Donelle Howell

Variable and potentially fatal amounts of nicotine in e-cigarette nicotine solutions

Experimental research on electronic cigarettes (e-cigarettes) is sparse. Regulated as tobacco products by the US Food and Drug Administration, e-cigarette safety has not been determined. This enables the sale of e-cigarettes and tobacco-derived nicotine solution to consumers without rigorous safety regulations that would be required if the products were regulated as drug delivery devices .1 As such, despite the recent popularity of e-cigarettes as an alternative to cigarette smoking, consumers currently do not have industry-regulated information on the concentration of e-cigarette solutions or their safety.1 The present study reports the nicotine concentration of several of these solutions. A convenience sample of seven e-cigarette nicotine solutions was analysed. Samples ranged from prepackaged and sealed with concentration levels printed on the labels to blank bottles with hand-written labels with no concentration level, warning …

Disparities in Unmet Need for Mental Health Services in the United States, 1997–2010

OBJECTIVES This study estimated unmet need for mental health services, identified population risk factors related to unmet need, and established baseline data to assess the impact of the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act. METHODS National Health Interview Survey data (1997-2010) were analyzed. RESULTS Unmet need increased from 4.3 million in 1997 to 7.2 million in 2010. Rates in 2010 were about five times higher for uninsured than for privately insured persons. In a multivariate logistic model, likelihood was higher among children (age two to 17), working-age adults (age 18-64), women, uninsured persons, persons with low incomes, in fair or poor health, and with chronic conditions. CONCLUSIONS Unmet need is widespread, particularly among the uninsured. Expansion of coverage under the ACA, in conjunction with federal parity, should improve access, but ongoing monitoring of access is a research and policy priority.

Missing Data in Substance Abuse Treatment Research: Current Methods and Modern Approaches

Two common procedures for the treatment of missing information, listwise deletion and positive urine analysis (UA) imputation (e.g., if the participant fails to provide urine for analysis, then score the UA positive), may result in significant biases during the interpretation of treatment effects. To compare these approaches and to offer a possible alternative, these two procedures were compared to the multiple imputation (MI) procedure with publicly available data from a recent clinical trial. Listwise deletion, single imputation (i.e., positive UA imputation), and MI missing data procedures were used to comparatively examine the effect of two different buprenorphine/naloxone tapering schedules (7- or 28-days) for opioid addiction on the likelihood of a positive UA (Clinical Trial Network 0003; Ling et al., 2009). The listwise deletion of missing data resulted in a nonsignificant effect for the taper while the positive UA imputation procedure resulted in a significant effect, replicating the original findings by Ling et al. (2009). Although the MI procedure also resulted in a significant effect, the effect size was meaningfully smaller and the standard errors meaningfully larger when compared to the positive UA procedure. This study demonstrates that the researcher can obtain markedly different results depending on how the missing data are handled. Missing data theory suggests that listwise deletion and single imputation procedures should not be used to account for missing information, and that MI has advantages with respect to internal and external validity when the assumption of missing at random can be reasonably supported.

Duration Effects in Contingency Management Treatment of Methamphetamine Disorders

The primary aim of this study was to determine whether different durations of contingency management (CM) in conjunction with psychosocial treatment produced different rates of abstinence among methamphetamine dependent individuals. Participants were randomized to one of the four 16-week treatment conditions: standard psychosocial treatment or psychosocial treatment plus one of the three durations of CM (one-month, two-month, or four-month). A total of 118 participants were randomized to the four treatment conditions. There were significant differences across treatment conditions for number of consecutive days of methamphetamine abstinence (p<0.05). These differences were in the hypothesized direction, as participants were more likely to remain abstinent through the 16-week trial as CM duration increased. A significant effect of treatment condition (p<0.05) and time (p<0.05) on abstinence over time was also found. Longer durations of CM were more effective for maintaining methamphetamine abstinence.

Voucher-Based Reinforcement for Alcohol Abstinence Using the Ethyl-Glucuronide Alcohol Biomarker.

This study assessed the effects of a contingency management (CM) intervention for alcohol consumption in 10 alcohol-dependent participants. An ABCA design was used. Vouchers were provided contingent on results of ethyl glucuronide (EtG) urine tests (an alcohol biomarker with a 2-day detection period) and alcohol breath tests during the C phase. The percentage of negative urines was 35% during the first baseline phase, 69% during the C phase, and 20% during the return-to-baseline phase. Results suggest that EtG urine tests may be a feasible method to deliver CM to promote alcohol abstinence.

