bluuebunny/crossref_metadata_2025 huggingface dataset:
Heavy alcohol consumption and marital status: disentangling the relationship in a national study of young adults
Authors: Power Chris , Rodgers Bryan , Hope Steven
Published: March 2003

Aims. To investigate why alcohol consumption varies by marital status, assessing (i) differences in heavy consumption prior to changes in marital status (indicating selection) and increases or decreases in heavy consumption associated with changes in marital status (indicating causation), (ii) whether such increases or decreases are transient, and (iii) the possible mediating effect of parental status.

Design. Longitudinal cohort.

Setting. Great Britain.

Participants. Data from the 23‐ and 33‐year surveys of the 1958 British birth cohort (all born in England, Wales and Scotland, 3‐9 March 1958).

Measurements. Heavy drinking, defined as more than 35 (men) and 20 (women) units/week; changes between ages 23 and 33 in consumption and marital status.

Findings. The divorced had the highest consumption levels at both ages, the married had the lowest. Selection effects were minimal in both sexes. Overall, heavy drinking declined between ages 23 and 33 (21.4‐13.0% in men, 6.4‐3.4% in women), but increased among individuals who divorced, compared to the continuously married (adjusted OR = 2.05, 95% CI = 1.49,2.83 for men; OR = 2.61, 95% CI = 1.67,4.09 for women), most strikingly for recent divorces (adjusted OR = 4.97, 95% CI = 2.86,8.57 and OR = 5.25, 95% CI = 2.60,10.65). High rates of heavy drinking persisted for never married men (19.1%) and women (5.2%).

Conclusions. The heavy drinking level of divorced young adults was not due to selection. Marital separation was accompanied by increases in heavy drinking, with pronounced short‐term effects. Adverse alcohol‐related health consequences may occur in the immediate period around divorce. Individuals who never marry appear to have a chronic heavy consumption pattern that may contribute to their increased mortality.
Psychiatric disorders in adult children of problem drinkers: prevalence, first onset and comparison with other risk factors
Authors: Cuijpers Pim , Langendoen Yvonne , Bijl Rob V.
Published: March 2003

Aims. (1) To confirm the increased risk of psychiatric disorders in Adult Childrenof Alcoholics (ACOAs); (2) to test if the age of onset of the disorders differs for ACOAs versus non‐ACOAs; (3) to estimate the weight of being an ACOA compared to other risk factors including childhood traumas, other parental problem behaviours and current risk factors.

Design, setting, and participants. A random sample of the Dutch population ( N = 7147) was interviewed (response rate: 69.7%).

Measurements. Psychiatric disorders were assessed using the CIDI. Parental problem drinking, other parental problem behaviours and childhood traumas were assessed using self‐report measures.

Findings. (1) ACOAs had a significantly higher life‐time, 12‐month and 1‐month prevalence of mood, anxiety and abuse/dependence disorders. Sons of problem drinkers also had a higher prevalence of eating disorders and schizophrenia. The prevalence rates were particularly high for the children of fathers with drinking problems. (2) The first onset of the mood and anxiety disorders took place at a younger age in ACOAs than in non‐ACOAs. (3) Relative to other parental problem behaviours and childhood traumas, parental problem drinking is a strong predictor of psychiatric disorders, in particular abuse/dependence disorders.

Conclusions. Children of fathers with a drinking problem are a high‐risk group for psychiatric disorder. From a public health perspective it is an important target to break through this continuing circle. The further development of prevention and early treatment interventions at schools, youth care and addiction treatment centres is an important issue.
Brief intervention for alcohol use in pregnancy: a randomized trial
Authors: Chang Grace , Wilkins‐Haug Louise , Berman Susan , Goetz Margaret Ann
Published: March 2003

Aims. To assess the impact of a brief intervention on antepartum alcohol consumption.

Design. A randomized clinical trial.

Setting. The obstetrics practices of the Brigham and Women's Hospital in Boston, MA, USA.

Participants. Two hundred and fifty eligible women initiating prenatal care.

Intervention. A comprehensive assessment of alcohol use (assessment only, AO) or the same comprehensive assessment with a brief intervention (BI).

Measurement. Demographic background and obstetric history of subjects, current and lifetime use of alcohol and substances, composite Addiction Severity Index scores, and antepartum alcohol use.

Findings. Of the 250, 247 (99%) subjects provided information on their antepartum drinking. Both the AO and BI groups had reductions in antepartum alcohol consumption, but differences in reductions by group were not statistically significant ( p > 0.05).Risk of antepartum drinking after either the AO or BI was increased nearly threefold if the subject had any prenatal alcohol consumption before assessment ( p = 0.0001). For the 143 subjects who were abstinent pre‐assessment, however, those who received the BI maintained higher rates of abstinence (86% versus 72%, p = 0.04).

