Adolescent cigarette smoking and health risk behavior

During the past 30 years, tobacco use among adolescents has substantially increased, resulting in major health problems associated with tobacco consumption. The purpose of this study was to identify adolescent smoking behaviors and to determine the relationship among smoking, specific demographic variables, and health risk behaviors. The sample consisted of 93 self-selecting adolescents. An ex post facto design was used for this study and data were analyzed by using nonparametric statistics. Findings included a statistically significant relationship between lifetime cigarette use and ethnicity. Statistically significant relationships were also found among current cigarette use and ethnicity, alcohol use, marijuana use, suicidal thoughts, and age at first sexual intercourse. Nurses and other providers must recognize that cigarette smoking may indicate other risk behaviors common among adolescents.     

Multiple risk factors: prevalence and correlates of alcohol,tobacco and other drug (ATOD) use among university students in Egypt

Abstract

There is a lack of research on Alcohol, Tobacco and Other Drug (ATOD) use in the Eastern Mediterranean region (EMR). We assessed four ATOD behaviors (risk factors; smoking, alcohol consumption behavior, one’s own illicit drug/s use, friend’s illicit drug/s use), two mental health indicators (depressive symptoms, perceived stress), two socio-demographic features (gender, age) and two policy variables (agree with smoking and alcohol bans at university). A self-administered questionnaire was completed by 3258 students at 11 faculties of Assiut University in Egypt (2009–2010). As for ATOD individual risk factors, about 8.8% of the participants smoked cigarettes (occasionally or daily), 3.8% reported “high frequency” alcohol use (a few times each week, every day and a few times each day), 4.5% had ever used illicit drugs, and 15.3% had a friend who used illicit drug/s. For ATOD multiple risk factors, 28.5% of the sample reported any ATOD risk factor, and 8.7% of the sample reported ≥2 risk factors, and the frequencies were significantly higher among males. Depressive symptoms were positively associated with illicit drug/s use and with having a friend/s who use illicit drug/s. Smoking was positively associated with one’s illicit drug/s use, but negatively associated with having a friend who use illicit drug/s. Higher frequency of alcohol use was positively associated with illicit drug/s use. Age and perceived stress were not associated with any of ATOD variables. These findings contribute to lack of research on ATOD use across the EMR, and provide a platform for planning prevention/intervention policies.     

Prevalence, self-care behaviors, and self-care activities for peripheral neuropathy symptoms of HIV/AIDS

As part of a larger randomized controlled trial examining the efficacy of an HIV/AIDS symptom management manual ( n  = 775), this study examined the prevalence of peripheral neuropathy in HIV-infected individuals at 12 sites in the USA, Puerto Rico, and Africa. Neuropathy was reported by 44% of the sample; however, only 29.4% reported initiating self-care behaviors to address the neuropathy symptoms. Antiretroviral therapy was found to increase the frequency of neuropathy symptoms, with an increased mean intensity of 28%. A principal axis factor analysis with Promax rotation was used to assess the relationships in the frequency of use of the 18 self-care activities for neuropathy, revealing three distinct factors: (i) an interactive self-care factor; (ii) a complementary medicine factor; and (iii) a third factor consisting of the negative health items of smoking, alcohol, and street drugs. The study's results suggest that peripheral neuropathy is a common symptom and the presence of neuropathy is associated with self-care behaviors to ameliorate HIV symptoms. The implications for nursing practice include the assessment and evaluation of nursing interventions related to management strategies for neuropathy.     

Trends in drinking,smoking and illicit drug use among 15‐ and 16‐year‐olds in the UK (1995–2003)

This paper describes the results of drinking, smoking and illicit drug use among a representative sample of 2,032 UK school students aged 15 and 16 years in a cross‐sectional, single‐phase survey based on a stratified cluster sample of 77 UK secondary schools between March and July 2003. These findings are compared with those of two earlier surveys conducted in 1995 and 1999. Pupils completed a 380‐item standardized questionnaire under examination conditions. Over 90% had consumed alcohol at some time and 75% had experienced being drunk; almost 30% had smoked cigarettes in the past 30 days and almost 40% had tried illicit drugs at some time, mainly cannabis. Comparison with two previous surveys suggests that “binge” drinking among girls had risen and illicit drug use had fallen between 1995 and 1999 and that there was no further change in 2003. For boys, there was a significant drop in the variable “cigarette smoking in the past 30 days” between 1999 and 2003. There were no statistically significant changes in frequency of alcohol consumption and experience of intoxication between 1995 and 2003. The statistically significant increase in binge drinking among girls contrasts with the stability of the other variables considered over the 8 years under consideration. Heavy or “binge” drinking and illicit drug use amongst teenagers are clearly still matters for real concern. The increase in risky drinking among girls requires special attention. Even so, the continued tobacco use of some teenagers remains the major risk to health. It is concluded that past strategies to curb potentially problematic use of alcohol, tobacco and illicit drugs have met with only limited success. Health promotion is clearly not enough to reduce the risks associated with legal and illicit drugs by young people. Innovative “harm minimization” measures should be adopted and evaluated.     

