Intimate relationship characteristics associated with condom use among drug users and their sex partners: a multilevel analysis

This study compared the safety and efficacy of sublingual buprenorphine tablets with oral methadone in a population of opioid-dependent individuals in a double-blind, randomized, 6-week trial using a flexible dosing procedure. Fifty-eight patients seeking treatment for opioid dependence were recruited in three outpatient facilities and randomly assigned to substitution with buprenorphine or methadone. The retention rate was significantly better in the methadone maintained group (90 vs. 56%; P<0.001). Subjects completing the study in both the treatment groups had similar proportions of opioid positive urine samples (buprenorphine 62%; methadone 59%) and positive urine specimens, as well as mean heroin craving scores decreased significantly over time (P=0.035 and P<0.001). The proportion of cocaine-positive toxicology results did not differ between groups. At week six mean stabilization doses were 10.5 mg per day for the sublingual buprenorphine tablet, and 69.8 mg per day for methadone, respectively. Patient performance during maintenance was similar in both the groups. The high attrition rate in the buprenorphine group during the induction phase might reflect inadequate induction doses. Thus, buprenorphine is a viable alternative for methadone in short-term maintenance treatment for heroin dependence if treatment induction is done with adequate dosages.     

Nicotine replacement therapy use among a cohort of smokers

BACKGROUND: Nicotine replacement therapy (NRT) has been shown to assist smokers to stop smoking in randomized trials, but little is known about its use in the general population. METHODS: As part of ongoing follow-up of a cohort established in 1989 in Washington County, Maryland, a questionnaire mailed in 1998 included a question about ever use of the two NRT products then available over-the-counter: nicotine gum and nicotine patch. This study reports on ever use of NRT among the 1,954 respondents who were current smokers in 1989 and subsequently provided data on NRT use and smoking habits in 1998. RESULTS: Overall, 36% of the smokers in 1989 had ever used NRT in some form by 1998; 10% used gum only, 16% used patch only, and 10% used both gum and patch. Number of cigarettes smoked per day at baseline was the strongest predictor of ever use of NRT (ptrend < 0.001). Compared to nonusers, ever users of NRT were more likely to have more than 12 years of education (p < 0.01) and be 25-54 years old at baseline (p < 0.001). When NRT use was assessed in relation to smoking status in 1998, 30% of NRT ever users compared to 39% of nonusers had quit smoking (p < 0.01). Among persistent smokers, the likelihood of reducing the number of cigarettes smoked per day was similar between NRT ever users (40%) and nonusers (41%). CONCLUSIONS: Ever use of NRT was common among this cohort of smokers, particularly among heavy smokers. Compared to nonusers, ever users of NRT were less likely to have stopped smoking and equally likely to cut down the frequency of smoking. This may reflect a tendency to turn to NRT for help after failing to quit by other means.     

Association between nicotine replacement therapy use in pregnancy and smoking cessation

Background

There is an urgent need to find better ways of helping pregnant smokers to stop. Randomized controlled trials (RCTs) have not detected an effect of nicotine replacement therapy (NRT) for smoking cessation in pregnancy. This may be because of inadequate dosing because of faster nicotine metabolism in this group. In England, many pregnant smokers use single form and combination NRT (patch plus a faster acting form). This correlational study examined whether the latter is associated with higher quit rates.

Methods

Routinely collected data from 3880 pregnant smokers attempting to stop in one of 44 Stop Smoking Services in England. The outcome measure was 4-week quit rates, verified by expired-air carbon monoxide level < 10 ppm. Outcome was compared between those not using medication versus using single form NRT (patch or one of the faster acting forms), or combination NRT. Potential confounders were intervention setting (specialist clinic, home visit, primary care, other), intervention type (one-to-one, group, drop-in, other), months pregnant, age, ethnicity and occupational group in multi-level logistic regressions.

Results

After adjustment, combination NRT was associated with higher odds of quitting compared with no medication (OR = 1.93, 95% CI = 1.13–3.29, p = 0.016), whereas single NRT showed no benefit (OR = 1.06, 95% CI = 0.60–1.86, p = 0.84).

Conclusions

Use of a combination of nicotine patch and a faster acting form may confer a benefit in terms of promoting smoking cessation during pregnancy. While this conclusion is based on correlational data, it lends support to continuing this treatment option pending confirmation by an RCT.     