Conclusions. After a comprehensive assessment of alcohol use, subjects in both the AO and BI groups reduced their antepartum alcohol consumption. The importance of screening for prenatal alcohol use is underscored by the findings that any prenatal alcohol consumption increases the risk of continued antepartum drinking.
Exploring the dose‐response relationship between alcohol consumption and the risk of several alcohol‐related conditions: a meta‐analysis
Authors: Corrao Giovanni , Bagnardi Vincenzo , Zambon Antonella , Arico Sarino
Published: March 2003

Objective. To compare the strength of the evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of six cancers (oral cavity, oesophagus, colorectum, liver, larynx, breast), hypertension, cerebrovascular diseases, gastric and duodenal ulcer, liver cirrhosis and other chronic liver diseases, pancreatitis and injures and adverse effects.

Methods. A search of the epidemiological literature from 1966 to 1998 was performed by several bibliographic databases. Metaregression models were fitted considering fixed and random models and linear and non‐linear effects of alcohol intake on the risk of each condition. The effects of some characteristics of the studies including an index of their quality were considered as putative sources of heterogeneity of the estimates. Publication bias was also investigated by asymmetry of funnel plots.

Results. Of the 397 initially reviewed studies, 200 were selected for meta‐analysis. Since qualitative characteristics of the studies were often significant sources of heterogeneity among them, the estimates of the pooled dose‐response slopes were based only on the 123 studies with higher quality score and/or reporting adjusted estimates of relative risks. Higher alcohol‐related risks were found for liver cirrhosis, neoplasms of the upper respiratory and digestive tracts, haemorrhagic stroke and injuries and adverse effects. Weaker but significant associations were found for colorectum, liver and breast cancers, essential hypertension and chronic pancreatitis. For all these conditions, low intakes, corresponding to daily consumption of two drinks or two glasses of wine (25 g/day), have shown significant risks. Ischaemic stroke and gastric and duodenal ulcer seem independent of alcohol intake. The area in which the study was performed, the study's design and the outcome variable differently affected the slopes.

Conclusions. The small number of sufficiently reliable studies, the strong indications of heterogeneity across them and the suspicion of publication bias suggest that there is a great need for well‐conducted epidemiological studies performed in several countries, to examine the dose‐response relationship between alcohol intake and the risk of several alcohol‐related conditions, as well as the role of drinking pattern in determining the risk.
Patterns of cannabis use, abuse and dependence over time: incidence, progression and stability in a sample of 1228 adolescents
Authors: Perkonigg Axel , Lieb Roselind , Hofler Michael , Schuster Peter , Sonntag Holger , Wittchen Hans‐Ulrich
Published: March 2003

Aims. To present data on the incidence of cannabis use at follow‐up, and its progression, stability, abuse and dependence in a representative sample of adolescents (N = 1228), aged 14‐17 years at baseline‐the outset of the study‐in Munich, Germany. Design. The study employed a prospective longitudinal design using a representative population sample. The mean follow‐up time was 19.7 months. The Composite International Diagnostic Interview (M‐CIDI) was used to assess patterns of use, abuse and dependence according to DSM‐IV criteria. Findings. (1) In our sample, 34.8% of males and 30.2% of females had tried cannabinoids at least once. (2) Of those who used cannabis repeatedly (two or four times) at baseline, 26.1% stopped using by follow‐up; the majority went on to regular use in the follow‐up period. Similarly, only 17.7% of the regular users at the outset stopped using cannabis completely; 74.2% continued their pattern of regular use. Thus, the higher the baseline use pattern, the higher was the probability of continued or heavier use during follow‐up. (3) Although the cumulative life‐time incidence for DSM‐IV cannabis abuse (3.5%) in this age group was low, it is noteworthy that complete diagnostic remissions were relatively rare (31.7% for dependence, 41.1% for abuse). (4) There was considerable concurrent use of other drugs. Conclusions. Cannabis use was almost as widespread in this sample of adolescents in Germany as in similar age groups in metropolitan areas of North America. There was a relatively low spontaneous remission rate among regular and repeated users. Cannabis use in adolescence appears to be less transient than many people would believe.
Contrasting levels of adolescent drug use between adjacent urban and rural communities in Scotland
Authors: Forsyth Alasdair J. M. , Barnard Marina
Published: March 2003

Aims. To compare life‐time prevalence of illicit drug use between adolescents resident in adjacent urban and rural localities. Design. Samples of schoolchildren attending urban and rural comprehensive schools (n = 2558) were obtained using an identical questionnaire survey method. Setting. Respondents were recruited from 10 schools in two contrasting adjacent local authorities. Five representative schools in each locality were chosen. Participants. All children present in each school, in the two final compulsory school years, were eligible for this study. Measurements. Respondents were asked to provide detailed information about their place of residence and use of illegal drugs. The data obtained in schools were compared with local geographical statistics, such as levels of deprivation. Findings. As expected from the demographics of their respective localities, the urban schools displayed higher levels of deprived children and lower levels of school achievement. These socio‐economic differences were not reflected in reported levels of life‐time drug use. This was true both between and within the urban and rural samples. Conclusion. These findings suggest that adolescent drug use in Scotland is not particularly concentrated in areas of urban deprivation.
Alcoholic beverage choice, risk perception and self‐reported drunk driving: effects of measurement on risk analysis
Authors: Greenfield Thomas K. , Rogers John D.
Published: March 2003

