Substantiated
The Demand for Cigarettes as Derived from the Demand for Weight Control
John Cawley & Stephanie von Hinke Kessler Scholder
NBER Working Paper, February 2013
Abstract:
We provide new evidence on the extent to which the demand for cigarettes is derived from the demand for weight control (i.e. weight loss or avoidance of weight gain). We utilize nationally representative data that provide the most direct evidence to date on this question: individuals are directly asked whether they smoke to control their weight. We find that, among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight. This practice is significantly more common among youths who describe themselves as too fat than those who describe themselves as about the right weight. The derived demand for cigarettes has important implications for tax policy. Under reasonable assumptions, the demand for cigarettes is less price elastic among those who smoke for weight control. Thus, taxes on cigarettes will result in less behavior change (but more revenue collection and less deadweight loss) among those for whom the demand for cigarettes is a derived demand. Public health efforts to reduce smoking initiation and encourage cessation may wish to design campaigns to alter the derived nature of cigarette demand, especially among adolescent girls.
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Less Drinking, Yet More Problems: Understanding African American Drinking and Related Problems
Tamika Zapolski et al.
Psychological Bulletin, forthcoming
Abstract:
Researchers have found that, compared to European Americans, African Americans report later initiation of drinking, lower rates of use, and lower levels of use across almost all age groups. Nevertheless, African Americans also have higher levels of alcohol problems than European Americans. After reviewing current data regarding these trends, we provide a theory to understand this apparent paradox as well as to understand variability in risk among African Americans. Certain factors appear to operate as both protective factors against heavy use and risk factors for negative consequences from use. For example, African American culture is characterized by norms against heavy alcohol use or intoxication, which protects against heavy use but also provides within-group social disapproval when use does occur. African Americans are more likely to encounter legal problems from drinking than European Americans, even at the same levels of consumption, perhaps thus resulting in reduced consumption but more problems from consumption. There appears to be one particular group of African Americans, low-income African American men, who are at the highest risk for alcoholism and related problems. We theorize that this effect is due to the complex interaction of residential discrimination, racism, age of drinking, and lack of available standard life reinforcers (e.g., stable employment and financial stability). Further empirical research will be needed to test our theories and otherwise move this important field forward. A focus on within-group variation in drinking patterns and problems is necessary. We suggest several new avenues of inquiry.
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The Economic Effect of Banning Smoking in Wisconsin's Bars and Restaurants
Joshua Glonek
Contemporary Economic Policy, forthcoming
Abstract:
There is much debate as to whether or not the passage of no-smoking laws has adverse consequences for businesses in the hospitality industry. In 2010, the state of Wisconsin implemented a law that banned smoking in all public places. Using a panel of county-level employment data, I examine the relationship between the implementation of smoking bans in Wisconsin and the subsequent changes in bar and restaurant employment. Using variation in the timing of bans that occurred as a result of four counties that implemented local bans prior to the July 2010 statewide ban, I conduct a difference-in-differences analysis to measure the average treatment effect of implementing a smoking ban in Wisconsin. I find that restaurant employment is not affected and that bar employment is significantly reduced as a result of the smoking ban. I also find that counties with higher levels of smoking prevalence see greater reductions in bar employment when a smoking ban is enacted. Back-of-the-envelope estimates suggest that even though there are employment losses, the benefits of the smoking ban outweigh the costs.
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Paul Frijters et al.
Social Science & Medicine, forthcoming
Abstract:
There is considerable policy interest in the impact of macroeconomic conditions on health-related behaviours and outcomes. This paper sheds new light on this issue by exploring the relationship between macroeconomic conditions and an indicator of problem drinking derived from state-level data on alcoholism-related Google searches conducted in the US over the period 2004-2011. We find the current recessionary period coincided with an almost 20% increase in alcoholism-related searches. Controlling for state and time-effects, a 5% rise in unemployment is followed in the next 12 months by an approximate 15% increase in searches. The use of Internet searches to inform on health-related behaviours and outcomes is in its infancy; but we suggest that the data provides important real-time information for policy-makers and can help overcome the under-reporting in surveys of sensitive information.
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Problematic drinking and physiological responses among female college students
Stephanie Wemm et al.