Pharmacogenetics and smoking cessation with nicotine replacement therapy

Nicotine replacement therapies (NRTs), including transdermal patch, gum, lozenge, nasal spray and inhaler, are widely used for the treatment of tobacco dependence; however, only one-quarter to one-third of smokers who utilise NRTs to quit smoking are able to maintain long-term abstinence from tobacco use. Pharmacogenetic studies of NRT may be useful to identify subgroups of smokers who respond more favourably to specific NRTs, and to determine the optimal dose and duration of NRT.To date, pharmacogenetic studies have examined genes coding for nicotine metabolising enzymes, as well as proteins in neurotransmitter pathways that mediate the effects of nicotine. Initial findings suggest that polymorphisms in nicotine metabolising enzymes, and selected genes in the dopaminergic and opioidergic pathways, may have predictive validity for NRT response; however, independent replication is necessary before translation to clinical practice. Larger-scale investigations that incorporate pathway-based or genome-wide analysis, as well as intermediate measures of nicotine dependence (i.e. 'endophenotypes'), may be necessary to capture the complexity of pharmacogenetic effects.     

Adherence to nicotine replacement therapy versus quitting smoking among Chinese smokers: a preliminary investigation

Rationale There are over 300 million Chinese smokers, but use of nicotine replacement therapy (NRT) is rare. On the other hand, data on the factors associated with quitting and adherence to NRT use are scarce in the East.Objectives To describe adherence and other predictors of quitting smoking at the 12-month follow-up amongst Chinese smokers in Hong Kong.Methods Chinese smokers (1186) who attended the Smoking Cessation Health Centre from August 2000 through January 2002 were studied. Trained counsellors provided individual counselling and carried out follow-up interviews. We used structured questionnaires at baseline and at 1, 3 and 12 months and an intention-to-treat approach for analysis.Results Among those who received NRT (1051/1186), the prevalence of adherence (self-reported NRT use for at least 4 weeks) was 16% (95% confidence interval 14–18%). The 7-day point prevalence quit rate at 12 months (not smoking any cigarette during the past 7 days at the 12 month follow-up) was 27% (95% CI, CI 24–29%). Stepwise logistic regression model showed that adherence to NRT use, a higher income, good perceived health and having more confidence in quitting were significant predictors of quitting. The quit rate in the adherent group (40%) was greater than that of the non-adherent group (25%) (P<0.001). Older age, male, higher education, experience of NRT use, perceiving quitting as more difficult and willingness to pay were significant predictors of adherence.Conclusions Clinically significant smoking cessation rates can be achieved among Chinese smokers in a clinic-based smoking cessation service. The NRT adherence was low and low adherence was associated with a lower quit rate. Trials of interventions to improve adherence and increase quit rates are needed.Professor A.J. Hedley (Chair Professor, Department of Community Medicine, The University of Hong Kong; Former Chairman, Hong Kong Council on Smoking and Health, COSH), Professor T.H. Lam (Head, Department of Community Medicine, The University of Hong Kong; Vice Chairman, COSH), Dr. A.S. M Abdullah, (Director, Hong Kong Smoking Cessation Health Centre; Research Assistant Professor, Department of Community Medicine, The University of Hong Kong), Dr. S.C. Chan (Head, Department of Nursing Studies, The University of Hong Kong), Mr. Marcus Yu and Dr. Raymond LM Ho (Former and current Executive Director, COSH), Dr. W.L. Lo (Council Member, COSH), Mr. Alfred Chan (Former Senior Project Manager, COSH), Professor Edith Lau, (Professor, Department of Community and Family Medicine, Chinese University of Hong Kong; Council Member, COSH), Dr. J.L. Tang (Associate Professor, Department of Community and Family Medicine, Chinese University of Hong Kong), Dr. S.Y. Chan (Associate Professor, Department of Community and Family Medicine, Chinese University of Hong Kong), Dr. H.C. Ma (Chief Executive, Ruttonjee Hospital), Dr. C.W. Lam (Head of Respiratory Medicine, Ruttonjee Hospital), Dr. Y.K. Lau (Head of Cardiology Division, Ruttonjee Hospital).     