Aims. The present study examined effects of measurement on risk curve analysis in an application involving prediction of frequency and indicator measures of drunk driving with beverage‐specific alcohol consumption and risk perception measures. Design and participants. From a 1995 in‐person survey of the US adult household population (response rate = 77%) the responses of 1260 adult drivers who reported any drinking in the prior year were selected for analysis. Regression and graphical techniques were used to investigate relationships between drinking pattern, beverage choice, perception of risks of drinking before driving, and frequency of drunk driving. Measurements. Self‐reported drunk driving (occurrence) was measured by a question assessing driving after drinking enough to be in trouble if stopped by the police within the prior 12 months; those affirming this (n = 191) were asked how many times they did so (frequency). Alcohol consumption was assessed by beverage and in combination. Risk perception was assessed as a factor score from three correlated measures. Demographic variables included age, ethnicity, education and income. Findings. Controlling for demographics, heavy beer consumption (p < 0.01) more than heavy wine (NS) or liquor/spirits (p < 0.05) intake was strongly predictive of risk perception. A regression analysis showed a significant interaction between heavy beer consumption and perceived risk (p < 0.001) in predicting reported frequency of drunk driving, after controlling for heavy beer consumption (p < 0.05), total alcohol consumption and risk perception (both ps < 0.001). No interactions were important in equivalent models predicting dichotomous occurrence. Graphic analysis showed the shape of the risk curve is altered when frequency of drunk driving is taken into account rather than simple occurrence. Conclusions. Individuals' underestimation of beer's intoxicating effects, compared to other alcoholic beverage types, helps explain beer's over‐representation in drinking driving violation reports. There is a need for creative public health campaigns designed to inform young men of beer's alcohol content and associated risks.
French general practitioners' attitudes and reported practices in relation to their participation and effectiveness in a minimal smoking cessation programme for patients
Authors: Slama Karen , Karsenty Serge , Hirsch Albert
Published: March 2003

Aims. To examine the participation and effectiveness of GPs in offering a minimal smoking cessation intervention according to attitudinal and reported behaviour variables. Design. General practitioners were surveyed about their practices and attitudes and then matched pairs of smoking and non‐smoking doctors were invited to participate in a regional smoking cessation intervention. The relationship of survey responses and the degree of participation and effectiveness in a smoking cessation trial was examined. Setting. Primary care doctors in a large region of southern France, Provence‐Alpes‐Cote d'Azur (PACA). Participants. Two thousand, eight hundred and sixty GPs from the PACA region in France were interviewed about their attitudes and behaviours. From among 371 smoking GPs and 375 non‐smoking GPs invited to take part in a smoking cessation trial with patients, 170 smokers and 202 non‐smokers participated. Measurements. The GPs' attitudes and reported professional and personal practices were assessed in a telephone interview. These responses were compared with the GPs' participation in the cessation trial, and with GP "success" (1 or more patients stopping smoking at 1 month, 12 months or both) or "non‐success" (no patient cessation at 1 month or at 12 months). Findings. A significantly lower proportion of smokers than non‐smokers among the GPs who initially accepted did not participate in the study (45% vs. 54.1%, chi2=5.147 df="1," p 0.05, difference: 8.3% 95% CI: 1.2%; 15.5%), but thereafter, there were no significant associations between GPs' reported smoking practices and attitudes and the extent of their participation or effectiveness. Conclusions. The study results indicate that, when minimal advice has an effect, it is due more to the systematic nature of the provision of the intervention than to the attitudes or reported practices of the practitioner providing the advice.
Alcohol disorders and re‐employment in a 5‐year follow‐up of long‐term unemployed
Authors: Claussen Bjorgulf
Published: March 2003

Aims. To establish whether the high prevalence of alcohol abuse among unemployed people is explained by alcohol abuse causing unemployment, or vice versa. Design. A 5‐year postal follow‐up survey of a community sample of unemployed from Grenland, southern Norway. Participants. Two hundred and twenty‐eight unemployed people, registered for more than 12 weeks, aged 16 to 63 years. Response rate 74%. Measurements. The Alcohol Use Disorder Identification Test (AUDIT) and DSM‐III diagnoses of alcohol disorders in medical examinations. Findings. At the 5‐year follow up, 23% of those still unemployed and 12% of those re‐employed scored higher than the AUDIT cut‐point of 10. Re‐employment reduced the chance of scoring positive on the AUDIT to 34% of the chance for those still unemployed. Significant selection to long‐term unemployment according to AUDIT score was not demonstrated. None of the 7% who had a DSM‐III diagnosis of an alcohol disorder had a job 5 years later, however, suggesting that alcohol‐related selection to unemployment does occur. Conclusion. The high prevalence of harmful drinking among Norwegian unemployed is explained mainly by unemployment causing alcohol abuse rather than vice versa. Reducing unemployment should contribute to reduced alcohol problems in Norway.
Reinforcing, subjective, and psychomotor effects of sevoflurane and nitrous oxide in moderate‐drinking healthy volunteers
Authors: Zacny James P. , Janiszewski Debra , Sadeghi Parvine , Black Matthew L.
Published: March 2003

