Vaughan W. Rees

Clinical profile of participants in a brief intervention program for cannabis use disorder

The increasing demand for cannabis dependence treatment has led to the identification of significant gaps in the knowledge of effective interventions. A randomized controlled trial of brief cognitive-behavioral interventions (CBT) for cannabis dependence was undertaken to address this issue. A total of 229 participants were assessed and allocated to either a 6-session CBT program, a single-session brief intervention, or a delayed-treatment control group. This paper demonstrates that individuals with cannabis use disorder will present for a brief intervention program. While they report similar patterns of cannabis use to nontreatment samples, they report a range of serious health and psychosocial consequences. While they appear relatively socially stable, they typically demonstrated severe cannabis dependence and significantly elevated levels of psychological distress, with the most commonly cited reason for cannabis use being stress relief. There were clinically relevant gender differences among the sample. This study provides more evidence of the demand for, and nature of issues relevant to, interventions for cannabis use disorders, and supports the need for further research into how best to assist individuals with these disorders.

Electronic cigarettes: a new ‘tobacco’ industry?

Electronic cigarettes (e-cigarettes) have gained considerable attention since their introduction into European and American markets in 2006 and 2007, respectively. Research to date has focused on acute exposure,1 2 nicotine delivery1–3 and consumer response,4 yet little information has so far been available on this new and rapidly developing industry. Knowledge of e-cigarette sales and marketing strategies is needed to fully inform responses from the tobacco control community, including consideration of product regulation.5 In the USA, e-cigarette promotion has coalesced around three organisations. The Electronic Cigarette Association ‘was founded to institute and promote industry-wide standards and a code of conduct, work to maintain sound professional and practices, educate the public and policy-makers on the …

Longitudinal Course of Behavioral and Emotional Problems in Williams Syndrome.

A follow-up study of behavior and emotional problems in a cohort of young people with Williams syndrome 5 years after first assessment is described. Using a between-/within-subjects factorial layout, we compared scores on the Developmental Behaviour Checklist between young people with Williams syndrome and a large epidemiological control sample of young people with mental retardation due to other causes from Time 1 (1990/1991) to Time 2 (1995/1996). Results showed substantial persistence of the overall level of behavior and emotional problems. However, there were changes in certain types of behavior. Participants with Williams syndrome had significantly higher overall behavioral and emotional problems, communication disturbance, and anxiety over the 5-year period. Further, 10 or 13 checklist items maintained significantly higher levels among the Williams syndrome sample.

Association of alcohol consumption with HIV sex- and drug-risk behaviors among drug users

The relationship between alcohol use and HIV transmission is well recognized but not fully understood. In particular, the role of alcohol abuse as a mediator of HIV risk behavior among drug users is not well documented. We hypothesized that alcohol use in drug users will result in greater HIV risk-taking behavior. Participants were 354 drug users, of whom 105 were recent injection drug users. Multiple regression models were used to characterize whether measures of sexual and injection drug use HIV risk behavior were related to alcohol consumption, controlling for other potentially associated factors. We found that sexual HIV risk-taking behavior is associated with increased alcohol consumption among women (p = 0.02), with women having more risky sexual behavior than males. However, contrary to our hypothesis, there was no significant association of alcohol consumption with risky injection drug behavior. Addressing alcohol problems among drug users, particularly women, may be an important opportunity to reduce HIV sexual risk behavior among this high-risk population.

Storefront Cigarette Advertising Differs by Community Demographic Profile

Purpose. Tobacco manufacturers have targeted youth and ethnic/racial minorities with tailored advertising. Less is known about how characteristics of storefront tobacco advertisements, such as location, position, size, and content, are used to appeal to demographic subgroups. Design. The occurrence and characteristics of storefront cigarette advertising were observed for all licensed tobacco retailers in two defined communities. Setting. Measures were taken in two Boston, Massachusetts, area urban communities: a low-income, minority community and a high-income, nonminority community. Subjects. No human subjects were involved in this study. Measures. Advertisement position (attached or separated from storefront), size (small, medium, or large), mentholation, and price were recorded. Geographic coordinates of tobacco retailers and schools were mapped using ArcGIS 9.2. Analysis. Differences between the communities in advertisement number and characteristics were assessed using bivariate analyses. Logistic regression was used to ascertain the odds of specific advertising features occurring in the low-income/minority community. Results. The low-income/minority community had more tobacco retailers, and advertisements were more likely to be larger, promote menthol products, have a lower mean advertised price, and occur within 1000 feet of a school. Conclusion. Storefront cigarette advertising characteristics that increase exposure and promote youth initiation were more prominent in a low-income/minority community. The findings emphasize the need for more effective regulation of storefront tobacco advertising.