Changes in perceived risk of different substance use by ranking order of drug attitudes in different ESPAD‐countries

Data from the surveys in eight countries of the European Schools Project on Alcohol and other Drugs in the years 1995, 1999, and 2003 were available. Changes over time in the perceptions of the risk of using alcohol, cigarettes, cocaine, marijuana, LSD, amphetamines, ecstasy, and inhalants were assessed. On average the overall proportions of the samples seeing use of these substances as ‘very risky’ fell between 1995 and 2003 in all eight countries as prevalences rose slightly in most of the countries. However, there was a tendency for the gap to widen over time between the proportions seeing regular use of illicit substances as very risky and the proportions seeing occasional use as very risky. Relative to other substances cigarette smoking and heavy weekend drinking were ranked more risky in 2003 than in 1995.     

PS1-01: Alcohol and Drug Use Among Chronic Opioid Therapy Patients

Background/Aims Opioid misuse and abuse is a significant public health problem, and there is a need to better identify at-risk individuals. Study aims were to examine patient characteristics associated with alcohol and other drug (AOD) use and aberrant drug related behaviors in chronic opioid therapy (COT) patients. Methods We conducted a telephone survey of a random sample of 972 COT patients in an integrated health care delivery system in 2009. Measures included weekly alcohol use and any illicit drug use in the last three months, and a composite measure of alcohol-only use, drug-only use, both alcohol and drug use, and tobacco only use. We conducted weighted multivariate logistic regressions models of AOD use and of aberrant drug-related behavior. Results Fourteen percent were weekly alcohol users (134/972), 16% used illicit drugs (157/972), 9% (83/972) used both alcohol and drugs, 8% used only drugs (74/972), 34% (334/491) used only alcohol, and 50% (481/972) did not use any substances. Multivariate models indicated illicit drug use was associated with a higher likelihood for weekly alcohol use, while being female, a higher daily opioid dose, and greater pain severity was associate with a lower likelihood of weekly alcohol use. Tobacco use, weekly alcohol use, depression symptoms, being male, and middle age was associated with a higher likelihood of illicit drug use. For aberrant drug related behaviors, drug-only use and both alcohol and drug use (compared to no AOD use) were associated with a higher likelihood of receiving opioids from friends or family in the last year, as were postive depressive symptoms and younger age. Both AOD use and depression symptoms were associated with a higher likelihood of giving opioids to others, while a high daily dose was associated with a lower likelihood of giving opioids to others, compared to the lowest dosage. Polysubstance use gender, and depression were risk factors in this sample. Post hoc analyses of primary care utilization indicated that those with high dosage opioids were more likely to have a certain threshold of primary care visits in the last year, suggesting there is an opportunity to manage these high risk patients.     

Predictors of the Transition From Experimental to Daily Smoking Among Adolescents in the United States

PURPOSE.  This study examined factors affecting the transition from experimental smoking at baseline to two types of daily smoking, temporary daily smoking, and continued daily smoking, at 1-year follow-up.
DESIGN AND METHODS.  This study analyzed data from the National Longitudinal Study of Adolescent Health ( n  = 4,903 U.S. adolescents). Baseline predictors were selected based on Problem Behavior Theory.
RESULTS.  Important problem behavior theory-related predictors of smoking were the number of friends who smoke, academic performance, and alcohol, marijuana, and other illicit drug use. Other significant predictors were age, gender, race, depression, perceived general health, and cigarette availability at home.
PRACTICE IMPLICATIONS.  To prevent teens from progressing to daily smoking, nursing professionals should consider multifaceted factors based on multiple theories.     

