JongSerl Chun

Smoking Prevalence in Addiction Treatment: A Review

INTRODUCTION This review explores whether smoking prevalence in addiction treatment samples exceeds that shown in epidemiological data for persons with alcohol or other drug use disorders and whether smoking may have decreased over time in the addiction treatment population as it has done in the general population. METHODS English language papers published between 1987 and 2009 were searched electronically. Forty papers reporting smoking prevalence for addiction treatment samples in the United States were identified, and key predictor variables were abstracted. Random logistic models were used to assess relationships between each individual predictor (year, treatment modality, primary drug treated, government status, and public/private funding status) and smoking prevalence. RESULTS The lowest smoking prevalence aggregated for studies reported in any single year was 65%, well above epidemiological estimates reported among those with alcohol use and drug use disorders. The odds of smoking were higher in methadone maintenance programs (odds ratio [OR] = 2.25, CI = 1.08, 4.68) as compared with outpatient programs. No other variables in the model were significant. Reanalysis omitting recent studies that may represent outliers or confounding with type of treatment showed a small but significant decrease in smoking over time (OR = 0.9891, CI = 0.9888, 0.9893). CONCLUSIONS The very high smoking rates reported in addiction treatment samples warrant significant, organized, and systemic response from addiction treatment systems, from agencies that fund and regulate those systems, and from agencies concerned with tobacco control.

An international systematic review of smoking prevalence in addiction treatment.

AIMS Smoking prevalence is higher among people enrolled in addiction treatment compared with the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally. METHODS PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation and substance use disorders using and/or Boolean connectors. For 4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies, collectively comprising 37,364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated and smoking prevalence. RESULTS The random-effect pooled estimate of smoking across people in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%). The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates were higher in programs treating opiate use compared with alcohol use [odds ratio (OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs (OR = 1.42, CI = 1.19, 1.68). CONCLUSIONS Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder.

Gender Differences in Factors Influencing Smoking, Drinking, and Their Co-occurrence among Adolescents in South Korea

INTRODUCTION This study aimed to examine gender differences in the influence of social, attitudinal, and intrapersonal factors on the onset of smoking, drinking, and the co-occurrence of tobacco and alcohol use among adolescents in South Korea. METHODS Using time-dependent Cox regression, the study analyzed the Korean Youth Panel Study conducted by the Korean National Youth Policy Institute. The study sample was middle-school second-graders (n = 3,188) in South Korea. RESULTS This study found gender differences between Korean male and female adolescents in models of smoking and alcohol uptake; the co-occurrence model was identical, however. At first, parental supervision, attachment to friends, drinking friends, self-control, and aggression were common factors in the onset of drinking among Korean adolescents. Stress was shown to be significantly correlated with the onset of male adolescent drinking, whereas family income was a significant factor just for females. In the smoking model, attachment to friends, smoking friends, stigma, and self-control were identified as common factors related to the onset of smoking in both male and female adolescents. Attachment to parents was found to be a significant factor for male adolescents and aggression for females. CONCLUSIONS The study findings indicate influences on the commencement of smoking, drinking, and concurrent tobacco and alcohol use among Korean male and female adolescents. Culturally sensitive interventions focusing on common risk factors with several differentiated strategies for both boys and girls should be developed and provided for Korean adolescents.

Drug Treatment Outcomes for Persons on Waiting Lists

This study examined treatment access and outcomes for persons placed on drug abuse treatment waiting lists. Participants (n = 170) were recruited when they entered either a methadone detoxification program or a day treatment program, and were waiting for methadone maintenance or residential treatment, respectively. Participants were interviewed at baseline and 2-months follow-up. Excluding the index treatment episode, 73% received some treatment during the follow-up period. Mixed effects regression was used to compare short-term outcomes for clients who did and did not enter treatment following the index episode. We found increased drug problems, over time, for all participants. Those enrolled in treatment at follow-up reported higher employment problems (collapsed across time) compared with those not in treatment. Last, participants enrolled in any subsequent treatment showed a decrease in psychiatric problems over time, while those not enrolled in subsequent treatment showed an increase in psychiatric problems. Participants who entered treatment within 60 days after being placed on a waiting list showed improvement on psychiatric measures but not on substance abuse measures.

Co‐occurring Patterns of Smoking and Alcohol Consumption among Korean Adolescents

This study seeks to assess the transition probabilities between smoking and alcohol consumption trajectories for ages 13-17 using data from the Korea Youth Panel Survey (KYPS). Four smoking trajectories were identified-noninitiator, late-onsetter, experimenter, and escalator. Similarly, four alcohol consumption trajectories were identified-noninitiator, late-onsetter, experimenter, and chronic user. Those in the chronic group of alcohol consumption were most likely to be smokers. Those who fell into a particular group for use of one substance were most likely to fall into the corresponding group for use of the other substance. Implications for smoking and alcohol prevention are discussed.

