Nicotine--drug addiction--AIDS. Drug use habits of Vienna addicts]

In Austria it is illegal to sell tobacco to young adolescents. A diverse sample of 358 narcotic addicts was investigated at the Psychiatric University Clinic of Vienna. Data were obtained from on site confidential interviews and a HIV-test was conducted. The individual drug use history was recorded and, interestingly, tobacco addiction was the first stage in starting a drug career. Furthermore, a strong correlation was observed between onset of heroin use and HIV-1 infection. It is concluded that in Austria not only the availability nicotine and alcohol to young adolescents should be prohibited, but also their use should be punishable. Easy access to nicotine as in public restaurants or from automatic distributors, has to be withdrawn. Tobacco advertisements may drive vulnerable young adolescents to early nicotine abuse and this may be followed by addition to other drugs and diseases causing death, including AIDS. Socioeconomic data, as well as the methadone data are presented. 180 out of the 358 patients were on methadone maintenance. Methadone treatment offers a first step toward social rehabilitation for drug addicts who have been living as criminals on the fringe of society. Physicians have a clear responsibility to lead the effort on all fronts against tobacco, especially in view of the HIV epidemic.     

Developmental concepts of nicotine addiction

Piagetian interviewing techniques were used to explore concepts of nicotine addiction among 96 children and adolescents aged between 5 and 17 years. Verbal probes elicited each subject's most sophisticated level of reasoning about smoking and addiction. Responses were scored using the six developmentally ordered categories of the Developmental Conceptions of Addiction scoring system. Data indicate progression in conceptual reasoning about addiction consistent with Piagetian stages of cognitive development and physical causality. Age was associated with but not predictive of Developmental Conceptions of Addiction scores. Findings provide information that may be useful in designing more effective smoking prevention and cessation interventions.     

Circumstances of substance use by street youth in Egypt support the case for intervening to prevent adverse childhood experiences

Background: Egyptian street youth use substances including tobacco, illicit drugs, and pharmaceutical drugs. To understand the circumstances, including adverse childhood experiences, that place adolescents at risk for engaging in substance use, we conducted in-depth interviews among a sample of Egyptian street children. Methods: From youth residing at or attending Caritas, a non-profit organization, which provides shelter and education to street youth, seven girls and twelve boys, aged 12–18 years, participated in open-ended, in-depth interviews. Results: Eight out of the 19 participants reported family history (early exposure) to substance use; and seven of them were initiated by either a family member (sibling), friend or coworker. Most of the participants reported a history of conflict with or abuse (verbal or physical) by their parents or siblings, or stressful situations at home; they used substance(s) to alleviate their stress. Few attended school, and some were forced to work and help their family. Conclusions: Among Egyptian youth, adverse childhood experiences, such as poverty, child abuse, and family substance use, challenge somewhat susceptible youths and lead them to the path of substance use and addiction. Prevention intervention should be multifaceted, culturally adaptable, and primarily targeting the social environment during childhood.     

Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts

Objective

Previous studies on smoking cessation have generally been conducted with adolescents or adults. Very little is known about the cessation attempts, their success, and/or use of pharmacological aids in young adult smokers who want to quit. The present study aimed to investigate quitting attempts in a group of both young male daily and occasional smokers.

Design and subjects

614 male smokers aged 18–26 years completed a standardized questionnaire about their smoking habits, quit attempts, and aids used in smoking cessation.

Results

Nearly all daily smokers (95.3%, 95% CI 93.1–96.8) were nicotine addicted to some extend according to the standardized questionnaire, and the more addicted they were, the more often they had tried to quit (p = 0.025). Of the daily smokers, 55.6% (95% CI 51.3–59.9) had made quit attempts and 36.2% (95% CI 32.1–40.4) had used nicotine replacement therapy (NRT). In all, 34.1% (95% CI 25.2–44.3) of all occasional smokers reported having intended to quit but they had seldom made more than one attempt whereas 20.2% of daily smokers had made at least three attempts. The stronger the nicotine dependence in daily smokers was, the more likely the subject was to have attempted to use NRT (quite dependent 23.8% vs. totally dependent 48.9%) (p < 0.001).