Aims. To characterize the reinforcing, subjective and psychomotor effects of sevoflurane, a volatile anesthetic, across a range of subanesthetic concentrations in non‐drug‐abusing humans. In addition, a concentration of nitrous oxide was included in the design in order to compare and contrast behavioral effects of a gaseous to a volatile anesthesic. Design. Repeated measures, double‐blind, placebo control experiment. Setting. Human psychopharmacology laboratory. Participants. Fourteen moderate‐drinking healthy volunteers. Intervention. In each of four sessions, subjects first sampled placebo‐oxygen and an active drug (end‐tidal concentrations of 0.2, 0.4, 0.6% sevoflurane and 30% nitrous oxide in oxygen) and then chose between the two. Measurements. Mood and psychomotor performance during the sampling trials, and choice of drug or placebo‐oxygen during choice trial. Findings. Nitrous oxide was chosen by 71% of the subjects, and 0.2, 0.4 and 0.6% sevoflurane were chosen by 50%, 57% and 50% of the subjects, respectively. Neither drug was chosen at levels that exceeded that of chance. Sevoflurane and nitrous oxide both impaired psychomotor performance and produced changes in mood. There were several differences in subjective effects between sevoflurane and nitrous oxide at concentrations which were considered to be equivalent in anesthetic effect. Finally, although sevoflurane did not function as a reinforcer in the majority of individuals tested, there was evidence that sevoflurane functioned as a reinforcer in some volunteers: subjects who chose to inhale sevoflurane over placebo‐oxygen tended to report a positive spectrum of subjective effects during the sevoflurane sampling trial, relative to those subjects who chose placebo‐oxygen over sevoflurane. Conclusions. Although sevoflurane did not function as a reinforcer in the majority of subjects tested, the correspondence between positive subjective effects of sevoflurane and subsequent sevoflurane choice suggests that the volatile anesthetic drug can function as a reinforcer in some moderate drinkers.
The Alberta Interlock Program: the evaluation of a province‐wide program on DUI recidivism
Authors: Voas Robert B. , Marques Paul R. , Tippetts A. Scott , Beirness Douglas J.
Published: March 2003

Aims. This study was designed to determine the efficacy of alcohol safety interlocks in reducing recidivism among first and second driving‐under‐the‐influence (DUI) offenders. It also evaluates the overall effectiveness of interlock programs where typically only a small portion of DUI offenders elect to install interlocks. Design. The driving records of DUI offenders participating in interlock programs for 6 months for first offenders and 2 years for second offenders were compared with similar offenders who chose not to participate. Setting. A province‐wide program in Alberta, Canada. Participants. Records of 35 132 drivers convicted of DUI between 1 July 1998 and 30 September 1996 were analyzed. Measurements. Repeat DUI offenses during and after the interlock period. Findings. While the offenders had interlocks on their vehicles, DUI recidivism was substantially reduced. Once the interlock had been removed and the participants had been reinstated, their DUI rate was the same as other offenders indicating that the interlock reduced recidivism while in place. Because only 8.9% of eligible drivers elected to participate in the interlock program, the program did not significantly increase the overall effectiveness of the province's management of DUI offenders. Conclusions. Interlocks are associated with a major reduction in DUI recidivism while on the vehicle of the offender. However, because few offenders elect to participate, the program produces only a small (5.9%) overall reduction in the recidivism rate of all DUI offenders.
A comparison of two measures of stage of change for smoking cessation
Authors: Etter Jean‐Francois , Perneger Thomas V.
Published: March 2003

Aims. To compare two questionnaires used to identify the stages of change of current and former smokers: a conventional five‐item questionnaire and an alternative one‐item questionnaire. Design and setting. Mail surveys of 1167 ever smokers in Geneva (Switzerland), conducted in 1997. Participants were classified into five stages: precontemplation, contemplation, preparation, action and maintenance. Other questions covered smoking‐related behaviours, attitudes and self‐efficacy. Findings. Only 62% of participants were classified as being in the same stage by the two questionnaires (weighted kappa = 0.69). The five‐item questionnaire produced more missing data (8%) than the one‐item questionnaire (2%, p < 0.001). Using the conventional questionnaire, the precontemplation stage included a group of smokers who had absolutely no intention of stopping smoking and a group more prone to change, and the preparation stage included only 43% of people who had made a "firm decision" to quit smoking in the next 30 days. Using the alternative questionnaire, the contemplation stage was also quite heterogeneous. The action stage included over 35% of people who were still smoking occasionally, whichever questionnaire was used. Conclusions. The single‐item questionnaire was better at avoiding missing responses. However, both staging questionnaires classified smokers in heterogeneous groups, and both misclassified many occasional smokers and ex‐smokers, which suggests that a discrete five‐stage model does not fit reality well. This may reflect underlying conceptual issues, notably that the classic definition of stages incorporates separate dimensions, albeit incompletely (current behaviour, quit attempts, intention to change, time). Both theoretical and methodological developments are needed to overcome these problems.
Inhalant use among urban American Indian youth
Authors: Howard Matthew Owen , Walker R. Dale , Walker Patricia Silk , Cottler Linda B. , Compton Wilson M.
Published: March 2003