Conceptualizing Stress and Coping Strategies of Korean Social Work Students in the United States: A Concept Mapping Application.

The number of Asian international students pursuing graduate degrees in social work in the U.S. has increased dramatically in recent years, especially among Koreans. Despite the growth and the need for culturally competent practices in higher education, no research has been devoted to the adjustment problems of this population. This study is the first of its kind in exploring stress and coping strategies of Korean international students in graduate social work education. Concept mapping revealed five major clusters of stressors: academic problems, financial difficulties, cultural barriers, psychological problems, and family concerns. Five major coping strategies emerged as well: psychological coping, physical coping, problem solving, social support, and entertainment. Social work schools and departments should demonstrate cultural competence with this population by providing support services to help these students cope successfully with their new environment.

Cigarette Smoking Among Opioid-Dependent Clients in a Therapeutic Community

This study examines smoking behavior in a sample of 231 opioid-dependent clients entering therapeutic community treatment, and investigates the relationship between smoking behavior and drug treatment outcomes. We applied regression analyses for selected Addiction Severity Index composites (alcohol, drug, medical, psychiatric), including factors for smoking (number of cigarettes per day, expired-air carbon monoxide level, nicotine dependence), time (baseline, 6 and 12-month), and smoking-by-time interaction. This study confirmed a high smoking prevalence (95%) among opioid users. Among participants interviewed at all time points (n = 206), 13% shifted from smoking to non-smoking status at some time after admission. Participants who reported a greater number of cigarettes were more likely to report higher drug severity at any time point.

Examining the Effects of Parental Influence on Adolescent Smoking Behaviors: A Multilevel Analysis of the Global School-Based Student Health Survey (2003–2011)

INTRODUCTION Based on a large cross-national dataset, we investigated the role of parental smoking (a risk factor) and parental supervision (a protective factor) on the frequency of smoking by youths in resource-poor countries. In addition, we tested for cross-level interactions between these two predictors and national wealth on the outcome variable. METHODS Pooled cross-sectional data from the Global School-based Student Health Survey (2003-2011) were analyzed, which consists of 58956 students in 31 countries. Hierarchical linear models were estimated to examine the associations between the two parental influence variables and adolescent smoking. RESULTS Among the control variables, age, gender (male), the experience of being bullied, frequency of getting into physical fights, truancy, and anxiety were significantly related to higher frequency of smoking. With respect to the main predictors, both at the individual level, parental supervision was negatively associated with adolescent smoking, while parental smoking was positively related to it. Two cross-level interaction terms were also observed. National wealth (GDP per capita) significantly moderated, that is, increased, these effects of parental influence on how often the adolescents smoked. CONCLUSIONS We provided new evidence on the factors related to adolescent smoking in low-income countries, a topic that has received very little attention. We showed that the associations between parental influences and adolescent smoking behaviors are not constant but vary according to the level of economic development. Future research should incorporate this comparative dimension in elaborating and specifying the conditions under which parental influences and other predictors differentially affect adolescent smoking. IMPLICATIONS Prior research on adolescent smoking focused on developed countries. Based on the secondary analysis of the Global School-based Student Health Survey (2003-2011), this study examines the associations between parental influence (parental smoking and parental supervision) on the frequency of youth smoking behaviors in resource-poor countries. We show that parental smoking is positively related to adolescent smoking, while parental supervision is negatively related to it. We also find that these two associations vary according to national wealth: both effects are stronger in a country with higher per capita GDP.

Outcomes in a Sample of Opioid-Dependent Clients Treated under California's Proposition 36

This study evaluated treatment outcomes for the reduction of criminal justice involvement and substance use among opioid dependent clients in a therapeutic community setting under Californias Proposition 36. We compared treatment outcomes between those mandated to treatment under Proposition 36 (n = 24) and those on probation but not involved in Proposition 36 (n = 61) over 12 months. Over time, both groups showed significant improvement on drug use and employment measures, were more likely to be involved in job training and less likely to be engaged in work activity, and had similar retention in treatment. There was no evidence that treatment outcomes were different between the two groups. These findings may be helpful in guiding policy makers and clinicians in states where similar initiatives are under consideration.

Factors associated with perceived health among Korean adolescents.

This study examined the influences of personal, social, and environmental-structural factors on the perceived health of Korean adolescents. Using a two-stage generalized hierarchical logistic linear multilevel model, this study found that general high school enrollment, younger age, normal weight, and frequent exercise increased the likelihood of a positive self-perception of health. Higher levels of parental concern and quality of school life also contributed to the likelihood of students perceiving themselves as healthy. In contrast, psychological symptoms and negative self-esteem decreased the likelihood that students perceived themselves as healthy. The results provide implications for disease prevention and health promotion programs.