Conclusions

A high proportion of young male daily smokers were nicotine addicted. Young smokers make many unsuccessful attempts to stop smoking using nicotine replacement therapy (NRT) on their own. A better availability of professional cessation services directed to young adult smokers is needed.Key Words: Finland, general practice, male smoking cessation, nicotine dependence, pharmacological aid, quit attempt, young adults

• Nearly all young male daily smokers concede that they suffer from nicotine addiction, whereas most occasional smokers consider the question of nicotine addiction irrelevant.
• Both daily and occasional young male smokers make unsuccessful attempts to stop smoking without nicotine replacement therapy (NRT) and/or use NRT on their own without supervision.
• Young male quitters seem to be unfamiliar with free national web-based counselling services or they lack plans for quitting beforehand.

     

Clinical pharmacology of nicotine: implications for understanding, preventing, and treating tobacco addiction

Understanding the basic and clinical pharmacology of nicotine provides a basis for improved prevention and treatment of tobacco addiction. Nicotine acts on nicotinic cholinergic receptors in the brain to release dopamine and other neurotransmitters that sustain addiction. Neuroadaptation and tolerance involve changes in both nicotinic receptors and neural plasticity. Nicotine addiction can occur in the context of physical dependence characterized by self-medication to modulate negative affect and/or to relieve withdrawal symptoms, as well as, in light or occasional smokers, primarily for positive reinforcement in specific situations. Nicotine is metabolized primarily by CYP2A6. Its clearance exhibits considerable individual variability that is determined by genetic, racial, and hormonal (sex) factors. Genetically slow metabolism of nicotine appears to be associated with a lower level of dependence. Nicotine dependence is highly heritable and appears to be influenced by genes coding for some nicotine receptor subtypes, some neurotransmitter genes, and genes involved in neural connectivity. Novel pharmacotherapies for nicotine dependence include partial agonists for nicotinic receptors and nicotine vaccines. Pharmacogenetic studies suggest various candidate genes and a nicotine metabolism phenotype that influence outcome. Human pharmacology studies of nicotine and smoking behavior also provide a basis for assessing the benefits and risks of long-term nicotine use for harm reduction and for a potential cigarette regulatory strategy that includes reducing nicotine content of cigarettes to nonaddictive levels.     

New tobacco trends: Waterpipe (hookah) smoking and implications for healthcare providers

Purpose: To inform healthcare providers about waterpipe smoking, a new trend in tobacco use that is gaining popularity among adolescents and young adults.
Data sources: American Lung Association Tobacco Policy Alert on Waterpipe Smoking, World Health Organization Tobacco Regulation Advisory Note on Waterpipe Smoking, and pertinent publications available in the literature.
Conclusions: Waterpipe smoking is a new trend in tobacco use that is associated with multiple health problems, including addiction. Healthcare providers should be aware of new tobacco trends that may affect patients, such as waterpipe smoking, that are potential gateways to nicotine addiction.
Implications for practice: Tobacco comes in many forms, all of which are addicting. Healthcare providers must be knowledgeable about new forms of tobacco to address all types of tobacco use with patients. Healthcare providers also have a responsibility to educate patients about the health risks inherent in these products to help prevent the long-lasting problem of nicotine addiction.     