Aims. To assess the prevalence of inhalant use among urban American Indian youth and to examine differences between inhalant users and non‐users. Design. Baseline (T1) self‐report questionnaires completed in 5th‐6th grade and at seven annual follow‐up assessments (T2‐T8). Settings. Seattle metropolitan area. Participants. Two hundred and twenty‐four Indian youth. Measurements. Youth‐completed measures of substance use, ethnic self‐identity, involvement in traditional Indian activities, family conflict, family history of alcoholism, peer and sibling deviance, self‐esteem, delinquency, aggression, anxiety, depression, sensation seeking, conduct disorder and alcohol dependence. Findings. Lifetime inhalant use was reported by 12.3% of adolescents. At T1, inhalant users had significantly lower perceived self‐worth and average annual household incomes and significantly greater density of familial alcoholism and expression of aggressive and delinquent conduct than non‐users. Aggressive behavior was the most important T1 predictor of inhalant use. Lifetime conduct and alcohol dependence disorders were 3.3 and 2.6 times more prevalent among inhalant users than non‐users at T5. Inhalant users had more extensive deviant peer networks, were more sensation‐seeking, and evidenced lower perceived self‐worth than non‐users at T8. Conclusions. Inhalant use was less prevalent in this particular sample of urban Indian adolescents than in most studies of reservation Indian youth. As with other studies of inhalant abuse, aggressive and delinquent males of low SES and low‐perceived self‐worth with family histories of alcohol dependence, were at highest risk for inhalant use.
Substance abuse studies and prevention efforts among Arabs in the 1990s in Israel, Jordan and the Palestinian Authority‐a literature review
Authors: Weiss Shoshana , Sawa Ghazi H. , Abdeen Ziad , Yanai Joseph
Published: March 2003

This paper is the result of a collaborative project of Israeli, Jordanian and Palestinian scientists gathered to reveal the current extent of substance abuse and efforts at prevention among Arabs in Israel, Jordan and the Palestinian Authority territories, in order to identify needs and suggest future collaborative activities and directions for regional cooperation. The article provides data and covers the current state of substance abuse prevention and research among Moslems, Christians and Druze in the trilateral region in the 1990s by reviewing prevention materials and studies published in the professional literature, as well as in reports and Doctoral and Master's theses in Arabic, which have been located in academic libraries and other institutions, in the framework of a comprehensive search. This manuscript is the first to summarize Jordanian and Palestinian findings in the substance abuse domain. The review shows that most of the Israeli research in the Arab sector deals with alcohol use among youth, that the majority of Jordanian studies focus on illicit drug use, that the research among Palestinians is in its infancy, and that comprehensive prevention programs are lacking in the trilateral region. It describes the key results of most of the 12 Israeli studies among Arabs, 11 Jordanian studies and four Palestinian studies. It reveals that drug abuse among Israeli Arab students is probably more prevalent than among Jewish adolescents, that the typical Jordanian drug addict has a higher level of education than the typical Palestinian drug addict, and that the Palestinian is more likely to be a multiple drug user. Recommendations for future activities include organization of a regional collaborative workshop in order to establish data collection systems for basic statistics relevant to drug abuse and development of comprehensive prevention programs, as well as studies in the substance abuse domain concerning knowledge, attitudes and behavior among the general Arab population.
Balancing on the edge of death: suicide attempts and life‐threatening overdoses among drug addicts
Authors: Rossow Ingeborg , Lauritzen Grethe
Published: March 2003

Aims. Assessment of prevalence of non‐fatal overdoses and suicide attempts and predictors of and co‐variation between such behaviours among drug addicts. Design. Cross‐sectional survey. Setting. Inpatient and outpatient treatment units in Norway. Participants. National sample of 2051 drug addicts admitted to treatment in Norway in 1992‐93. Measurements. Self‐reports of suicide attempts and of life‐threatening overdoses from structured interviews with therapists. Findings. Almost half (45.5%) the clients reported having experienced one or more life‐threatening overdoses. A third (32.7%) reported one or more suicide attempts. Suicide attempts were more often reported among those who had overdosed (odds ratio (OR) = 6.3), and the number of life‐threatening overdoses and number of suicide attempts were positively and moderately associated (Pearson's r = 0.39). Drug addicts who had exhibited both life‐threatening behaviours were characterized by polydrug use, poor social functioning and HIV risk‐taking behaviour. Suicide attempters were also characterized by psychiatric problems. Conclusions. The substantial co‐variation between suicide attempts and drug overdose suggests some common underlying causal factors. These seem to be related to heavy drug use and poor social integration.
The quantification of mortality resulting from the regular use of illicit opiates
Authors: Hulse G. K. , English D. R. , Milne E. , Holman C. D. J.
Published: March 2003

