A test strategy for the assessment of additive attributed toxicity of tobacco products

The new EU Tobacco Product Directive (TPD) prohibits tobacco products containing additives that are toxic in unburnt form or that increase overall toxicity of the product. This paper proposes a strategy to assess additive attributed toxicity in the context of the TPD. Literature was searched on toxicity testing strategies for regulatory purposes from tobacco industry and governmental institutes. Although mainly traditional in vivo testing strategies have been applied to assess toxicity of unburnt additives and increases in overall toxicity of tobacco products due to additives, in vitro tests combined with toxicogenomics and validated using biomarkers of exposure and disease are most promising in this respect. As such, tests are needed that are sensitive enough to assess additive attributed toxicity above the overall toxicity of tobacco products, which can associate assay outcomes to human risk and exposure. In conclusion, new, sensitive in vitro assays are needed to conclude whether comparable testing allows for assessment of small changes in overall toxicity attributed to additives. A more pragmatic approach for implementation on a short-term is mandated lowering of toxic emission components. Combined with risk assessment, this approach allows assessment of effectiveness of harm reduction strategies, including banning or reducing of additives.     

Incarceration or mandatory treatment: Drug use and the law in the Middle East and North Africa

In the Middle East and North Africa (MENA), drug policies are embedded in the prohibition paradigm. Laws and legislation criminalize all types of activities related to illicit drugs. This article gives a detailed assessment of the provisions of Arab national laws to control the use of illicit drugs across the areas of punishment of drug users, penalties for drug dependence, legislation on use and dependence treatment, and the right of the convicted people who use drugs to confidentiality. It reviews the national legislations on drug control of 16 Arab countries as amended in January 2011.     

Deconstructing myths,building alliances: a networking model to enhance tobacco control in hospital mental health settings

Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.     

Does the benefits schedule of cash assistance programs affect the purchase of temptation goods? Evidence from Peru

A critique of cash assistance programs is that beneficiaries may spend the money on “temptation goods” such as alcohol and tobacco. We exploit a change in the payment schedule of Peru's conditional cash transfer program to identify the impact of benefit receipt frequency on the purchase of temptation goods. We use annual household data among cross-sectional and panel samples to analyze the effect of the policy change on the share of the household budget devoted to four categories of temptation goods. Using a difference-in-differences estimation approach, we find that larger, less frequent payments increased the expenditure share of alcohol by 55–80% and sweets by 10–40%, although the absolute magnitudes of these effects are small. Our study suggests that less frequent benefits scheduling may lead cash recipients to make certain types of temptation purchases.     

Measuring Liability for Substance Use Disorder among College Students: Implications for Screening and Early Intervention

Background: Heavy drinking and illicit drug use among college students has been a longstanding public health concern. Current methods to screen and identify college students at-risk for the development of substance use disorders (SUD) are somewhat limited. Objectives: This study aimed to cross-validate the work by Kirisci et al. (), who developed the Transmissible Liability Index (TLI), by deriving a set of items that would be potentially useful for characterizing SUD risk across multiple dimensions among college students. We examined: 1) variations in the TLI-College Version (TLI-CV) by race, sex, SES, religiosity, and family history of substance use problems; 2) the association between the TLI-CV and alcohol and/or marijuana dependence, both cross-sectionally and prospectively, by race and sex; and, 3) the sensitivity and specificity of the TLI-CV for identifying cases of marijuana and/or alcohol dependence. Methods: Data from an ongoing longitudinal study of college students (n = 1,253) was used to conduct item response theory (IRT) analyses; the resulting TLI-CV consisted of 33 items. Results: The TLI-CV was significantly associated with baseline dependence and significantly higher for non-dependent individuals who later became dependent during the subsequent three years of college. These associations were observed for both sexes, Whites, Blacks/African-Americans, Asians, and other racial minorities. The sensitivity and specificity were suboptimal. Conclusions and Scientific Significance: The TLI-CV advances prior research to identify college students at risk for SUD. This approach holds potential promise to identify and ultimately modify the trajectories of college students who may be at risk for the development of SUD.     

家庭关怀度对酒依赖患者生活质量和应对方式的影响

目的探讨酒依赖患者家庭关怀度情况及其对生活质量和应对方式的影响。方法对入组80例患者采用家庭关怀度指数问卷(APGAR)、生活质量综合评定问卷-74(GQOLI-74)和特质应对方式问卷(TCSQ)进行评定,并以家庭关怀度的高与低将患者分为两组,比较两组的生活质量和应对方式情况。结果 162%的酒依赖患者家庭关怀度较低;高家庭关怀度组GQOLI-74因子评分均高于低家庭关怀度组,其中以躯体功能和物质生活状态差异显著(t=2.57,2.39;P0.05),心理和社会功能差异非常显著(t=3.02,2.89;P0.01),具有统计学意义;2高家庭关怀度组TCSQ的积极应对评分高于低家庭关怀度组(t=2.71,P0.01),消极应对评分高于家庭关怀度高组(t=-2.99,P0.01),消极应对表现突出,差异均具有统计学意义。结论酒依赖患者存在较低的家庭关怀度;低家庭关怀度者生活质量也较低,且面对应激时倾向于消极应对。     