Alcohol, March 2013, Pages 149-157
Abstract:
Problematic drinking is a widespread problem among college students, and can contribute to alcohol dependence during later adulthood, particularly among females. The current study assessed vulnerability for alcohol-related consequences by comparing self-reported drinking with coping styles and physiological and behavioral stress responses during a challenging task. Cardiovascular measurements and saliva samples were taken from 88 female students at the beginning of the experiment and after the task. Hypothalamic-pituitary-adrenal (HPA) activity was measured by assessing cortisol and dehydroepiandrosterone (DHEA) salivary levels. The behavioral task consisted of a set of three anagrams of increasing difficulty, the last of which had no possible solution, to test the distress tolerance of the participants. Results showed that the majority of participants (70%) reported drinking in the six months prior to data collection, most of whom reported at least one incident of binge drinking. Excessive alcohol use was related to an impaired physiological response to stress during the impossible task. College students who drank to cope with stress had significantly higher basal levels of cortisol and DHEA, an indication of HPA axis over-regulation, while their stress response remained remarkably flat. Self-reported consequences of drinking were related to motives for drinking and lower DHEA levels. Regression analysis indicated that higher cortisol levels mediated the relationship between motives for drinking and problematic drinking.
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James Lightwood & Stanton Glantz
PLoS ONE, February 2013
Background: Previous research has shown that tobacco control funding in California has reduced per capita cigarette consumption and per capita healthcare expenditures. This paper refines our earlier model by estimating the effect of California tobacco control funding on current smoking prevalence and cigarette consumption per smoker and the effect of prevalence and consumption on per capita healthcare expenditures. The results are used to calculate new estimates of the effect of the California Tobacco Program.
Methodology/Principal Findings: Using state-specific aggregate data, current smoking prevalence and cigarette consumption per smoker are modeled as functions of cumulative California and control states' per capita tobacco control funding, cigarette price, and per capita income. Per capita healthcare expenditures are modeled as a function of prevalence of current smoking, cigarette consumption per smoker, and per capita income. One additional dollar of cumulative per capita tobacco control funding is associated with reduction in current smoking prevalence of 0.0497 (SE.00347) percentage points and current smoker cigarette consumption of 1.39 (SE.132) packs per smoker per year. Reductions of one percentage point in current smoking prevalence and one pack smoked per smoker are associated with $35.4 (SE $9.85) and $3.14 (SE.786) reductions in per capita healthcare expenditure, respectively (2010 dollars), using the National Income and Product Accounts (NIPA) measure of healthcare spending.
Conclusions/Significance: Between FY 1989 and 2008 the California Tobacco Program cost $2.4 billion and led to cumulative NIPA healthcare expenditure savings of $134 (SE $30.5) billion.
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"They're Going to Die Anyway": Smoking Shelters at Veterans' Facilities
Naphtali Offen, Elizabeth Smith & Ruth Malone
American Journal of Public Health, April 2013, Pages 604-612
Abstract:
Military personnel and veterans are disadvantaged by inadequate tobacco control policies. We conducted a case study of a Department of Veterans Affairs (VA) effort to disallow smoking and tobacco sales in VA facilities. Despite strong VA support, the tobacco industry created a public relations-focused grassroots veterans' opposition group, eventually pushing the US Congress to pass a law requiring smoking areas in every VA health facility. Arguing that it would be unpatriotic to deny veterans this "freedom" they had ostensibly fought for and that banning smoking could even harm veterans' health, industry consultants exploited veterans' organizations to protect tobacco industry profits. Civilian public health advocates should collaborate with veterans to expose the industry's manipulation, reframe the debate, and repeal the law.
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Liam Delaney, Arie Kapteyn & James Smith
Review of Economics of the Household, March 2013, Pages 1-27
Abstract:
This paper studies determinants of drinking behavior and formation of subjective thresholds of acceptable drinking behavior using a sample of students in a major Irish University. We find evidence of strong associations between amounts of alcohol students consume and drinking of their fathers and older siblings. In contrast, we find little evidence of impacts of other non-drinking aspects of family background on students' drinking. Parental and older sibling drinking appears to affect subjective attitudes of students towards what constitutes problem drinking behavior. We investigated historical origins of drinking behavior including the role of the Church, English cultural influences, the importance of the brewery and distilling industry, and the influence of weather. We find relatively strong influences of the Catholic Church and English colonial settlement patterns on Irish drinking patterns but little influence of Irish weather. Historical licensing restrictions on the number of pubs and off-license establishments also appear to matter.
