Tobacco consumption and its association with illicit drug use among men in Bangladesh

AIMS: This study examined the association of tobacco consumption (smoking and chewing) with illicit drug use among Bangladesh males. DESIGN: Cross-sectional survey data from the Bangladesh Demographic and Health Survey 2004 were used. SETTING: Bangladesh. PARTICIPANTS: A total of 4297 males aged 15-54 years. MEASUREMENTS: Age, education, religion, marital status, place of residence; tobacco consumption such as cigarette and bidi smoking, chewing sada, pata, tobacco leaves, gul, betel quid with zarda; taking illicit drugs such as ganja, charas, heroin, pethedine, phensidyl; having sexually transmitted diseases (STDs). FINDINGS: Overall prevalence of tobacco consumption was 59%. Bidi smoking (29.6%), cigarette smoking (27.8%) and chewing betel quid with tobacco/zarda (17.5%) were predominant. Overall prevalence of illicit drug use was 4%. Ganja was the main drug (3%), followed by phensidyl (0.8%), heroin (0.3%) and charas (0.3%). Age, education, place of residence, marital status, having STDs, premarital and extra-marital sex were associated significantly with tobacco smoking. Almost all variables were also associated significantly with illicit drug use. Smoking cigarettes and bidi and eating tobacco leaves/shada pata/gul showed significantly positive associations with illicit drug use when adjusted for other variables. CONCLUSIONS: Tobacco consumption is common and associated positively with the illicit drug use among males in Bangladesh.     

The longitudinal association between multiple substance use discrepancies and marital satisfaction

Aims   The objective of this work was to examine the relation between patterns of substance use among newly married couples and marital satisfaction over time. In particular, this work examined if differences between husbands' and wives' heavy alcohol use and cigarette smoking, rather than simply use per se , predicted decreases in marital satisfaction over the first 7 years of marriage.
Methods   Married couples ( n  = 634 couples) were assessed on a variety of substance use and relationship variables at the time of marriage and again at the first, second, fourth and seventh years of marriage.
Results   After controlling for key socio-demographic variables, discrepancies in husband and wife cigarette smoking and heavy alcohol use were related to significant reductions in marital satisfaction. Importantly, couples who were discrepant on both substances experienced the greatest declines in marital satisfaction over time.
Conclusions   Patterns of substance use among newly married couples are important predictors of changes in marital functioning over time. It was not simply the heavy alcohol use or cigarette smoking that predicted dissatisfaction but, rather, differences between husbands' and wives' substance use that impacted the relationship.     

Revisiting drug progression: long-range effects of early tobacco use

AIMS: Drug progression models have been a cornerstone of scientific and public policy discussions for decades. These models have been criticized for their lack of causal mechanisms leading to drug dependence. Future research should focus on identification of pathways and covariates. This study re-examines tobacco use onset and progression to drug dependence in a multi-ethnic sample followed longitudinally from early to late adolescence (1990 to 1998-2000). METHODS: Data were collected in schools (n = 1208) during early adolescence (mean age 11.07), and subsequently face-to-face interviews were conducted at late adolescence (mean age 20.01). FINDINGS: Results indicated ethnic differences in rates and progression of tobacco use, with African Americans and foreign-born Latinos having larger proportions of abstainers and lower rates of persistent use. Most early adolescent smokers progressed to regular use. The odds of progression to marijuana abuse or dependence by later adolescence were highest (O.R. = 4.9) among persistent smokers, but not significant for foreign-born Latinos. The odds of progression to drug abuse or dependence were also highest (O.R. = 6.4) for persistent smokers, but not significant for African Americans. CONCLUSIONS: Implications for research on pathways and mechanisms of progression are discussed. Prevention programs may interrupt drug progression if they delay onset of tobacco use until mid-adolescence. Preventing targeted marketing efforts by the tobacco industry, regulating and enforcing tobacco control laws and pricing cigarettes at cost levels that adolescents find prohibitive are effective supplements to traditional behavior change interventions.     