Investigating reinforcer magnitude and reinforcer delay: a contingency management analog study.

The influence of reinforcer magnitude and reinforcer delay on smoking abstinence was studied using an analog model of contingency management. Participants (N = 103, 74% men) visited our laboratory 3 times daily for 5 days and received money for providing a breath sample that indicated smoking abstinence (carbon monoxide level ≤6 parts per million). Using a factorial design, we assigned participants randomly to 1 of 4 groups that could earn a total of either

Biochemical Marker of Use Is a Better Predictor of Outcomes Than Self‐Report Metrics in a Contingency Management Smoking Cessation Analog Study

207.50 (high-magnitude condition) or

Young adult waterpipe smokers: Smoking behaviors and associated subjective and physiological effects.

70.00 (low-magnitude condition), and received earnings either at each visit (no-delay condition) or in a single lump sum 1 week following the study (delay condition). High-magnitude reinforcement, regardless of delay, was associated with higher rates of abstinence than was low-magnitude reinforcement. High magnitude of reinforcement provided immediately but in incremental amounts was associated with longer intervals to relapse during treatment in comparison with high-magnitude reinforcement provided in a single lump sum after a delay. Low rates of responding in the low-magnitude conditions made interpretation of the impact of delay in those conditions difficult. These findings further demonstrate that high magnitude of reinforcement results in better outcomes than does low magnitude of reinforcement, and that a delay to reinforcement can be detrimental-even when a high magnitude of reinforcement is provided.

Longitudinal missing data strategies for substance use clinical trials using generalized estimating equations: an example with a buprenorphine trial.

BACKGROUND AND OBJECTIVES This investigation compared cotinine (primary metabolite of nicotine) at study intake to self-report metrics (e.g., Fagerstrom Test of Nicotine Dependence [FTND]) and assessed their relative ability to predict smoking outcomes. METHODS We used data from an analog model of contingency management for cigarette smoking. Non-treatment seeking participants (N = 103) could earn money in exchange for provision of a negative carbon monoxide (CO) sample indicating smoking abstinence, but were otherwise not motivated to quit. We used intake cotinine, FTND, percent of friends who smoke, and years smoked to predict longitudinal CO and attendance, time-to-first positive CO submission, and additional cross-sectional outcomes. RESULTS Intake cotinine was consistently predictive (p < .05) of all outcomes (e.g., longitudinal CO and attendance, 100% abstinence, time-to-first positive CO sample), while years smoked was the only self-report metric that demonstrated any predictive ability. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Cotinine could be more informative for tailoring behavioral treatments compared to self-report measures.

Depression and Pain Interference Among Patients With Chronic Pain After ED Encounters

INTRODUCTION The purpose of this pilot study was to investigate smoking behaviors and subjective and physiological effects of nicotine on young adult occasional waterpipe smokers. METHODS This study utilized a repeated-measures design that included one repeated factor for condition (nicotine and non-nicotine). For each participant, the sequencing of the repeated factor was assigned using random allocation. The two nicotine conditions were nicotine (0.75 g) and non-nicotine (0 g placebo) tobacco. Over the course of two weeks, twenty-two participants completed subjective (Acute Subjective Effects of Nicotine) and physiological (blood pressure, heart rate, and CO level) measures. Additional measures (QSU and MNWS-R) were used to assess for withdrawal symptoms. SAMPLE The participants (n=22) were young adults (23 ± 3.1years); 71% smoked waterpipe once a month in the past year and 29% smoked waterpipe 1-2 times per week. In addition, 60% reported sharing their waterpipe with friends while smoking. None of the participants reported using any other forms of tobacco products. RESULTS Under the nicotine condition, participants tended to smoke longer (i.e. smoking duration, p=0.004), take more puffs (p=0.03), take shorter puffs (p=0.03), and inhale less volume with each puff (p=0.02). The repeated measures analysis of the factor headrush revealed an effect of the nicotine condition (F=9.69, p<0.001, partial η(2)=0.31) and time (F=8.17, p=0.02, partial η(2)=0.30). Heart rate increased significantly across the nicotine condition (F=7.92, p=0.01, partial η(2)=0.31) and over time (F=12.64, p=0.01, partial η(2)=0.41). CONCLUSIONS This study demonstrates how differences between nicotine and non-nicotine waterpipe smoking are associated with changes in smoking behaviors, experiencing a headrush and an increase in heart rate.