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Jennifer Kam & Ashley Middleton
Human Communication Research, April 2013, Pages 208-229
Abstract:
Using primary socialization theory and theory of planned behavior, this study examined how targeted parent-child communication against substance use and parents' references to the negative consequences of their own past substance use (from the youth's perspective) directly and indirectly relate to Latino and European American youth's external norms (e.g., injunctive and descriptive), internal beliefs (e.g., personal norms, attitudes, and refusal efficacy), and substance use. This study used cross-sectional survey data from 253 Latino and 308 European American (N = 561) 6th- to 8th-grade students. Targeted parent-child communication was related to higher levels of antisubstance-use perceptions, whereas parents' references to their own past use was related to lower levels of antisubstance-use perceptions. Ethnic differences emerged with respect to specific mediators.
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Yvonne Terry-McElrath, Patrick O'Malley & Lloyd Johnston
Journal of Adolescent Health, forthcoming
Purpose: This study uses 14 years of data from nationally representative samples of U.S. middle and high school students in the Monitoring the Future study to examine associations between school student drug testing (SDT), substance use, and participation in extracurricular activities.
Methods: Analyses use questionnaire data collected from 1998 to 2011 from 89,575 students in 883 middle schools and 157,400 students in 1,463 high schools to examine: (1) the current prevalence of SDT; (2) SDT trends over time; (3) associations between substance use and SDT type, volume, or duration among the general student population or students participating in activities subject to testing; (4) associations between students' beliefs/attitudes about marijuana use and SDT; and (5) associations between extracurricular participation rates and SDT.
Results: Moderately lower marijuana use was associated with any random testing of the general high school student population and for SDT of middle and high school sub-populations specifically subject to testing (athletes or participants in nonathletic extracurricular activities). However, SDT generally was associated with increased use of illicit drugs other than marijuana.
Conclusions: Because the study design is observational and the data are cross-sectional, no strong causal conclusions can be drawn. However, there is evidence of lower marijuana use in the presence of SDT, and evidence of higher use of illicit drugs other than marijuana. Until further research can clarify the apparent opposing associations, schools should approach SDT with caution.
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Adolescent parties and substance use: A situational approach to peer influence
Owen Gallupe & Martin Bouchard
Journal of Criminal Justice, May-June 2013, Pages 162-171
Purpose: This study takes a situational approach to testing criminogenic peer influence effects on substance use by examining audience characteristics at the last two parties that adolescents attended. We examine the applicability of situational approaches to social learning theory and symbolic interactionist perspectives on criminogenic peer group effects.
Methods: Using a sample of adolescents in a large Canadian city, we test the cross-sectional correlates of substance use at parties (n = 775) as well as how changes in audience characteristics relate to changes in substance use from one party to the next (n = 361).
Results: We found that higher levels of substance use are more likely to occur in smaller group settings. But having more friends use alcohol/cannabis and in larger amounts is strongly related to greater personal substance use. Further, it was found that increases in the amount that friends drink/smoke from one party to the next is related to increases in personal substance use.
Conclusions: There appears to be little support for a generalized audience effect; what is important is the behavior of peers in specific situations. Findings suggest that integrating a situational audience perspective provides valuable insights into peer influence dynamics.
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State Cigarette Excise Tax, Secondhand Smoke Exposure, and Periodontitis in US Nonsmokers
Anne Sanders & Gary Slade
American Journal of Public Health, April 2013, Pages 740-746
Objectives: We assessed the relationship of state cigarette excise tax with cigarette sales, secondhand smoke (SHS) exposure, and periodontitis among US lifetime nonsmokers.
Methods: Cigarette excise tax and per capita sales data from 1983 to 1998 were obtained for 50 states and the District of Columbia. Periodontal data were analyzed for 3137 adults in 28 states from 3 National Health and Nutrition Examination Survey cycles (1999-2004). Measures of periodontal pocket depth and attachment level were used to classify people with moderate or severe periodontitis. SHS exposure was classified according to gender- or race/ethnicity-specific thresholds of serum cotinine concentration. Statistical analysis adjusted for the complex survey design.