Aims/Design. Estimates of mortality associated with illicit opiate use provide useful information to those directing and monitoring local, national and international policies and programmes. Most studies investigating the association have, however, been small with imprecise estimates of increased mortality. The current study combines data from a number of international studies in a meta‐analysis to estimate more precisely mortality associated with illicit opiate use. Because HIV infection among injecting drug users differs dramatically between countries and localities, we excluded studies where AIDS was a major contributor to mortality. Studies were included only where AIDS‐specific mortality accounted for less than 2% of total mortality. Findings. Our results show a mortality rate for people regularly using illicit opiates, which is more than 13 times greater than that observed for the general community. It is estimated that 9.4% of total mortality in Australians aged 15‐39 years of age can be attributed to regular use of illicit opiates. Application of this aetiological fraction to Australian mortality data for 1992 indicate that approximately 401 male and 161 female deaths occurred as a result of opiate use. This represents some 15 429 and 6261 person‐years of life lost (to age 70) for males and females, respectively. Conclusions. The mortality rate for illicit opiate users is approximately 13 times greater than for the general population. The large number of years of life lost is reflective of the relatively young population (15‐39 years of age) in which opiate‐related mortality occurs. Relative risk estimates can also be applied to data on the prevalence of illicit opiate use in other countries to produce locally based aetiological fractions and estimates of person‐years of life lost.
Comparison of methadone and slow‐release morphine maintenance in pregnant addicts
Authors: Fischer Gabriele , Jagsch Reinhold , Eder Harald , Gombas Wolfgang , Etzersdorfer Petra , Schmidl‐Mohl Katrin , Schatten Christian , Weninger Manfred , Aschauer Harald N.
Published: March 2003

Aims. To investigate whether the neonatal abstinence syndrome (NAS) is different in children born to women maintained on slow‐release morphine, compared with those maintained on methadone, and to compare additional drug consumption in these groups of women . Design, Setting and Participants. An open, randomized trial was conducted in an established clinic. Forty‐eight pregnant women who presented to the clinic as opiate or polysubstance abusers were enrolled and maintained on either methadone (24 women) or slow‐release morphine (24 women) up to and following delivery. The programme included psychosocial therapy and support for their opiate‐addicted partners . Measurements. Standard urinalysis methods were used to measure consumption of cocaine and benzodiazepines during pregnancy. Injection sites were monitored to indicate additional opiate use. NAS was measured according to Finnegan score and the amount of phenobarbiturates prescribed to alleviate the symptoms . Findings. No difference was found in the number of days that NAS was experienced by neonates born to methadone or morphine maintained mothers (mean = 16 and 21 days, respectively). All children were born healthy and no serious complications arose. Fewer benzodiazepines ( p 0.05) and fewer additional opiates ( p 0.05) were consumed by the morphinemaintained women compared with those who took methadone, but no difference was seen in cocaine consumption. Nicotine consumption was reduced significantly in both groups during pregnancy ( p 0.02) . Conclusions. Both methadone and morphine are suitable maintenance agents for pregnant opiate addicts. Maintenance agents that result in a less prolonged NAS should be studied in further trials.
The identification of alcohol dependence criteria in the general population
Authors: Caetano Raul
Published: March 2003

Aims. To assess the criteria used to identify alcohol dependence in the general population. Design and setting. Two independent probability surveys of the US household population 18 years of age and older were analyzed: the 1994 National Telephone Survey (NTS‐94), which interviewed 637 respondents, and the 1988 National Household Interview Survey (NHIS‐88) which interviewed 43 809 respondents in their homes. Participants. The analyses of the NHIS‐88 dataset focused on drinkers who consumed at least 12 drinks of alcohol in the 12 months prior to the survey interview ( N = 22, 102). The analyses of the NTS‐94 dataset focused on drinkers who consumed at least one drink in the 12 months prior to the survey interview ( N = 637). Measurements. Criteria for DSM‐IV alcohol dependence were operationalized using 15 items from a standardized questionnaire. Findings. Analyses suggested that normal drinking behavior can be misidentified as dependence criteria. Results for men who drank up to two drinks per day suggest that if the dependence criteria were invalid, reductions in the prevalence of specific indicators of alcohol dependence would range from 0.3% to 5.2%. Correcting for the misidentification of alcohol dependence diagnosis would reduce the overall prevalence of alcohol dependence by 0.5%. Up to 7% of the men could have been diagnosed as alcohol‐dependent and could have provided invalid reports. Conclusions. The identification of alcohol dependence in general population samples must include careful probing of the nature of drinking‐related behavior reported by respondents. This will decrease misidentification of dependence criteria, increasing the validity of dependence diagnosis in survey research.
Validity of the Fagerstrom test for nicotine dependence and of the Heaviness of Smoking Index among relatively light smokers
Authors: Etter Jean‐Francois , Duc Trinh Vu , Perneger Thomas V.
Published: March 2003