The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants

Pain in human immunodeficiency virus (HIV) frequently co-occurs with substance use and depression. The complex associations among patient characteristics, pain, depression, and drug use in HIV suggests a role for testing models that can account for relationships simultaneously, control for HIV status, and also test for mediation. Using structural equation modeling, the current study examined associations among pain, sociodemographics, illicit drug use, and depressive symptoms in 921 HIV-seropositive and 1019 HIV-seronegative men from the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural history of HIV infection among gay/bisexual men. Longitudinal repeated measures data collected over a 6-year period were analyzed using predictive path models in which sociodemographics, HIV status, and CD4+ cell counts predicted pain, which, in turn, predicted depressive symptoms and illicit drug use. The path models did not differ substantially between HIV-seropositive and -seronegative men. Analyses using the total sample indicated that pain served both as a mediator and as a predictor of more use of cannabis, cocaine, and heroin, as well as more depressive symptoms. HIV-seropositive status predicted more use of inhaled nitrites. In this cohort, having lower CD4+ cell counts (predicted by HIV status), being African American, less educated, and older were all associated with more pain, which, in turn, was associated with more illicit drug use and more depressive symptoms. The results underscore the need for adequate pain management, particularly among vulnerable subgroups of HIV-seropositive and HIV-seronegative men to reduce the risk of drug use and depression.     

Addictive behaviors related to opioid use for chronic pain: A population-based study

The growing body of research showing increased opioid use in patients with chronic pain coupled with concerns regarding addiction encouraged the development of this population-based study. The goal of the study was to investigate the co-occurrence of indicators of addictive behaviors in patients with chronic non-cancer pain in long-term opioid treatment. The study combined data from the individual-based Danish Health Survey in 2010 and the official Danish health and socio-economic, individual-based registers. From a simple random sample of 25,000 adults (16 years or older) living in Denmark, 13,281 individuals were analyzed through multiple logistic regression analyses to assess the association between chronic pain (lasting ?6 months), opioid use, health behavior, and body mass index. Six potential addictive behaviors were identified: daily smoking; high alcohol intake; illicit drug use in the past year; obesity; long-term use of benzodiazepines; and long-term use of benzodiazepine-related drugs. At least 2 of the 6 addictive behaviors were observed in 22.6% of the long-term opioid users with chronic pain compared with 11.5% of the non-opioid users with chronic pain and 8.9% of the individuals without chronic pain. Thus, a strong association was demonstrated between long-term opioid use and the clustering of addictive behaviors. An intricate relationship between chronic pain, opioid use, and addictive behaviors was observed in this study, which deserves both clinical attention and further research.     

A culturally-tailored behavioral intervention trial for alcohol use disorders in three American Indian communities: Rationale,design, and methods

BackgroundDisproportionately high rates of alcohol use disorders are present in many American Indian/Alaska Native (AI/AN) communities, yet little information exists regarding the effectiveness of alcohol treatments in AI/AN populations. Contingency management is an intervention for illicit drug use in which tangible reinforcers (rewards) are provided when patients demonstrate abstinence as assessed by urine drug tests. Contingency management has not been widely studied as an intervention for alcohol problems because until recently, no alcohol biomarker has been available to adequately verify abstinence.AimsThe HONOR Study is designed to determine whether a culturally-tailored contingency management intervention is an effective intervention for AI/AN adults who suffer from alcohol use disorders.MethodsParticipants include 400 AI/AN alcohol-dependent adults residing in one rural reservation, one urban community, as well as a third site to be decided, in the Western U.S. Participants complete a 4-week lead-in phase prior to randomization, then 12 weeks of either a contingency management intervention for alcohol abstinence, or a control condition where participants receive reinforcers for attending study visits regardless of alcohol use. Participants are then followed for 3-more months post-intervention. The primary study outcome is urinary ethyl glucuronide-confirmed alcohol abstinence; secondary outcomes include self-reported alcohol and drug use, HIV risk behaviors, and self-reported cigarette smoking.DiscussionThis will be the largest randomized, controlled trial of any alcohol for AI/ANs and the largest contingency management study targeting alcohol use disorders, thus providing important information to AI/AN communities and the alcohol treatment field in general.     

Pharmacologic considerations in the treatment of substance abuse.