Results: For each additional $0.10 in excise tax, predicted sales decreased by 0.74 packs per person per month and adjusted odds of moderate or severe periodontitis decreased 22% (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.62, 0.97). For each pack sold per person per month, adjusted odds of SHS exposure increased 28% (95% CI = 1.17, 1.40) and adjusted odds of periodontitis increased 15% (95% CI = 1.03, 1.29). Odds of periodontitis for those exposed to SHS were elevated 2-fold relative to those who were unexposed (OR = 2.03; 95% CI = 1.30, 3.20).
Conclusions: Cigarette excise tax may protect nonsmokers against periodontitis.
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James Cunningham et al.
Drug and Alcohol Dependence, 1 April 2013, Pages 125-136
Background: This study examines whether Mexico's controls on ephedrine and pseudoephedrine, the two precursor chemicals that yield the most potent form of methamphetamine, d-methamphetamine, impacted the prevalence/availability of less potent types of methamphetamine in the United States-types associated with the alternative precursor chemical P2P.
Method: Using ARIMA-intervention time series analysis of monthly drug exhibits (a prevalence/availability indicator) from the System to Retrieve Information from Drug Evidence (STRIDE), we tested whether Mexico's controls, which began in 2005, were associated with growth/decline in d-methamphetamine and growth/decline in P2P-associated, less potent l-methamphetamine, racemic methamphetamine (a 50:50 ratio of d- and l-isomers), and mixed isomer methamphetamine (an unequal ratio of d- and l-isomers). Heroin, cocaine and marijuana exhibits were used for quasi-control (01/2000-04/2011).
Results: Mixed-isomer exhibits constituted about 4% of the methamphetamine exhibits before Mexico's controls, then rose sharply in association with them and remained elevated, constituting about 37% of methamphetamine exhibits in 2010. d-Methamphetamine exhibits dropped sharply; l-methamphetamine and racemic methamphetamine exhibits had small rises. d-Methamphetamine exhibits partially recovered in the US West, but little recovery occurred in the US Central/South. Quasi-control series were generally unaffected.
Conclusion: The US methamphetamine market changed. Widespread emergence of less potent methamphetamine occurred in conjunction with Mexico's controls. And prevalence/availability of the most potent type of the drug, d-methamphetamine, declined, a partial recovery in the West notwithstanding. Granting that lower potency drugs typically engender less dependence and attendant problems, these findings suggest that, following Mexico's controls, the potential harm of a sizeable amount of the US methamphetamine supply decreased.
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Genetic Sensitivity to Peer Behaviors: 5HTTLPR, Smoking, and Alcohol Consumption
Jonathan Daw et al.
Journal of Health and Social Behavior, March 2013, Pages 92-108
Abstract:
We investigate whether the serotonin transporter-linked polymorphic region (5HTTLPR), a gene associated with environmental sensitivity, moderates the association between smoking and drinking patterns at adolescents' schools and their corresponding risk for smoking and drinking themselves. Drawing on the school-based design of the National Longitudinal Study of Adolescent Health in conjunction with molecular genetic data for roughly 15,000 respondents (including over 2,000 sibling pairs), we show that adolescents smoke more cigarettes and consume more alcohol when attending schools with elevated rates of tobacco and alcohol use. More important, an individual's susceptibility to school-level patterns of smoking or drinking is conditional on the number of short alleles he or she has in 5HTTLPR. Overall, the findings demonstrate the utility of the differential susceptibility framework for medical sociology by suggesting that health behaviors reflect interactions between genetic factors and the prevalence of these behaviors in a person's context.
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Kevin Conway et al.
Journal of Adolescent Health, forthcoming
Purpose: The current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students.
Methods: A nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524).
Results: Past-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms.
Conclusions: The findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral.