Effects of Smoking on Chest Expansion,Lung Function,and Respiratory Muscle Strength of Youths

[Purpose] Smoking has a direct effect on the respiratory system. The rate of cigarette smoking among young people has continued to increase steadily. The present study quantified and compared the respiratory function of smoking and non-smoking youths. [Subjects] Smoking and non-smoking male participants aged between 15 to 18 years were recruited (n=34 per group). [Methods] Participants were asked to complete a questionnaire relating to smoking habits and the Fagerström test for nicotine dependence questionnaire, and their respiratory function was tested (measurement of chest expansion, lung function test with a spirometer, and assessment of respiratory muscle strength). [Results] All respiratory function tests demonstrated significant differences between the smoking and non-smoking groups. Smokers initiated cigarette smoking between the ages of 15 to 18 years. The most common duration of cigarette smoking was 1-3 years and the degree of nicotine dependence among the youths was at a low level. [Conclusion] This study’s findings show that the early effects of cigarette smoking found in youths can lead to problems with the respiratory system. Such information can be used to illustrate the harm of smoking and should be used to encourage young people to quit or avoid cigarette smoking.Key words: Cigarette smoking, Youth, Respiratory function     

Factors influencing adolescents' decision not to smoke

ABSTRACT Objective: Although adolescents ultimately make their own decisions to smoke or not to smoke, social, economic, and environmental circumstances shape their choices. Most research on prevention of youth tobacco use focuses on predictors of smoking initiation. In this study, we explored nonsmoking attitudes, beliefs, and norms from the perspective of 16–17‐year‐old nonsmokers. Design: This qualitative study targeted nonsmoking youths because most social policy in the arena of tobacco prevention aims to support adolescents who are tobacco free. Sample: Participants were 39 nonsmokers recruited from youth organizations in an urban community and included 22 African Americans (12 females; 10 males) and 17 Caucasian Americans (10 females; 7 males). Methods: A health behavior framework guided the development of semistructured questions on attitudes, beliefs, and norms associated with nonsmoking, used in eight in‐depth group interviews. Results: Concerns for health and addiction, a positive self‐image, and perceived confidence, emerged as factors affecting participants' decisions not to smoke. The approval of parents and friends, and personal beliefs further reinforced adolescents' nonsmoking decisions. Conclusions: There were more commonalities than differences in nonsmoking attitudes across gender and race. Future studies of youth tobacco prevention should employ multifaceted approaches targeting adolescents' attitudes, families, and peer networks.     

Electronic cigarettes and adolescents

Question I see in my office an increased number of adolescents who use electronic cigarettes (e-cigarettes). Should I encourage adolescents to choose e-cigarettes over regular cigarettes if they decide to smoke? Are e-cigarettes less harmful and a potential smoking cessation method for adolescents?Answer While e-cigarettes do not have carcinogenic tobacco, most contain nicotine, which not only leads to addiction, but can also impair brain development and cognitive function in youth. Recent studies have also shown that adolescents who use e-cigarettes are more likely to begin smoking tobacco cigarettes. It is therefore essential that physicians explain to adolescents the risks and health concerns e-cigarettes present, and implement measures to prevent or cease e-cigarette use.     

Nicotine addiction.

Nicotine maintains tobacco addiction. Nicotine acts on nicotinic cholinergic receptors, which demonstrate diversity in subunit structure, function, and distribution in the nervous system, mediating the multiple actions of nicotine described in tobacco users. Nicotine addiction is more prevalent and more severe in people with a history of major depression, schizophrenia, or alcohol or other drug abuse problems. The cigarette is a highly efficient drug delivery system, delivering nicotine rapidly and in relatively high concentrations to the brain, a situation that optimizes the likelihood of self-administration. The severity of nicotine addiction can be as- sessed using the Fagerstr?m Tolerance Questionnaire or the DSM-IV, but these instruments are imprecise predictors of the key behavior in addiction, which is the difficulty in stopping tobacco use when there are compelling reasons to do so.     

Genetic testing: the future of smoking cessation therapy?

In the UK, approximately one-third of the population currently smoke. It is estimated that up to 70% of these smokers want to stop smoking but smoking cessation rates currently only stand at 20-30%. In order to reduce the health burden associated with smoking in the short-term we need to increase cessation rates. This will stem from deeper understanding of the processes involved in nicotine addiction, targeted therapy and the development of new pharmacological cessation agents. This article is not intended to be an exhaustive examination of nicotine addiction but rather an overview of some of the genetic aspects and how we can go on to use this knowledge in order to develop a genetic test to aid smoking cessation.     