Drug and alcohol abuse continue to be commonly encountered problems in most patient populations. To deal effectively with these problems, the primary care physician must have a thorough knowledge of the pharmacology of commonly abused drugs and the adjunctive agents used in treatment. Management of alcoholism may involve a range of medical interventions, including the treatment of alcohol intoxication, the use of benzodiazepines for alcohol withdrawal, and possibly the short-term administration of disulfiram to maintain sobriety. Successful management of cocaine or amphetamine abuse requires an understanding of the powerful reinforcing properties of these drugs and the unique problems that arise in the recovery period. Barbiturate intoxication and withdrawal are potentially life-threatening events requiring skilled in-patient treatment. Prolonged use of benzodiazepines can lead to drug dependence; successful withdrawal involves gradual dosage reduction. Acute intoxication from marijuana or hallucinogenic drugs may occasionally result in adverse reactions requiring medical intervention, but significant withdrawal reactions are rare. Management of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid antagonists. Promising new pharmacologic approaches are now being successfully applied to the management of opioid dependence. An acceptance of nicotine as the addictive component of tobacco smoke has led to the development of nicotine gum as substitution therapy for cigarette smoking. Successful pharmacologic management of overdose or withdrawal is often the prerequisite for effective long-term treatment and recovery.     

Suicide risk and protective factors among youth experiencing school difficulties

Youth who experience difficulty in school are at risk for suicide, yet there is little published information specific to risk and protective factors among this group. The purpose of this study was to conduct an in-depth examination of risk and protective factors associated with suicidal behaviour among youth who were experiencing problems in school and to compare these factors between suicide risk and non-suicide risk subgroups. Participants were 730 high school students in the Northwest and Southwest regions of the United States, aged 14-21 years. All participants were known to be experiencing difficulty with grades and/or attendance. Students completed a paper-and-pencil questionnaire and a one-on-one interview, which assessed suicidal behaviours as well as risk factors (e.g. drug involvement, emotional distress, stress), and protective factors (e.g. self-esteem, coping, support). Analysis of covariance tests, controlling for age and sex, were conducted to examine differences between the suicide risk and non-suicide risk groups on each risk and protective factor. The suicide risk subgroup reported higher levels of all risk factors, except alcohol and marijuana use, and lower levels of protective factors. While the groups did not differ on frequency of alcohol or marijuana use, they did differ on other illicit drug use and consequences of alcohol and other illicit drug use. Recommendations for nurses practising in school settings are discussed.     

Problematic use of psychoactive substances in undergraduates: a comparison of four patterns of substance use

The aim of the study was to examine the difference between alcohol-related and illicit drug-related negative consequences in a sample of undergraduates. The survey study was conducted on a sample of 458 lifetime drug users among second-year students, aged between 19 and 25 years (M?=?21.24, SD?=?1.15). The Chi-square test of independence revealed a significant dominance of alcohol-related consequences, in comparison to drug-related ones. Separate repeated measures analyses of variance (ANOVAs) were performed to examine mean differences between substance-related consequences (alcohol-related and illicit drug-related) among the groups of current substance users in four patterns: (1) frequency of alcohol use (non-users, occasional, regular), (2) quantity of alcohol use (non-users, moderate, binge), (3) frequency of illicit drug use (non-users, occasional, regular) and (4) concurrent alcohol and illicit substance use (non-user, alcohol only user, concurrent alcohol and drug user). The strongest association was found between regular illicit drug users and substance-related consequences, when comparing four models of multivariate analysis of variances (MANOVAs). Collectively, these results extend previous findings that identification of regular illicit drug users among undergraduates may be a powerful tool for predicting both alcohol-related and drug-related negative consequences and a potential target for clinical intervention and prevention efforts at universities.     

Drug use and HIV risk--related sex behaviors: a street outreach study of black adults

BACKGROUND: Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk-related sex behaviors of black adults. The study focused on three HIV-related risks: multiple sex partners, unprotected sex, and drugs during sex. METHODS: Data for this study were collected in a street outreach community survey for a drug abuse and HIV intervention study in Birmingham, Ala. A total of 780 black men and women completed the survey. RESULTS: High-risk sex behaviors were far more prevalent among cocaine users than marijuana or alcohol users. A greater number of cocaine users reported having multiple sex partners, not using condoms, and using drugs during sex. Female cocaine users showed the same risk level for HIV infection as male cocaine users. CONCLUSIONS: Increased risk of HIV infection through sexual transmission is associated with use of noninjecting cocaine for both men and women. Condom use should be considered as a major component of HIV prevention programs.     