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Age, period, and cohort effects in heavy episodic drinking in the US from 1985 to 2009
Katherine Keyes & Richard Miech
Drug and Alcohol Dependence, forthcoming
Background: Evaluating population-level patterns of heavy episodic drinking by age, period, and cohort is critical to understanding population-level influences on rates over time and to forecasting future trends for public health planning efforts. The present study examined trends in heavy episodic drinking in the US from 1985 through 2009 in a nationally representative sample that included adolescents and adults.
Methods: Data are drawn from repeated cross-sectional surveys of US households as part of the National Household Survey on Drug Use and Health conducted in 1985, 1988, and annually from 1990 though 2009, inclusive (N = 809,281). Heavy episodic drinking was defined as any instance of consuming five or more drinks in one sitting in the past month. Age-period-cohort models were identified using the Intrinsic Estimator algorithm.
Results: Heavy episodic drinking is decreasing in the US among adolescents and young adults, with the most recently born cohorts (born in the 1990s) at lower odds of heavy episodic drinking compared with cohorts born in the 1960s, 1970s, and 1980s. Results were consistent across sex and race/ethnicity, with the exception that the decrease is not apparent among Hispanics.
Conclusions: These data are promising in that young cohorts appear to be reducing heavy episodic drinking, however the lack of decrease among Hispanics suggests targeted intervention and prevention as well as increased surveillance are necessary.
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Where to Snuff the Puff? Relative Effectiveness of U.S. Smoking Control Policies
Rajeev Goel
Journal of Socio-Economics, forthcoming
Abstract:
This research examines the relative effectiveness of various smoking control initiatives in lowering U.S. smoking prevalence. The main contribution lies in considering alternate state-level restrictions on retailers as well as smokers. Greater restrictions on smokers lower smoking prevalence, while those directed at retailers are largely ineffective. Upon disaggregation, territorial restrictions banning smoking in restaurants are found to be effective, whereas those in workplaces and in bars do not appreciably lower smoking prevalence. We also find some gender differences in the effectiveness of smoking restrictions. These findings are generally robust to alternate model specifications.
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Brand-Specific Consumption of Alcohol Among Underage Youth in the United States
Michael Siegel et al.
Alcoholism, forthcoming
Background: Little is known about brand-specific alcohol consumption among underage youth, as existing information is collected at the level of alcoholic beverage type. This study identifies the alcohol brands consumed by a nationally representative sample of underage youth in the United States.
Methods: We obtained a national sample of 1,032 underage youth, aged 13 to 20, using a pre-recruited Internet panel maintained by Knowledge Networks. Youth aged 18 to 20 were recruited directly from the panel via email invitation. Teens aged 13 to 17 were identified by asking adult panelists to identify a member of their household. The survey assessed the past 30-day consumption of 898 brands of alcohol among 16 alcoholic beverage types, including the frequency and amount of each brand consumed in the past 30 days. Market share for a given brand was calculated by dividing the total number of drinks for that brand in the past 30 days across the entire sample by the total number of drinks for all identified brands.
Results: The alcohol brands with highest prevalence of past 30-day consumption were Bud Light (27.9%, 95% confidence interval [CI] 23.3 to 32.4%), Smirnoff malt beverages (17.0%, 95% CI 12.9 to 21.1%), and Budweiser (14.6%, 95% CI 11.0 to 18.3%). Brand market share was concentrated in a relatively small number of brands, with the top 25 brands accounting for nearly half of all market shares.
Conclusions: Underage youth alcohol consumption, although spread out over several alcoholic beverage types, is concentrated among a relatively small number of alcohol brands. This finding has important implications for alcohol research, practice, and policy.
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Shannon Kenney, Joseph LaBrie & Andrew Lac
Journal of Health Communication, forthcoming
Abstract:
Of the alcohol-related risks faced by college students, it is arguable that none presents a greater public health hazard than driving after drinking (DAD). The present study examined the extent to which students' injunctive misperceptions toward DAD predicted the likelihood to engage in DAD and how this relation was mediated by self-approval of DAD. Participants were 2,848 college students (59.1% female, 64.6% Caucasian) from two U.S. West Coast universities who completed confidential web-based surveys assessing DAD beliefs and behaviors. Results revealed that respondents tended to overestimate their peers' approval toward DAD. Moreover, the subgroups likely to engage in DAD - men, 21+ years of age, Greek affiliated students, Caucasians, students with a family history of alcohol abuse - were also more likely to misperceive (i.e., overestimate) their peers' level of approval toward DAD. Using binary logistic regression analyses, self-approval of DAD emerged as an important statistical mediator in the relation between misperception of typical student approval toward DAD and engagement in DAD. Results point to the considerable role injunctive peer misperceptions may play in the pathways leading to drinking-driving risk. These findings provide preliminary support for DAD-specific social normative interventions, either complementing or supplementing existing alcohol interventions. By targeting high-risk student subgroups and communicating accurate drinking-driving norms, these proposed interventions have the potential to reduce self-approval and incidence of DAD.