Measuring nicotine dependence among youth: a review of available approaches and instruments

This paper reviews issues and concepts related to the measurement of nicotine dependence among youth. The primary objectives of this review are to: (1) review the measures of nicotine dependence currently being used; and (2) delineate a future research agenda in an attempt to advance the quality of measurement and instrumentation for this important research endeavor. Existing measures of nicotine dependence, including formal diagnostic interviews, related withdrawal assessments, brief self-report measures, and single-item indicators, are described. While formal diagnostic systems have been considered the 'gold standard' for evaluating dependence clinically, their specific limitations related to use for research purposes are outlined. Each broad class of measure is evaluated in terms of its rationale for use, strengths and limitations, and the extent to which it has successfully been applied to adolescent populations. A research agenda follows in the second section of the paper. In this section, the need for identification and inclusion of a standard set of optimal dependence measures, for enhancement of current measures, and for the onset of a new and comprehensive measures development program is outlined.     

Ecstasy use and associated risk factors among Asian-American youth: findings from a national survey

This study examined ecstasy use and associated risk and protective factors among Asian American youth. Data from 996 Asian American adolescents and 1,108 Asian American young adults were used. Ecstasy use was relatively common among Asian American youth. Among adolescents, it was associated with older age, poor parent-child communication, having been approached by drug sellers, living in a metropolitan area, and positive attitudes toward substance use. Among Asian American young adults, it was associated with having been born in the United States, having been approached by drug sellers, criminal justice system involvement, and positive attitudes toward substance use. Implications for designing substance use prevention/intervention programs for this minority group are discussed.     

Factors associated with regular marijuana use among high school students: a long-term follow-up study

The present study investigated whether several behavioral and psychosocial factors measured during early adolescence predicted regular marijuana use 6 years later in a sample of high school students. As part of a school-based survey. 7th-grade students (N = 1,132) reported levels of alcohol, tobacco, and marijuana use, and were assessed on several domains of psychosocial functioning potentially relevant in the etiology of marijuana use. When students were followed-up in the 12th-grade, 14% smoked marijuana on a regular basis (once or more per month). Findings indicated that early cigarette smoking, alcohol use, and alcohol intoxication predicted later regular marijuana use. For boys, early marijuana use increased the odds for later regular marijuana use. Cigarette smoking by friends and siblings during early adolescence also increased the likelihood of later monthly marijuana use. The findings suggest that early prevention programs for adolescent alcohol, tobacco, and/or other drug use may have important preventive effects in terms of potentially more serious levels of marijuana involvement later in adolescence and early adulthood.     

吸烟的危害与尼古丁替代疗法

吸烟是引起死亡的主要原因之一,全球每年有500余万人死于吸烟。它已成为严重的公共卫生问题。研究显示,烟雾中含有4000余种化合物,其中至少有43种为致癌物。长期吸烟可致多种疾病如癌症、肺气肿、心脏病及脏器损害,并可引起依赖性（成瘾）。依赖性主要由烟草含有的尼古丁所致。经常吸烟者大多对尼古丁成瘾。因此,经常吸烟者停止吸烟可出现尼古丁戒断症状,表现为烦躁、焦虑、头晕、头昏、头痛、失眠及注意力不集中。大多数吸烟者戒烟失败主要与尼古丁成瘾有关。鉴此,推出了尼古丁替代疗法（nicotine replacement therapy,NRT）。NRT是一种不经吸烟而使尼古丁缓慢进入体内的方法。该法不仅能消除或减轻尼古丁戒断症状,并且能避免吸烟的危害。研究结果表明,NRT能明显提高戒烟的成功率,而且其成瘾风险低。NRT常用制剂有咀嚼胶、贴剂、吸入剂、鼻喷剂等。这些制剂均能引起一些不良反应,反应的程度均较轻,但反应类型各制剂有所不同。NRT制剂可安全地用于心血管病患者。NRT不宜用于孕妇、乳母及未成年人。总之,NRT对吸烟者而言是一种安全有效的戒烟方法,NRT制剂在很多国家已作为OTC使用多年,值得推荐。     

Exposure to positive peer sentiment about nicotine replacement therapy in an online smoking cessation community is associated with NRT use