Aims. To assess the validity of the Fagerstrom test for nicotine dependence (FTND, six items) and of a short‐form of this questionnaire, the Heaviness of Smoking Index (HSI, two items), in a population of relatively light smokers. Design. Comparison of item content with published definitions of addiction. Test‐retest reliability and multiple tests of construct validity, based on a secondary analysis of a cohort study conducted between November 1995 and June 1996. Setting. University of Geneva, Switzerland. Participants. Students (82%), academic (12%) and administrative staff (6%): 643 smokers at baseline and 482 smokers at follow‐up. Measurements. French‐language versions of the FTND and HSI, smoking status, saliva cotinine level, self‐efficacy for quitting smoking and other variables related to addiction with cigarettes. Findings. A literature review showed that both composite scales fail to assess several recognised aspects of tobacco dependence. In this population of relatively light smokers (average: 12 cigarettes per day), both tests had important floor effects with, respectively, 55% and 63% of participants with scores equal to 0 or 1 on these scales. In addition, two of the FTND items (Difficult‐to‐refrain and Hate‐most‐to‐give‐up) had poor psychometric properties. Even though FTND and HSI correlated about as expected with criterion variables, the number of cigarettes smoked per day performed better than either composite scale on most validation criteria. Conclusion. In a population of relatively light smokers, FTND and HSI seem to measure little more than the number of cigarettes per day. Designing a new and more broadly applicable test of addiction to cigarettes is a research priority.
Predictors of smoking cessation during pregnancy
Authors: Woodby Lesa L. , Windsor Richard A. , Snyder Scott W. , Kohler Connie L. , Diclemente Carlo C.
Published: March 2003

Aims. The purpose of this study was to determine predictors of smoking cessation from a sample of pregnant Medicaid recipients. Of special interest was whether patient stage of change, based on the transtheoretical model, was predictive of smoking behavior change during pregnancy. Participants/setting. The sample was drawn from a cohort of pregnant smokers who were participants in a prospective, randomized clinical trial conducted in four public health maternity clinics in Birmingham, Alabama, USA. Design/measurements. The 435 participants entered prenatal care on or before their 24th week of gestation and had saliva collected for cotinine assays at baseline and follow‐up. In this secondary analysis, descriptive statistics defined the sample, cross‐tabulation procedures identified a preliminary set of predictor variables, and discriminant function analyses predicted group membership‐quitter or smoker. Findings/conclusions. Discriminant function analyses revealed that patient baseline cotinine value, duration of smoking habit, self‐efficacy, exposure to environmental tobacco smoke, and exposure to patient education methods were predictive of non‐smoking status assessed during the third trimester of pregnancy.
Alcohol policy and the young adult: establishing priorities, building partnerships, overcoming barriers
Authors: Mosher James F.
Published: March 2003

Young adults (defined here as those 18‐29 years of age) in the United States and Canada constitute a demographic group most likely to suffer serious alcohol problems, yet the alcohol policy field has made little effort to develop prevention strategies that respond specifically to their circumstances and needs. This paper briefly reviews relevant research, analyzes prevention policy priorities, presents the barriers to implementation and outlines strategies for overcoming them. Its main conclusions are: (1) Strategies to reduce alcohol availability and increase alcohol prices will significantly reduce alcohol problems among young adults. (2) A high priority should be given to harm reduction strategies and strategies that target the physical environments where young adults are likely to congregate. (3) The alcohol industries and the industries' allies will vigorously oppose these policy reforms, and their resistance constitutes a formidable barrier to implementation. (4) Resistance from other community institutions, which may benefit from the status quo, is an additional barrier that must be addressed. (5) There is a tendency to compromise with the alcohol industries and others and substitute individual‐based prevention strategies for public policy reforms. Individual‐based strategies complement public policy reforms but should not replace them. (6) Overcoming barriers will require community organizing, coalition building, media advocacy and policy advocacy and an expanded research effort. The field needs to develop new messages and themes in both media and policy advocacy that address the specific concerns and interests of young adults, thereby encouraging their active leadership in prevention policy development.
Peril, chance, adventure: concepts of risk, alcohol use and risky behavior in young adults
Authors: Leigh Barbara C.
Published: March 2003

This paper discusses issues in applying concepts of "risk" to alcohol use. There is a wide variety of definitions of "risk," including dimensions of positive vs. negative aspects of risk‐taking, short‐term vs. long‐term harm, generality vs. specificity of risk behaviors, knowledge of probability of harm, and objective vs. subjective risk. Alcohol can play a role in risky behavior on multiple levels. The paper describes the methods used to examine a link between alcohol and risk‐taking (population‐based, person‐based, event‐based and experimental methods) and illustrates these methods from research findings on the association of alcohol to risky driving, crime and violent behavior, and sexual risk‐taking. Theoretical models of the association of alcohol and risk‐taking are outlined, and the implications of these models for alcohol policy and prevention are discussed.
Predictors of change in alcohol consumption among Frenchmen of the GAZEL study cohort
Authors: Zins M. , Carle F. , Bugel I. , Leclerc A. , Orio F. Di , Goldberg M.
Published: March 2003