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Catherine Goodall, Michael Slater & Teresa Myers
Journal of Communication, forthcoming
Abstract:
An experiment investigated emotional reactions to news on policy support. Stimuli were selected from a nationally representative sample of local crime/accident news, and a nationally representative online panel of U.S. adults. Stories were manipulated to mention or not mention the role of alcohol. Anger elicited by stories increased blame of individuals, whereas fear increased consideration of contributing societal factors. Mention of alcohol increased likelihood of different emotional responses dominating - greater anger when alcohol was mentioned and greater fear when not mentioned. Such emotions influence policy support: enforcement of existing laws controlling individual behavior in addition to new laws when anger predominated, and, indirectly, support for new laws changing social context in which alcohol is promoted and sold when fear predominated.
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Caroline Davis & Natalie Loxton
Addictive Behaviors, forthcoming
Abstract:
The purpose of this study was to examine reward-related genetic risk for addictive behaviours in a healthy community sample (n = 217) of men and women. We tested a mediation model predicting that a quantitative multilocus genetic profile score - reflecting the additive effects of alleles known to confer relatively increased dopamine signaling in the ventral striatum - would relate positively to a composite measure of addictive behaviours, and that this association would be mediated by personality traits consistently associated with addiction disorders. Our model was strongly supported by the data, and accounted for 24% of the variance in addictive behaviours. These data suggest that brain reward processes tend to exert their influence on addiction risk by their role in the development of relatively stable personality traits associated with addictive behaviours.
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E. Fuller-Thomson, J. Filippelli & C.A. Lue-Crisostomo
Public Health, forthcoming
Objective: To investigate gender-specific differences between individual adverse childhood experiences (ACEs) and smoking behaviours in adulthood; while controlling for several known risk factors, including adult health behaviours, adult mental health, adult socio-economic indicators and social support.
Methods: Data were obtained from the 2010 Behavioral Risk Factor Surveillance System. The sample included 19,356 individuals (11,506 females and 7850 males) aged ≥18 years who were asked questions about their ACEs. Using logistic regression, the independent factors associated with ever smoking and current smoking were determined.
Results: Childhood physical abuse was associated with ever smoking for both males and females. Neither sexual abuse nor verbal abuse were significantly associated with ever smoking for males, but they were for females [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.13-1.63 and OR 1.14, 95% CI 1.02-1.27, respectively]. For both genders, childhood exposure to parental separation or divorce, household drug abuse or household problem drinking, were significantly associated with ever smoking.
Conclusion: These findings underscore the need for future research that investigates gender-specific differences, and the possible mechanisms, linking individual ACEs and smoking behaviours.
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Relationship of opioid prescription sales and overdoses, North Carolina
F. Modarai et al.
Drug and Alcohol Dependence, forthcoming
Background: In the United States, fatal drug overdoses have tripled since 1991. This escalation in deaths is believed to be driven primarily by prescription opioid medications. This investigation compared trends and patterns in sales of opioids, opioid drug overdoses treated in emergency departments (EDs), and unintentional overdose deaths in North Carolina (NC).
Methods: Our ecological study compared rates of opioid sales, opioid related ED overdoses, and unintentional drug overdose deaths in NC. Annual sales data, provided by the Drug Enforcement Administration, for select opioids were converted into morphine equivalents and aggregated by zip code. These opioid drug sales rates were trended from 1997 to 2010. In addition, opioid sales were correlated and compared to opioid related ED visits, which came from a Centers for Disease Control and Prevention syndromic surveillance system, and unintentional overdose deaths, which came from NC Vital Statistics, from 2008 to 2010. Finally, spatial cluster analysis was performed and rates were mapped by zip code in 2010.
