (i.e., made fewer switches between slot machine arms) than nonsmokers within the first 300 trials of the bandit task. The overall proportion of exploratory choices negatively correlated with self-reported measures of delay aversion and nonplanning impulsivity. These preliminary results suggest that smokers make fewer initial exploratory choices on the bandit task. The bandit task is a promising measure that could provide valuable insights into how nicotine use and dependence is associated with explore/exploit decision-making.


Prevalence of problem gambling in Iowa: Revisiting Shaffer's adaptation hypothesis

Donald Black et al.
Annals of Clinical Psychiatry, November 2012, Pages 279-284

Background: Pathological gambling (PG) is an important public health problem. We assessed the prevalence of PG and problem (at-risk) gambling in a random sample of Iowa adults and compared the results to survey data collected in 1989 and 1995. The goal of this study was to examine whether continued expansion of gambling venues is associated with increased rates of problematic gambling behavior.

Methods: A random digit dialing telephone screening was conducted in eastern Iowa of men and women age ≥18. Respondents were administered the South Oaks Gambling Screen (SOGS) to assess lifetime gambling behavior. Demographic and clinical variables were collected.

Results: A total of 356 respondents (147 men, 209 women) completed the SOGS, and all reported lifetime gambling participation. PG (SOGS ≥5) was found in 5 (1.4%) and problem gambling (SOGS = 3, 4) in 8 (2.2%) respondents. Disordered gambling (SOGS ≥3) was found in 13 (3.6%) respondents. Risk factors for disordered gambling included age (odds ratio [OR] = 0.64 per 10-year age increase), income (OR = 0.82 per $10,000 increase), minority group status (OR = 5.75), number of lifetime gambling activities (OR = 1.27), and having ever gambled ≥$100 (OR = 13.3). Overall gambling participation was significantly less in the current sample, compared with data collected in 1995.

Conclusions: Recent gambling participation was less than in 1995, despite the continued expansion of gaming opportunities. Disordered gambling was associated with younger age, lower income, and minority group status. The results are consistent with Shaffer's "adaptation" hypothesis, which posits that following an initial increase in gambling participation, problematic gambling stabilizes at a lower level.

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