An EEG-based functional connectivity measure for automatic detection of alcohol use disorder

BackgroundThe abnormal alcohol consumption could cause toxicity and could alter the human brain’s structure and function, termed as alcohol used disorder (AUD). Unfortunately, the conventional screening methods for AUD patients are subjective and manual. Hence, to perform automatic screening of AUD patients, objective methods are needed. The electroencephalographic (EEG) data have been utilized to study the differences of brain signals between alcoholics and healthy controls that could further developed as an automatic screening tool for alcoholics.MethodIn this work, resting-state EEG-derived features were utilized as input data to the proposed feature selection and classification method. The aim was to perform automatic classification of AUD patients and healthy controls. The validation of the proposed method involved real-EEG data acquired from 30 AUD patients and 30 age-matched healthy controls. The resting-state EEG-derived features such as synchronization likelihood (SL) were computed involving 19 scalp locations resulted into 513 features. Furthermore, the features were rank-ordered to select the most discriminant features involving a rank-based feature selection method according to a criterion, i.e., receiver operating characteristics (ROC). Consequently, a reduced set of most discriminant features was identified and utilized further during classification of AUD patients and healthy controls. In this study, three different classification models such as Support Vector Machine (SVM), Naïve Bayesian (NB), and Logistic Regression (LR) were used.ResultsThe study resulted into SVM classification accuracy = 98%, sensitivity = 99.9%, specificity = 95%, and f-measure = 0.97; LR classification accuracy = 91.7%, sensitivity = 86.66%, specificity = 96.6%, and f-measure = 0.90; NB classification accuracy = 93.6%, sensitivity = 100%, specificity = 87.9%, and f-measure = 0.95.ConclusionThe SL features could be utilized as objective markers to screen the AUD patients and healthy controls.     

Association between Second-hand Smoke Exposure and Urinary NNAL Level in Korean Adolescents

BackgroundThe 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is a metabolite of tobacco-specific lung carcinogen that can be found in both smokers and non-smokers. Particularly, NNAL levels of children with a history of exposure to second-hand smoke (SHS) are higher than those of adults. Thus, we aimed to investigate the association between SHS exposure and urine NNAL levels in Korean adolescents.MethodsThis cross-sectional study used data from the Korea National Health and Nutrition Examination Survey VII. Overall, 648 never-smoking adolescents (425 boys and 223 girls) aged 12 to 18 were included in this study. Logistic regression analyses identified the relationship between SHS exposure and elevated urine NNAL levels.ResultsThe mean urine NNAL levels of the no exposure and exposure group in boys were 1.39 and 2.26 ng/mL, respectively, whereas they were 1.01 and 2.45 ng/mL in girls, respectively (P < 0.001). Among the adolescents exposed to SHS, the confounder-adjusted odds ratio (95% confidence intervals) for elevated urine NNAL levels according to exposure area as overall, home, and public area were 2.68 (1.58–4.53), 31.02 (9.46–101.74), and 1.89 (1.12–3.17) in boys; and 6.50 (3.22–13.11), 20.09 (7.08–57.04), and 3.94 (1.98–7.77) in girls, respectively.ConclusionSHS exposure was significantly associated with elevated urine NNAL levels in Korean adolescents, particularly in female adolescents and in those with home exposure. These findings remind us of the need to protect adolescents from SHS.     

An Assessment of the Genetic Relationship Between Alcohol Metabolism and Alcoholism Risk in Australian Twins of European Ancestry

The present analyses examined genetic influences on alcohol metabolism and their possible relationship to risk of alcohol dependence. Subjects were 206 Australian twin pairs who participated in an alcohol challenge protocol in 1979–1981, in which they were given a 0.75 g/kg dose of alcohol; blood alcohol concentrations (BACs) measured at five times over a 3-hr period after alcohol ingestion were examined. Structural equation modeling, fitting a combined autoregressive and common factor model, indicated significant heritabilities for both men and women (h ² range = 0.19–0.71), with significant parameter heterogeneity as a function of gender. In 1992–1993, both twins from 159 of the alcohol challenge pairs completed a telephone-administered psychiatric diagnostic interview. Repeated-measures MANOVAs were used to examine whether respondent's or cotwin's DSM-III-R alcohol dependence status, or parental history of alcohol problems, was associated with variation in alcohol metabolism. There was some evidence that individuals at increased genetic risk of alcohol dependence [with either a paternal history of alcohol problems (women) or an MZ male cotwin who reported a history of alcohol dependence by 1992–1993] showed lower initial BACs than other groups. However, this effect was not seen in those who themselves had a history of alcohol dependence by interview follow-up, perhaps because this relationship was already masked by a history of excessive drinking at baseline.