Results: Opioid sales increased substantially from 1997 to 2010. From 2008 to 2010, the quarterly rates of opioid drug overdoses treated in EDs and opioid sales correlated (r = 0.68, p = 0.02). Specific regions of the state, particularly in the southern and western corners, had both high rates of prescription opioid sales and overdoses.
Conclusions: Temporal trends in sales of prescription opioids correlate with trends in opioid related ED visits. The spatial correlation of opioid sales with ED visit rates shows that opioid sales data may be a timely way to identify high-risk communities in the absence of timely ED data.
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The CRHR1 Gene, Trauma Exposure, And Alcoholism Risk: A Test Of G × E Effects
Lara Ray et al.
Genes, Brain and Behavior, forthcoming
Background: The corticotropin-releasing hormone type I receptor (CRHR1) gene has been implicated in the liability for neuropsychiatric disorders, particularly under conditions of stress. Based on the hypothesized effects of CRHR1 variation on stress reactivity, measures of adulthood traumatic stress exposure were analyzed for their interaction with CRHR1 haplotypes and SNPs in predicting the risk for alcoholism.
Method: Phenotypic data on 2,533 non-related Caucasian individuals (1167 alcoholics and 1366 controls) were culled from the publically available Study of Addiction: Genetics and Environment (SAGE) genome-wide association study (GWAS). Genotypes were available for 19 tag SNPs. Logistic regression models examined the interaction between CRHR1 haplotypes / SNPs and adulthood traumatic stress exposure in predicting alcoholism risk.
Results: Two haplotype blocks spanned CRHR1. Haplotype analyses identified one haplotype in the proximal block 1 (p = 0.029) and two haplotypes in the distal block 2 (p = 0.026, 0.042) that showed nominally significant (corrected p < .025) genotype × traumatic stress interactive effects on the likelihood of developing alcoholism. The block 1 haplotype effect was driven by SNPs rs110402 (p = 0.019) and rs242924 (p = 0.019). In block 2, rs17689966 (p = 0.018) showed significant, and rs173365 (p = 0.026) showed nominally significant, gene × environment (G x E) effects on alcoholism status.
Conclusions: This study extends the literature on the interplay between CRHR1 variation and alcoholism, in the context of exposure to traumatic stress. These findings are consistent with the hypothesized role of the extra hypothalamic CRF system dysregulation in the initiation and maintenance of alcoholism. Molecular and experimental studies are needed to more fully understand the mechanisms of risk and protection conferred by genetic variation at the identified loci.
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Childhood Maltreatment Affects the Serotonergic System in Male Alcohol-Dependent Individuals
Kristina Berglund et al.
Alcoholism, forthcoming
Background: Reduced central serotonergic neurotransmission has been demonstrated in individuals with excessive alcohol consumption and/or alcohol dependence. Childhood maltreatment has also been found to have a negative impact on central serotonergic neurotransmission. The aim of this study was to evaluate the impact of childhood maltreatment on central serotonergic dysfunction in alcohol-dependent individuals.
Methods: Adult men with a diagnosis of alcohol dependence (n = 18) were recruited from outpatient treatment units for alcoholism. Central serotonergic neurotransmission was assessed by a neuroendocrine method, that is, the prolactin (PRL) response to the selective 5-HT reuptake inhibitor citalopram. Childhood maltreatment was assessed retrospectively by the Childhood Trauma Questionnaire.
Results: Alcohol-dependent individuals with childhood experience of emotional abuse had significantly lower PRL response compared with those without such abuse (3 ± 5 and 64 ± 24 mU/l, respectively; t = 6.51, p < 0.001). Among those who reported childhood emotional abuse, 4 of 7 individuals had flat PRL responses in comparison with none in those with no report of such abuse (p < 0.01).
Conclusions: This is the first study to show that self-reported childhood maltreatment, in particular emotional abuse, in male alcohol-dependent individuals is associated with a quite dramatic (more than 90%) reduction in central serotonergic neurotransmission. It should, however, be noted that the number of individuals is relatively small, and the results should therefore be considered as preliminary.