The association between problematic alcohol use,risk perceptions,and e-cigarette use

ABSTRACT

Background: Use of e-cigarettes among college students has escalated, in part due to the perception that they are less harmful than traditional cigarettes and have other benefits such as circumventing smoking bans. College students also drink more heavily than other age groups, and e-cigarettes are associated with alcohol, especially among students who engage in problematic drinking.

Objective: The present study sought to determine if an interaction between problematic alcohol use and increased perceptions of benefits and decreased perceptions of risks of e-cigarettes would predict whether participants had ever used an e-cigarette.

Method: The present study included 1,133 undergraduate college students surveyed between November 2014 – November 2016. Participants were primarily Caucasian (82.3%) and female (78.1%). Participants completed questionnaires regarding demographics, smoking status/history, and expectancies.

Results: Higher levels of problematic drinking and higher perceived benefits of e-cigarette use were both associated with having tried e-cigarettes. This relationship was significant even when controlling for several covariates such as cigarettes smoking status. However, there was not a significant interaction between problematic alcohol use and perceived benefits or risks of e-cigarettes. There was also no relationship between risk perceptions of e-cigarettes and e-cigarettes use.

Conclusions: Both problematic alcohol use and perception of benefits of e-cigarettes were associated with having tried an e-cigarette. This finding is problematic as the use of e-cigarettes may influence further engagement in risky behaviors including problematic drinking or transitioning to regular cigarette use. Thus, it is important to develop interventions to help college students develop more accurate risk perceptions about e-cigarettes.     

电子烟气溶胶暴露对小鼠肺功能的影响

目的:探讨电子烟IQOS气溶胶对小鼠肺功能的影响。方法:将24只C57BL/6 J雄性小鼠随机分为对照组、香烟组和IQOS组,每组8只。对照组小鼠给予呼吸新鲜空气,IQOS组及香烟组小鼠置于自制染毒箱中,IQOS气溶胶或烟雾暴露1 h/d,5 d/周,共处理24周。观察每组小鼠一般情况及体质量变化,测量其肺功能;取各组...     

Exploring e-cigarette policy recommendations and the role of evidence in international public health guidelines: a citation network analysis

BackgroundPublic health guidelines internationally aspire to be evidence based. However, different public health bodies have recommended adopting different approaches to e-cigarettes. While some have actively encouraged e-cigarette use, others have cautioned that e-cigarettes might introduce new health risks and renormalise tobacco smoking. We investigated the sources of evidence used by public health bodies when making recommendations about e-cigarette policy.MethodsWe did a citation network analysis of international public health guidelines across four purposively selected diverse policy contexts. We systematically identified relevant public health guideline documents focused on e-cigarette policy. Information about all cited references was extracted from 18 public health guidelines, eight from the UK, four from Australia, four from the USA, and two from WHO (worldwide data). The primary outcome was the source of evidence drawn upon by public health bodies. We did a network analysis of the citations (using R Studio, version 1.2.1335) to understand if and how evidence use varied across guidelines.Findings2802 references (2332 unique references) were included across the 18 public health guidelines, with none to 958 references cited per guideline document. Results from the citation network show that the four different contexts report from similar evidence. 74 references were cited across three or more guidelines. Of these, the most common study design was toxicology (30 references), followed by survey-based studies (12 references); with non-systematic literature reviews being the least popular (one reference). Among the most cited 74 studies, 18 (24%) reported conflicts of interest with pharmaceutical companies and 13 (18%) reported conflicts of interest with e-cigarette companies.InterpretationWe showed that public health guidelines across different contexts and countries draw on similar studies, despite articulating different policy approaches. Conflicts of interest are common among the studies that have been most influential in decision making. Limitations of our study include the reliance on citations rather than broader forms of evidence use. Greater transparency is needed in how recommendations are being developed, with particular consideration of how to manage conflicts of interest.FundingMedical Research Council and Chief Science Office.     

Local spatial clustering in youths’ use of tobacco,alcohol, and marijuana in Boston

ABSTRACT

Background: Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods. Objectives: The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana. Methods: Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13–19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included “none,” “1–2,” “3–9,” and “10 or more.” The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan? software package. Results: Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with a p-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models. Conclusion: Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use.     

Differences in Self-Reported Discrimination by Primary Type of Drug Used among New York City Drug Users

Background: Illicit drug users experience various forms of discrimination which may vary by type of drug used, as there are different levels of stigma associated with different types of drugs. Objectives: This study investigated self-report of perceived discrimination by primary type of drug used. Methods: This analysis used data from “Social Ties Associated with Risk of Transition into Injection Drug Use” (START), a cross-sectional study of recently initiated injection drug users (IDUs) and prospective study of heroin/crack/cocaine-using non-IDUs (n = 652). Using log binomial regression, the relationship between primary drug used (i.e., single drug used most often) with discrimination due to drug use was examined. Results: Heroin users were significantly more likely (Prevalence ratio (PR): 1.52 (95% Confidence interval (CI): 1.15?2.07)) to report discrimination due to drug use compared to cocaine users. Conclusion and Scientific Significance: More research is needed to understand the mechanism through which discrimination affects heroin users, and its potential relation with other discrimination-related outcomes, namely depression and drug treatment.     

Factors associated with high-frequency illicit methadone use among rural Appalachian drug users

Abstract

Background: In recent years there has been a sharp increase in the use of illicit methadone as well as methadone-related overdose deaths. Objective: The purpose of this study was to describe factors associated with low- and high-frequency methadone use in a cohort of rural Appalachian drug users. Methods: Interviews assessing sociodemographics, illicit drug use and drug treatment, psychiatric disorders, health and sociometric drug network characteristics were conducted with 503 rural drug users between 2008 and 2010. A two-level mixed effects regression model was utilized to differentiate low- (one use per month or less in the past six months) versus high-frequency (daily or weekly use in the past six months) illicit methadone users. Results: The lifetime prevalence of illicit methadone use in this population was 94.7% (n?=?476) and slightly less than half (46.3%) were high-frequency users. In the mixed effects regression model, initiating illicit methadone use at a younger age was associated with high-frequency illicit methadone use. Taking a prescribed medication for a physical problem, undergoing additional weeks of outpatient drug free treatment, daily OxyContin® use in the past month, and having fewer ties and second-order connections in the drug network reduced the odds of high-frequency illicit methadone use. Conclusions: Rates of illicit methadone use and high-frequency illicit methadone use among this sample of rural drug users were considerably higher than those previously reported in the literature. Health practitioners in rural areas should routinely screen for illicit opioid use, including methadone.     

Not all non-drinkers with HIV are equal: demographic and clinical comparisons among current non-drinkers with and without a history of prior alcohol use disorders*

Studies of persons living with HIV (PLWH) have compared current non-drinkers to at-risk drinkers without differentiating whether current non-drinkers had a prior alcohol use disorder (AUD). The purpose of this study was to compare current non-drinkers with and without a prior AUD on demographic and clinical characteristics to understand the impact of combining them. We included data from six sites across the US from 1/2013 to 3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non-drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/crystal (49% vs. 16%), and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use, and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics, including drug use and depression. These results suggest that non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse (including alcohol treatment) should be included in behavioural health assessments as part of clinical care.