Effect of the New York State cigarette fire safety standard on ignition propensity, smoke constituents, and the consumer market

Objectives: This study examines empirical evidence from the New York experience testing tobacco industry arguments made in opposition to fire safety standards for cigarettes. Design: Percentages of cigarettes exhibiting full length burns (FLBs), cigarette sales before and following the implementation of the New York standards, a sample of retail cigarette prices, brand availability, and selected smoke constituent yields were compared between cigarettes sold in New York and two other states. Cigarette paper analysis was conducted on cigarettes sold in New York. Results: New York cigarette brands averaged 10.0% FLBs as compared to 99.8% for California and Massachusetts brands. Reduced ignition propensity (RIP) appears to have been achieved by cigarette paper banding. Cigarette sales, prices, and brand availability do not appear to have been affected by the New York standards. Yields of the majority of smoke constituents tested did not differ substantially between RIP cigarettes sold in New York as compared to the same brands sold in Massachusetts. Average yields of tar, carbon monoxide, and two compounds were slightly higher, the yields of seven compounds were higher for one brand only, and nicotine was lower, among New York brands tested. Conclusions: RIP cigarette brands have been designed to meet the New York fire safety standards. Their introduction has not affected cigarette sales or prices in New York. There is no evidence that the small increases in smoke constituent yields affect the already highly toxic nature of cigarette smoke. Data on smoking caused fires, deaths, and injuries dating from after the change in law are not yet available. Such data will be able to address the question of whether the demonstrated reduced ignition standards are associated with reduced fires and injuries. Based on the New York experience, prior industry objections to producing RIP cigarettes are unfounded. Other states and nations should adopt similar standards.

Efficacy of moderation-oriented cue exposure for problem drinkers: A randomized controlled trial

The effectiveness of cue exposure following a priming dose was compared with cognitive-behavioral intervention in a community sample of problem drinkers. Participants were randomly allocated to 1 of the 2 conditions and received a mean of 5.84 (SD = 2.69) sessions. A psychologist blind to treatment condition conducted an 8-month follow-up. Compared with pretreatment levels, significant decreases in alcohol consumption were evident posttreatment and maintained at follow-up for both groups. Reductions in severity of dependence, impaired control, and alcohol-related problems were also evident for both groups at follow-up. No differences in outcome associated with initial severity of alcohol dependence were apparent. The results raise the issue of the appropriateness of reserving a goal of controlled drinking for those with relatively mild alcohol problems and low alcohol dependence.

Can drug injectors be encouraged to adopt non-injecting routes of administration (NIROA) for drugs?

Drug use by injection can cause problems specific to this form of administration. Problems include an increased risk of drug overdose, drug dependence, the transmission of HIV, hepatitis B and hepatitis C and vein damage. Shifting drug injectors from injecting to another route of administration may minimize these problems. The aims of the study were to develop and trial an intervention to assist willing injecting drug users (IDUs) to shift to non-injecting routes of administration (NIROA) and to explore the acceptability and practicality of facilitating NIROA. IDUs were assessed and suitable subjects entered a cognitive behavioural trial consisting of five 1-hour sessions of individual therapy with a registered psychologist. Forty-two subjects were assessed (22 males and 20 females). Thirty subjects entered treatment. The mean age was 36 years. Twenty-one subjects were followed-up at 3 months and 10 subjects at 6 months. At 3 and 6 months, the proportion of subjects who had commenced using NIROA was 30% and 50%, respectively. This pilot study showed that it was possible to assist a minority of drug injectors to move from injecting to the non-injecting administration of drugs. However, many of these appeared to be already motivated to cease using drugs and adopting NIROA was one way of assisting this. Poor follow-up rate, lack of control group, questions about cost-effectiveness and the impact of market factors which possibly constrain shifting to NIROA suggest that further research is needed before it could be said that NIROA should be recommended as a viable harm reduction strategy in the Australian context.

Surveillance Methods for Identifying, Characterizing, and Monitoring Tobacco Products: Potential Reduced Exposure Products as an Example

Tobacco products are widely sold and marketed, yet integrated data systems for identifying, tracking, and characterizing products are lacking. Tobacco manufacturers recently have developed potential reduced exposure products (PREP) with implied or explicit health claims. Currently, a systematic approach for identifying, defining, and evaluating PREPs sold at the local, state, or national levels in the United States has not been developed. Identifying, characterizing, and monitoring new tobacco products could be greatly enhanced with a responsive surveillance system. This article critically reviews available surveillance data sources for identifying and tracking tobacco products, including PREPs, evaluating strengths and weaknesses of potential data sources in light of their reliability and validity. With the absence of regulations mandating disclosure of product-specific information, it is likely that public health officials will need to rely on a variety of imperfect data sources to help identify, characterize, and monitor tobacco products, including PREPs. (Cancer Epidemiol Biomarkers Prev 2009;18(12):3334–48)

Cigarette sales in pharmacies in the USA (2005–2009)

Background Several US jurisdictions have adopted policies prohibiting pharmacies from selling tobacco products. Little is known about how pharmacies contribute to total cigarette sales. Methods Pharmacy and total cigarette sales in the USA were tabulated from AC Nielsen and Euromonitor, respectively, for the years 2005–2009. Linear regression was used to characterise trends over time, with observed trends extrapolated to 2020. Results Between 2005 and 2009, pharmacy cigarette sales increased 22.72% (p=0.004), while total cigarette sales decreased 17.43% (p=0.015). In 2005, pharmacy cigarette sales represented 3.05% of total cigarette sales, increasing to 4.54% by 2009. Extrapolation of these findings resulted in estimated pharmacy cigarette sales of 14.59% of total US cigarette sales by 2020. Conclusions Cigarette sales in American pharmacies have risen in recent years, while cigarette sales nationally have declined. If current trends continue, pharmacy cigarette market share will, by 2020, increase to more than four times the 2005 share.