Tobacco cessation in primary care: maximizing intervention strategies

The most effective preventive intervention that a clinician can provide for tobacco-using patients against heart disease, cancer, cerebrovascular disease and chronic obstructive pulmonary disease is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete smoking cessation. Reduction provides no direct health benefits to the individual smoker. Interventions are readily available, but underutilized, in part due to lack of clinician training and organizational support. The present article summarizes the current guidelines for smoking cessation interventions as a framework from which to start. The guidelines incorporate the Transtheoretical Model of patient behavioral change and the "Five A's": Ask, Advise, Assess, Assist and Arrange. Pharmacotherapeutic tools, including nicotine replacement therapies (nicotine gums, patches, nasal sprays, inhalers and new therapies) and non-nicotine therapies (bupropion, clonidine, nortriptyline and other antidepressants and anxiolytics) are considered. Adherence validation methods, new approaches to tobacco and addiction treatment that appear in the recent research literature are reviewed. Beyond this framework, specific categories of tobacco users (including smokeless tobacco users), cultural and ethnic minorities, adolescents using snuff and bidis, women, Medicaid recipients, and users of multiple forms of tobacco require special consideration. With this framework and the modifications that may be required for specific categories of patients, practicing clinicians can incorporate into daily practice a successful tobacco cessation intervention program with quit rates approaching 20%.     

A qualitative analysis of addiction pathology in the families on the verge of breakdown

An increasing rate of addiction is being witnessed nowadays as a social issue that affects families as the most fundamental social institution and leads to divorce. Therefore, the aim of the present study was to investigate addiction pathology and demonstrate a paradigmatic model of addiction in the families on the verge of breakdown. To do so, in a qualitative design and based on the content analysis approach, 18 families that had been referred to family courts were selected through purposive sampling method and were studied through semi-structured interviews. In addition, some interviews were conducted with judges and attorneys to confirm and complete the data. The data analysis was conducted according to the conventional content method and the results were presented in a paradigmatic model, including context, causes, strategy and consequences. The results of the present study emphasize the importance of recognizing factors associated with addiction pathology in a paradigmatic model by which more comprehensive programs can be designed for harm reduction and addiction prevention.     

Negative allosteric modulation of nicotinic acetylcholine receptors blocks nicotine self-administration in rats

Drugs that antagonize nicotinic acetylcholine receptors (nAChRs) can be used to inhibit nicotine-induced behavior in both humans and animals. The aim of our experiments is to establish a proof-of-principle that antagonism of nAChRs by negative allosteric modulation can alter behavior in a relevant animal model of addiction, nicotine self-administration. We have identified a novel, negative allosteric modulator of nAChRs, UCI-30002 [N-(1,2,3,4-tetrahydro-1-naphthyl)-4-nitroaniline], with selectivity for the major neuronal nAChR subtypes over muscle-type nAChRs. After systemic administration, UCI-30002 significantly reduces nicotine self-administration in rats on both fixed ratio and progressive ratio schedules of reinforcement. The minimum effective dose that significantly alters nicotine self-administration corresponds to brain concentrations of UCI-30002 that produce at least 30% inhibition of the major neuronal nAChR subtypes measured in vitro. UCI-30002 has no effect on responding for food reinforcement in rats on either type of schedule, indicating that there is no effect on general responding or natural reward. UCI-30002 represents validation of the concept that negative allosteric modulators may have significant benefits as a strategy for treating nicotine addiction and encourages the development of subtype-selective modulators.     

Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy.