BackgroundLittle is known about the influence of online peer interactions on health behavior change. This study examined the relationship between exposure to peer sentiment about nicotine replacement therapy (NRT) in an online social network for smoking cessation and NRT use.MethodsParticipants were 3297 current smokers who enrolled in an Internet smoking cessation program, participated in a randomized trial, and completed a 3-month follow-up. Half received free NRT as part of the trial. Automated text classification identified 27,038 posts about NRT that one or more participants were exposed to in the social network. Sentiment towards NRT was rated on Amazon Mechanical Turk. Participants' exposure to peer sentiment about NRT was determined by analysis of clickstream data. Modified Poisson regression examined self-reported use of NRT at 3-months as a function of exposure to NRT sentiment, controlling for study arm and post exposure.ResultsOne in five participants (19.3%, n = 639) were exposed to any NRT-related posts (mean exposure = 6.5 ± 14.7, mean sentiment = 5.4 ± 0.8). The association between sentiment exposure and NRT use varied by receipt of free NRT. Greater exposure to positive NRT sentiment was associated with an increased likelihood of NRT use among participants who did not receive free NRT (adjusted rate ratio 1.22, 95% CI 1.01, 1.47; p = .043), whereas no such relationship was observed among participants who did receive free NRT (p = .48).ConclusionsExposure to positive sentiment about NRT was associated with increased NRT use when smokers obtained it on their own. Highlighting user-generated content containing positive NRT sentiment may increase NRT use among treatment-seeking smokers.     

Tailoring nicotine replacement therapy: rationale and potential approaches

Nicotine replacement therapy (NRT) is an effective treatment for smoking cessation, but as with all such pharmacotherapies, the majority of smokers who use NRT products do not stop smoking or remain abstinent long term. Treatment outcome is affected by a range of individual-specific factors, as well as the pharmacokinetic profile of each NRT formulation. This has led to speculation that abstinence rates could be improved if NRT treatments were individually tailored to best match each individual's needs and preferences. There are also populations for whom special product and dosage considerations are warranted to maximise treatment safety.This paper reviews the rationale for NRT treatment, standard dose recommendations and recommendations for how to best match NRT treatment to the specific needs of individual smokers. We also review emerging evidence that genetic profiling may one day be a useful consideration for tailoring NRT treatment.     

Correlates of use of electronic cigarettes versus nicotine replacement therapy for help with smoking cessation

Introduction

Electronic- or e-cigarettes are nicotine-delivery devices commonly used by smokers to quit or reduce smoking. At present, not much is known about the characteristics of smokers who specifically try e-cigarettes to quit smoking compared to the nicotine replacement therapy (NRT) products approved by the U.S. Food and Drug Administration (FDA). Determining the characteristics of smokers who are likely to choose e-cigarettes as cessation aids would help develop strategies to impart valid information about e-cigarettes to such smokers as facts regarding the safety and utility of e-cigarettes emerge.

Methods

This study is based on 834 daily smokers [mean age = 45.8 (standard deviation = 13)] from Hawaii. Demographic, smoking- and cessation-related variables were examined as correlates of ever use of e-cigarette only or any FDA-approved NRT product only or both as cessation aids.

Results

Results indicated that younger smokers, non-White smokers, and smokers reporting higher income, lower nicotine dependence, shorter smoking history, and higher lifetime quit attempts were more likely to have tried e-cigarettes but not NRT products for help with smoking cessation.

Conclusion

Smokers who are attracted to use e-cigarettes but not FDA-approved NRT products may differ from smokers who are likely to have used NRT products but not e-cigarettes in terms of demographic (e.g., age, ethnicity) and smoking- or cessation-related characteristics (e.g., nicotine dependence, quit attempts). Given the lack of knowledge regarding the health effects of e-cigarettes and their efficacy as cessation aids, future research needs to continue characterizing smokers who are likely to use e-cigarettes for smoking cessation.     

GHB use among Australians: characteristics,use patterns and associated harm

The aim of this study was to examine the characteristics of gamma-hydroxybutyrate (GHB) users, their GHB and other drug use patterns, and the harms associated with GHB use. Seventy-six GHB users were recruited and administered a structured interview on GHB use and related harms. GHB users appeared to be a stable, highly educated and well-functioning group. They had had extensive experience with a range of drugs, and GHB was typically used in conjunction with other drugs. Despite the fact that most GHB users had not had a long or extensive experience with GHB use, the proportion reporting significant negative side effects when using GHB was high (99% reported at least one), and the mean number of side effects ever experienced was 6.5. Notably, half (52%) reported becoming unconscious, 53% reported vomiting, 58% reported profuse sweating, and 8% reported having a fit or seizure. The high rate of problems reported by a group with limited use of this drug suggests that in a context of polydrug use, GHB use is associated with significant risks to users.     