Health promotion practices of emergency physicians

In this article we describe health promotion practices of emergency physicians (EPs). A survey was mailed to members of the West Virginia American College of Emergency Physicians. Main outcomes included the EP's beliefs regarding health promotion, perceived roles in health promotion, and perceived effectiveness in modifying the behavior of patients. Over 90% of respondents routinely asked about cigarette smoking and half about alcohol use. A minority routinely asked about illicit drug use, diet, exercise, domestic violence, or stress. The majority stated they were the main person responsible for patient health education in their emergency department (ED). Most felt prepared to counsel patients about smoking (68%) and alcohol (59%), although very few described themselves as successful in helping patients change their behavior. Although EPs feel responsible for promoting the health of their patients, only a minority reported routinely screening and counseling patients about prevention and most were not confident in their ability to help patients change their health-related behaviors.     

Living with HIV, antiretroviral treatment experience and tobacco smoking: results from a multisite cross-sectional study

BACKGROUND: To assess the prevalence of and factors associated with tobacco smoking and dependence in HIV patients. METHODS: In a one-day cross-sectional national survey of a representative sample of 82 French units specialized in HIV-infected patient care, 727 consecutive outpatients were asked to complete a self-administered questionnaire, assessing smoking habits, dependence, cessation motivation, other substance abuse, sociocultural characteristics, life with HIV and its treatment. Smoking prevalence and dependence were assessed and compared with a representative sample of the general French population. RESULTS: The questionnaire was completed by 593 (82%) patients: 12% were active or ex-intravenous drug users, 37% were homosexual men, and 43% were active smokers (compared with 31% in the French population) of whom 56% were classified as moderately or highly dependent. Fourteen percent of smokers were highly motivated and free of other substance abuse and of depressive symptoms. Smoking was independently associated with male sex (odds ratio [OR] = 2.38; 95% confidence interval [CI] 0.99-1.11), lower body mass index (OR 1.08; 95% Cl 1.14-1.03), smoking environment (OR 4.75; 95% Cl 3.02-7.49), excessive alcohol consumption (OR 2.50; 95% CI 1.20-5.23), illicit drug use (OR 2.43; 95% CI 1.41-4.19), HIV status disclosure to family (OR 1.81; 95% CI 1.16-2.85) and experience of rejection due to disclosure (OR 1.90; 95% CI 1.14-3.17). Disclosure and drug substitute usage were associated with high tobacco dependence. CONCLUSIONS: Very few HIV smokers seem to be good candidates for a standard tobacco cessation program. Tobacco reduction or cessation strategies should be adapted to this population.     

Contact highs and urinary cannabinoid excretion after passive exposure to marijuana smoke

Five healthy men were passively exposed under pre- and postplacebo controlled conditions to sidestream smoke from four and 16 standard marijuana cigarettes (2.8% delta-9-tetrahydrocannabinol [delta-9-THC]) for 1 hour each day for 6 consecutive days. Subjective effects produced by the 16-cigarette exposure conditions were similar to those observed after active smoking of one 2.8% delta-9-THC marijuana cigarette. Effects after the four-cigarette condition were less pronounced. Concurrent physiologic measurements showed no clear trends or effects of smoke exposure for either condition. Daily mean plasma levels of delta-9-THC ranged from 2.4 to 7.4 ng/ml with an individual high of 18.8 ng/ml for the 16-cigarette condition. With the use of EMIT cannabinoid assays with 20 ng/ml (EMIT 20) and 100 ng/ml (EMIT 100) cutoffs, urines positive per subject under the four- and 16-cigarette passive exposure conditions were 4.6 +/- 2.2 and 35.2 +/- 3.8, respectively, for the EMIT 20 and 0.0 and 1.0 +/- 0.8, respectively, for the EMIT 100 assay. From the results of these studies, caution is clearly indicated for individuals who might be substantially exposed to heavy marijuana cigarette smoke environments and for those interpreting marijuana screening data.     

Distal sensory polyneuropathy in the context of HIV/AIDS.

Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological problem in HIV disease. DSPN also represents a complex symptom that occurs because of peripheral nerve damage related to advanced HIV disease and in association with the use of antiretroviral therapy-particularly in individuals treated with dideoxynucleosides. Although DSPN is a frequent symptom, the specific pathophysiology is not well understood. The HIV-related neuropathies are commonly categorized as distal sensory polyneuropathies, although antiretroviral toxic neuropathies are described in the literature. Recently, mitochondrial toxicity has been identified as a possible etiology of DSPN. As individuals with HIV/AIDS survive longer, often living for decades with the disease, chronic symptoms like DSPN must be addressed. Pharmacologic approaches, complementary therapies, and self-care behaviors that may improve quality of life and limit symptoms of DSPN are important interventions for clinicians and those living with HIV/AIDS to consider in the management of peripheral neuropathy.