As rates of HIV increase in Vietnam, there is a need for data on social relations and sexual risk and protective behaviors among Vietnamese adolescents in a context of rapid social and economic changes. The authors report results from qualitative interviews with 159 Vietnamese adolescents living in Hanoi, Nha Trang City, and Ninh Hoa District and a survey of 886 adolescents in these same three sites. In the qualitative interviews, youths report a strong adherence to ideals and values regarding abstinence outside of marriage. Youths reported low rates of engagement in vaginal, anal, and/or oral sex with a significant difference in reported behaviors between males (29/469, 6.2%) and females (7/416, 1.7%; p = .000). A total of 15 of 32 (46.9%) sexually active youths reported rarely or never using condoms. Females had significantly higher scores for perceived sexual stigma than males (t = -10.22 [95% confidence interval (CI); -3.72 to -2.52; p = .000) whereas males scored significantly lower than females on a scale of perceived self-efficacy for abstinence (t = 5.31 [95% CI; .27 to .59]; p = .000). The stigmatization of sexual relations outside of marriage particularly for young women reinforces abstinence; however, these same values decrease adolescents' ability to obtain accurate information about sexuality and HIV and sexually transmitted infections and engage in safer sex.     

Nicotine dependence and gender differences in smokers accessing community mental health services

Despite evidence of differences in smoking behaviour between women and men, few studies have assessed these differences in individuals with mental illnesses. In this cross-sectional study, we explored gender differences in smoking behaviour among 298 individuals (60% male) accessing community mental health services. Individuals with a psychotic disorder as compared with a non-psychotic disorder, and individuals using a greater number of substances were more likely to be male. Readiness to change, daily cigarette consumption and level of nicotine dependence did not differ between men and women; however, subjective ratings of tobacco addiction were higher in women than in men. Among women, only scores on the subjective tobacco addiction scale were associated with nicotine dependence, while among men, a variety of variables were associated with nicotine dependence. These factors are important for understanding individual differences in tobacco dependence among clients with mental illnesses, and are expected to inform future studies examining tobacco use in mental health treatment populations.     

Recognition of alcohol and substance abuse

Ten percent of the population abuses drugs or alcohol, and 20 percent of patients seen by family physicians have substance-abuse problems, excluding tobacco use. These patients can be identified by relying on regular screening or a high index of suspicion based on "red flags" that can be noted in various clinical situations. The modified CAGE questionnaire is an excellent screening instrument, but several alternatives are available. The best screening test is one that the physician will routinely use well. Laboratory indicators such as gamma-glutamyl transpeptidase, mean corpuscular volume, and carbohydrate-deficient transferrin are nonspecific but can add to the evidence of alcohol abuse. If problem alcohol use is diagnosed, even brief physician advice can be helpful. If the problem has progressed to addiction, referral to an addiction specialist or treatment center is recommended. Special issues arise in dealing with substance abuse in adolescents, elderly patients, and patients with mental illness, but the family physician can play an important role in recognizing this common problem.     

Cigarette smoking and nicotine addiction.

Smokers smoke in large part because of the addictive effects of nicotine. Nicotine affects mood and performance and has been clearly implicated as the source of addiction to tobacco. People smoke to deliver desired doses of nicotine to their bodies, with certain rates of delivery and intervals between doses; these behaviors tend to be consistent for a person from day to day. Rational treatment of the pharmacologic aspects of tobacco addiction includes nicotine substitution therapy. New formulations of nicotine substitutes will provide more options to the physician for tailoring treatment to the needs of individual smokers. Other pharmacotherapies, particularly antidepressant drugs, hold promise for certain smokers.     

Characteristics and health care needs of homeless adolescents

There is a significant and growing number of adolescents who separate early from their families and become homeless. These youths are heterogeneous in terms of gender, race, ethnicity, and socioeconomic status, but the majority come from families that have been disruptive or dysfunctional in some way. Homeless adolescents are vulnerable to a variety of physical and psychologic problems related not only to their family histories but to the stressful environments in which they try to survive. Although numerous federal, state, and local programs have been developed to meet their needs for shelter, health care, and education, much remains to be done to ensure their healthy development and to prepare them for responsible life in the larger society.