Parental drug use, early adversities, later childhood problems and children's use of tobacco and alcohol at age 10: birth cohort study

Aims To estimate the prevalence of alcohol and tobacco use among children at age 10 years and to investigate possible influences on this. Design Birth cohort study. Setting England. Participants A total of 6895 children provided data at age 10. Measurements Parental tobacco, alcohol and cannabis use, parental social position, children's intelligence, behavioural and emotional problems, children's tobacco and alcohol use at age 10. Findings A total of 1.3% of children reported smoking and 1.8% reported drinking alcohol, with boys reporting higher use than girls. Parental social disadvantage was the strongest predictor of children's smoking and also predicted children's alcohol use. Some of this association appeared to be mediated through the greater experience of childhood behavioural and cognitive problems among the disadvantaged. Parental smoking and paternal alcohol use had little independent influence on offspring drug use. Postnatal, rather than prenatal, maternal alcohol use predicted children's alcohol use. Conclusions Strategies to prevent early initiation of tobacco and alcohol use should focus upon the reduction of childhood social disadvantage and the behavioural and cognitive problems associated with this.     

Alcohol and tobacco use in men: the role of alexithymia and externally oriented thinking style

Background: A high prevalence of alexithymia has been consistently reported in alcohol- and drug-dependent populations. However, less is known about the role of alexithymia, and its individual dimensions on substance use in healthier populations. Objectives: To examine how different alexithymia dimensions associate with substance use, while controlling for confounding factors. Methods: In the FinnBrain Birth Cohort Study, we analyzed a sample of 994 men. We assessed alexithymia levels (difficulty identifying feelings, difficulty describing feelings and externally oriented thinking (EOT) style), self-reported quantity and frequency of alcohol use in two different time points during and after their partners’ pregnancy, as well as cigarette smoking status. Age, education level, and anxiety scores were used as control variables. Results: Men scoring high on EOT style drank more alcohol per occasion, compared to low scorers (Cohen’s d = 0.43, p < 0.001 during pregnancy, and Cohen’s d = 0.3, p = 0.012 after pregnancy). Individuals in the high EOT quartile were also more likely to be daily smokers (8.7% vs. 17.3%, p = 0.023), and engage in binge drinking (23.7% vs. 43.6%, p = 0.001). Conclusions: The association of alexithymia and substance use may be specifically explained by EOT, a trait characterized by low levels of introspection and pragmatic thinking. It is important for future studies to distinguish between individual alexithymia dimensions and their specific roles in shaping mental health.     

Hypothalamic-pituitary-adrenal axis reactivity to social stress and adolescent cannabis use: the TRAILS study

Aims To investigate the relationship of life‐time and repeated cannabis use with hypothalamic–pituitary–adrenal (HPA) axis reactivity to social stress in a general population sample of adolescents. Design Adolescents who reported life‐time or repeated cannabis use, life‐time or repeated tobacco use and never use of either cannabis or tobacco were compared with respect to their HPA axis reactivity during the Groningen Social Stress Task (GSST), which was based on the Trier Social Stress Task. Setting A large prospective population study of Dutch adolescents [the TRacking Adolescents' Individual Lives Survey (TRAILS) study]. Participants A total of 591 adolescents (51% male) who participated in the GSST, which was an additional measurement during the third assessment wave. Measurements HPA axis stress‐reactivity was indexed by four cortisol samples collected before, during and after the GSST. Furthermore, all adolescents in our study completed self‐reported questionnaires on life‐time and repeated cannabis and tobacco use. Models were adjusted for sex, recent alcohol use, experimental session risk status, socio‐economic status, mood and time of the experimental session. Findings Life‐time cannabis users had significantly lower stress‐reactivity levels when compared to abstainers [odds ratio (OR) = 0.68, confidence interval (CI) = 0.55–0.85, P < 0.01] and life‐time tobacco users (OR = 0.79, CI = 0.64–0.98, P < 0.05). In addition, repeated cannabis users also exhibited lower stress‐reactivity levels when compared to life‐time ever users of either tobacco or cannabis (OR = 0.74, CI = 0.53–0.98, P < 0.05). Conclusions Lower hypothalamic–pituitary–adrenal‐axis stress‐reactivity in adolescents is related specifically to life‐time and repeated cannabis use.     