Age of first use,current marijuana use and driving after use among Canadian high school students

Early exposure to marijuana may have lasting effects into adulthood given that adolescence is a critical period during which most substance use is initiated. Recreational marijuana recently became legal in Canada, with a legal age of purchase set as either 18 or 19 years, depending on the province. Historically, the mean age of onset for marijuana use among youth occurs at a much younger age. The current study examined the association between age at first use of marijuana with current marijuana use patterns and driving after use among high school students. Data on 24,630 high school students (grades 9–12) were from the 2014–2015 Canadian Student Tobacco, Alcohol and Drugs Survey. We restricted our analyses to the students who reported having ever used marijuana and had data on age at first marijuana use (n = 6709). Multivariable logistic and negative binomial regressions were performed to examine the association between current marijuana use patterns and age at first marijuana use. Students with younger age at first use of marijuana had significantly higher odds of current marijuana use, a higher frequency of consumption, and were more likely to drive after use of marijuana. Effective enforcement of age restriction laws in combination with other prevention efforts may be beneficial in delaying the age of onset of marijuana until late adolescence and early adulthood.     

Risk factors for progression to regular injection drug use among street-involved youth in a Canadian setting

Background

Street-involved youth are at high risk for experimenting with injection drug use; however, little attention has been given to identifying the factors that predict progression to on-going injecting.

Methods

Logistic regression was used to identify factors associated with progression to injecting weekly on a regular basis among a Canadian cohort of street-involved youth.

Results

Among our sample of 405 youth who had initiated injecting at baseline or during study observation, the median age was 22 years (interquartile range [IQR] = 21–24), and 72% (293) reported becoming a regular injector at some point after their first injection experience. Of these, the majority (n = 186, 63%) reported doing so within a month of initiating injection drug use. In multivariate analysis, the drug used at the first injection initiation event (opiates vs. cocaine vs. methamphetamine vs. other; all p > 0.05) was not associated with progression; however, younger age at first injection (adjusted odds ratio [AOR] = 1.13), a history of childhood physical abuse (AOR = 1.81), prior regular use of the drug first injected (AOR = 1.77), and having a sexual partner present at the first injection event (AOR = 2.65) independently predicted progression to regular injecting.

Conclusion

These data highlight how quickly youth progress to become regular injectors after experimentation. Findings indicate that addressing childhood trauma and interventions such as evidence-based youth focused addiction treatment that could prevent or delay regular non-injection drug use, may reduce progression to regular injection drug use among this population.     

Neighborhood of residence and risk of initiation into injection drug use among street-involved youth in a Canadian setting

Background

While research has suggested that exposure to environments where drug use is prevalent may be a key determinant of drug-related risk, little is known regarding the impact of such exposure on the initiation of illicit injection drug use. We assessed whether neighborhood of residence predicted rates of injecting initiation among a cohort of street-involved youth in Vancouver, British Columbia.

Methods

We followed street-involved injecting naïve youth aged 14–26 and compared rates of injecting initiation between youth residing in Vancouver's Downtown Eastside (DTES) neighborhood (the site of a large street-based illicit drug market) to those living in other parts of the city. Univariate and multivariate Cox regression analyses were employed to determine whether residence in the DTES was independently associated with increased risk of initiation of injection drug use.

Results

Between September, 2005 and November, 2011, 422 injection-naïve individuals were followed, among whom 77 initiated injecting for an incidence density of injecting of 10.3 (95% confidence interval [CI] 5.0–18.8) per 100 person years. In a multivariate model, residence in the DTES was independently associated with initiating injection drug use (adjusted hazard ratio [AHR] = 2.16, 95% CI: 1.33–3.52, p = 0.002).

Conclusions

These results suggest neighborhood of residence affects the risk of initiation into injection drug use among street-involved youth. The development of prevention interventions should target high-risk neighborhoods where risk of initiating into injecting drug use may be greatest.     

Illuminating the relationship between bullying and substance use among middle and high school youth

The increased prevalence and negative impact of bullying and substance use among youth has been established independently in the literature; however, few researchers have examined the association between involvement in bullying and substance use across middle and high school youth. Thus, the aim of this study was to examine the self-reported prevalence of bullying and substance use (alcohol, cigarettes, and marijuana) among youth in middle and high school. Middle and high school students from 16 school districts across a large metropolitan area (N=78,333) completed a school-based survey. Scales were created to examine involvement in bullying, victimization, and substance use. A link between involvement in bullying and substance use was evident. Youth involved in bullying were more likely than students not involved in bullying to use substances, with bully-victims reporting the greatest levels of substance use. Differences at the school level and across status (i.e., bullies, victims, and bully-victims) are discussed. Implications for practice and prevention and intervention programs are offered. Findings support the need for continued research into risky behaviors, such as substance use, that are correlated with bullying behavior and may contribute to an increase in negative outcomes.