Aims. To identify the predictors of changes in alcohol intake among French men. Design. Longitudinal study over a 2‐year period. Setting. The GAZEL volunteer cohort comprising workers employed by Electricite de France‐Gaz de France. Participants. The study included 11 613 men aged 40‐50 years who had answered a self‐administered questionnaire in 1989 and 1991. Measurements. Subjects were defined according to initial levels of alcohol intake and changes in that intake (cessation, decrease and increase) and compared with subjects with corresponding levels but unchanged intake by logistic regression. The effects of individual characteristics and of occupational and health conditions were investigated. Findings. Different variables measured in 1989 were predictive of changes in alcohol consumption in 1991, depending on the change. Self‐perception of bad health, consumption of sleeping pills and unmarried status were predictive of the cessation of alcohol consumption. Working under favourable conditions (with no specific occupational risks) and being a non‐smoker tended to be associated with reduced consumption. Increased consumption was associated with the number of reported disease and the smoking status. Among abstainers or light daily drinkers, being exposed to more than one constraint enlarged the risk of increased consumption. For moderate drinkers, the risk of increased consumption was higher, irrespective of the number of physical constraints. Conclusions. These results highlight the fact that many inter‐related factors help to determine changes in drinking habits.
Physiological arousal and sensation‐seeking in female fruit machine gamblers
Authors: Coventry Kenny R. , Constable Beverley
Published: March 2003

Aims. To examine changes in physiological arousal, as indexed by heart rate, during fruit machine gambling while controlling for the confounding effect of movement and as a function of winning and losing, and to examine relationships between sensation‐seeking, self‐reported arousal during gambling, heart rate during gambling and frequency of gambling. Sample, design and measurements. Heart rate and subjective arousal were recorded in a sample of 32 female fruit machine players before, during and after the gambling process. At baseline measures were taken of sensation‐seeking, self‐reported arousal during gambling and frequency of gambling. A simulation of the behaviour used to operate fruit machines was used during baseline measurement. Findings. Significant increases in heart‐rate over movement controlled baselines were observed within participants during gambling, but only in those who won during play. No correlations between HR levels and subjective arousal were found. However, striking negative correlations between sensation‐seeking and frequency of gambling, and between subjective arousal and frequency were present. Conclusions. Gambling alone is not enough to induce increases in HR levels for female fruit machine gamblers; the experience of winning or the anticipation of that experience is necessary to increase HR levels. In addition sensation‐seeking appears to be negatively associated with this kind of gambling behaviour.
Self‐reported overdose among injecting drug users in London: extent and nature of the problem
Authors: Powis Beverly , Strang John , Griffiths Paul , Taylor Colin , Williamson Sara , Fountain Jane , Gossop Michael
Published: March 2003

Aims. To estimate the extent and nature of overdose and factors associated with overdose among injecting drug users in London. Design. Three hundred and twelve current injecting drug users were recruited and interviewed in community settings by a team of "privileged access interviewers". Measurements. A structured questionnaire was used that covered the following areas: demographic characteristics, drug use, injecting behaviour, sharing practices, severity of drug dependence, experience of overdose, injecting‐related health problems and treatment history. Findings. The results showed that experience of overdose was common (38%). A majority (54%) had witnessed someone else overdose. Overdosing was not a solitary experience; over 80% of subjects who had overdosed had done so in the presence of someone else, but only 27% reported ambulances having been called. Factors found to be associated with overdose were: age at which injecting began; gender (women being more likely to experience overdose); use of alcohol; and polydrug injection. The overall rate of overdosing was one per 6 years of injecting; however, once an individual had an overdose the chance of having another increased. The risk of experiencing a first overdose fell with years of injecting. Conclusions. Harm‐reduction interventions with drug injectors should educate users on the risk factors associated with overdose and actions that should be taken when someone has overdosed. Interventions designed to reduce the risk of overdose may be more effective if they are differentially targeted on drug injectors who have already experienced an overdose.
The cost‐effectiveness of methadone maintenance as a health care intervention
Authors: Barnett Paul G.
Published: March 2003

Aims. Cost‐effectiveness analysis using life‐years of survival as the measure of treatment benefit is widely used in the economic evaluation of health care interventions but has not been applied to substance abuse treatment. The cost‐effectiveness of methadone maintenance was evaluated to demonstrate the feasibility of applying this method to substance abuse treatment. Design. A literature review was undertaken to determine the effect of methadone treatment on the rate of mortality associated with opiate addiction. Information was also obtained on the average cost and duration of treatment. A two‐state Markov model was used to estimate the incremental effect of methadone on the life span and treatment cost of a cohort of 25‐year‐old heroin users. Findings. Providing opiate addicts with access to methadone maintenance has an incremental cost‐effectiveness ratio of $5915 per life‐year gained (that is, for every year of life that is saved by providing methadone to opiate addicts, an additional $5915 in treatment costs are incurred). One‐way sensitivity analysis determined that the ratio was less than $10 000 per‐life year over a wide range of modeling assumptions. Conclusions. The ratio determined for methadone is lower than that of many common medical therapies, and well within the $50 000 threshold for judging cost‐effectiveness. Even if decision makers do not wish use the same ratio that is applied to the general population, this method allows substance abuse treatment enhancements to be compared to improvements in health services offered to individuals with substance abuse disorders. Future work will require information on the impact of methadone treatment on the cost of health care and public programs, the indirect costs incurred by patients, and adjustments to reflect quality of life.