Smoking among patients in substance use disorders treatment: associations with tobacco advertising,anti-tobacco messages,and perceived health risks

Background: Although tobacco control efforts have contributed to an overall decline in smoking, individuals with substance use disorders (SUDs) continue to smoke at high rates and remain targets of advertising to vulnerable groups, including those with mental health disorders and SUDs. Objectives: We examined associations of tobacco advertising exposure and receptivity, anti-tobacco message awareness, and health-risk perception with smoking status and cigarettes-per-day (CPD) in a national sample of SUD treatment patients. Methods: The patients (N = 1,113) in 24 programs chosen randomly, stratified by program type, from among publicly funded adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network completed surveys of smoking, advertising exposure and receptivity, anti-tobacco message awareness, and perceived health risks. Results: Current smokers (77.9% of the sample) smoked a daily median of 10 cigarettes (IQR = 13). The participants reporting daily advertising exposure were 1.41 times more likely to be smokers (p = 0.019) than others. Those highly receptive to advertising were 2.34 times more likely to be smokers (p < 0.001) than those with low/moderate receptivity. Higher perceived health risk was associated with lower odds of smoking (OR = 0.99, 95% CI: 0.98–0.99, p < 0.001). CPD for smokers highly receptive to advertising was 11.1% (95% CI: 2.8%–20.0%) higher than for smokers with low/moderate advertising receptivity. Anti-tobacco message awareness was not associated with smoking status or CPD. Conclusion: The high rate of smoking among SUD treatment patients is associated with daily exposure and high receptivity to tobacco advertisements and lower perception of health-related smoking risks. Tobacco control efforts should target this vulnerable population.     

Patterns of over-the-counter nicotine gum use: persistent use and concurrent smoking

Aims To examine the occurrence of persistent use (i.e. use beyond 12 weeks) and concurrent use of nicotine gum with cigarettes among consumers who purchase nicotine gum over‐the‐counter (OTC). Design Assessment of gum use was conducted in the context of a smoking cessation trial among smokers who purchased Nicorette gum and enrolled in the optional Committed Quitters smoking cessation program. Eligible participants were contacted by telephone 6 weeks and 12 weeks following their self‐selected target quit date. Those who reported gum use at 12 weeks were contacted again at week 24. Participants A total of 2655 current smokers who purchased nicotine gum and enrolled in a clinical efficacy trial of the Committed Quitters program. Measurements Detailed information on smoking and gum use, including frequency of use, amount used and reasons for use was obtained at each of the three follow‐up assessments. Findings At the 24‐week assessment, 6% of participants reported current use of nicotine gum (i.e. persistent use). Those engaging in persistent use averaged 4.7 (SD = 2.5) days of gum use per week and 3.2 (SD = 3.5) pieces of gum per day. Sixty‐six per cent of persistent users reported at week 24 that they were not currently smoking, and 67% of persistent users reported they were using gum to establish or maintain abstinence. At the 6‐, 12‐ and 24‐week assessments, 14%, 10% and 2% of participants, respectively, reported current use of nicotine gum and current cigarette smoking (i.e. concurrent users). Those concurrent users reported at the 12‐week follow‐up that they did so an average of 4.4 (SD = 2.1) days per week, that they chewed an average of 2.6 (SD = 3.5) pieces of nicotine gum per day and that they smoked an average of 8.7 (SD = 8.6) cigarettes per day. Conclusion Extended use of nicotine gum is rare. Concurrent use with cigarettes is uncommon. In both cases, the amount of gum use is small. OTC marketing of nicotine gum does not appear to have increased use contrary to labeling nor resulted in patterns of use that should warrant clinical or public health concerns.